Murat YASSA, Ozan KARADENİZ, Cihan KAYA, Ozan DOĞAN, Baki ŞENTÜRK, Eray ÇALIŞKAN, Yaşam Kemal AKPAK, Pınar Birol İLTER, Sinem BOSTAN, Eralp BULUTLAR, Behzat CAN, Hüseyin CENGİZ, Murat EKİN, Mustafa Melih ERKAN, Selçuk ERKILINÇ, Elif ERYILMAZ, Mehmet GENCO, Ahkam Göksel KANMAZ, Osman Samet GÜNKAYA, İlkhan KESKİN, Fatma Ketenci GENCER, Memiş Ali MUTLU, İsa Aykut ÖZDEMİR, Koray Görkem SAÇINTI, Süleyman SALMAN, Mehmet Akif SARGIN, Arzu Bilge TEKİN, Mahmut YASSA
Anatolian Journal of Obstetrics and Gynecology Research - 2026;3(1):1-20
Purpose: Vaginal Natural Orifice Transluminal Endoscopic Surgery (vNOTES) hysterectomy is an increasingly adopted and most minimally invasive approach for benign gynecological indications. However, considerable heterogeneity exists in clinical practice regarding patient selection, perioperative management, surgical technique, and outcome reporting. This guideline aims to provide evidence-based and expert consensus-supported national recommendations for vNOTES hysterectomy in benign gynecology, developed on behalf of the Pelvic Floor and Cosmetic Gynecology (PETKOZ) Association. Methods: A systematic search of Medline/PubMed, Cochrane, EMBASE, and Google Scholar was conducted for articles published between January 2015 and March 2026, yielding 1960 records. Fifty-seven studies met inclusion criteria, comprising eight systematic reviews/meta-analyses, six randomized controlled trials, six prospective and 37 retrospective cohort studies. Evidence quality and recommendation strength were graded using the SIGN classification system. For clinical questions insufficiently addressed by the literature, a three-round Delphi consensus process was conducted among 22 expert surgeons, each with a minimum of 50 vNOTES cases; >=70% agreement defined consensus. Results: Compared with total laparoscopic hysterectomy, vNOTES hysterectomy was associated with significantly shorter operative time (evidence level: 1+), reduced early postoperative pain (1+), a modest reduction in hospital stay (1+), and faster postoperative recovery. Intraoperative and postoperative complication rates, conversion rates, and readmission rates were comparable to other minimally invasive approaches. Comprehensive recommendations covering contraindications, preoperative preparation, intraoperative technique, and postoperative care were established through both evidence synthesis and the Delphi process. Conclusion: This national guideline supports vNOTES hysterectomy as a safe and feasible approach for benign gynecological disease when performed in appropriately selected patients at centers with relevant surgical expertise. While findings are reinforced by structured evidence appraisal and formal consensus methodology, a substantial proportion of the evidence base remains observational. Future randomized trials, standardized outcome reporting, and prospective health-economic analyses are essential for refining recommendations in subsequent guideline updates.
