vNOTES vs Total Laparoscopic Hysterectomy: A Randomized Controlled Trial of Pain, Opioid Use, and Quality of Recovery
Journal of Minimally Invasive Gynecology, 2026 (SCI-Expanded, Scopus)
- Yayın Türü: Makale / Tam Makale
- Basım Tarihi: 2026
- Doi Numarası: 10.1016/j.jmig.2026.06.032
- Dergi Adı: Journal of Minimally Invasive Gynecology
- Derginin Tarandığı İndeksler: Science Citation Index Expanded (SCI-EXPANDED), Scopus, CINAHL, EMBASE, MEDLINE
- Anahtar Kelimeler: Opioid consumption, Postoperative pain, Quality of recovery, Total laparoscopic hysterectomy, vNOTES
- Sağlık Bilimleri Üniversitesi Adresli: Evet
Özet
Study Objective: To compare postoperative pain, opioid use, and recovery outcomes between Transvaginal Natural Orifice Transluminal Endoscopic Surgery (vNOTES) and total laparoscopic hysterectomy (TLH). Design: Prospective randomized controlled trial. Setting: Tertiary care university-affiliated hospital. Patients: Ninety female patients (18–75 years, ASA I–II) undergoing elective hysterectomy for benign indications. Interventions: Patients were randomized to undergo hysterectomy via vNOTES (n = 45) or TLH (n = 45) under standardized anesthesia and analgesia protocols. Measurements and Main Results: Pain scores were significantly lower in the vNOTES group (p < .001), with median NRS scores of 3 vs 7 at 12 hours and 2 vs 4 at 24 hours (both p < .001). No participants in the vNOTES group received postoperative rescue opioids, whereas all TLH patients did (p < .001); median tramadol consumption was 0 (0–0) mg vs 200 (200–300) mg (p < .001). Recovery was faster with vNOTES, including earlier return of bowel function, oral intake, mobilization (p = .001), and shorter hospital stay (all p ≤ .001). QoR-15 scores were higher (adjusted mean difference 10.8, 95% CI 5.9–15.7; p < .001), while fatigue scores were lower (−3.9; p < .001). Hemoglobin decrease was slightly greater in the vNOTES group (−1.92 ± 0.64 vs −1.65 ± 0.55 g/dL; p = .045), although this difference was not considered clinically significant. Postoperative nausea, shoulder pain, and respiratory distress were less frequent, with similar complication rates. Conclusion: vNOTES was associated with lower postoperative pain scores, reduced postoperative rescue opioid use, and improved immediate postoperative recovery compared with TLH, supporting its potential as a patient-centered minimally invasive approach.