Minimally Invasive Hysterectomy Approaches: Comparative Learning Curves and Perioperative Outcomes of Robotic Versus V-NOTES Techniques

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Kantarcı S., Karabulut A., Dağlı U., Baykuş B., Sarıkaya S., Özer M., ...Daha Fazla

Journal of Clinical Medicine, cilt.14, sa.24, 2025 (SCI-Expanded, Scopus)

  • Yayın Türü: Makale / Tam Makale
  • Cilt numarası: 14 Sayı: 24
  • Basım Tarihi: 2025
  • Doi Numarası: 10.3390/jcm14248743
  • Dergi Adı: Journal of Clinical Medicine
  • Derginin Tarandığı İndeksler: Science Citation Index Expanded (SCI-EXPANDED), Scopus, EMBASE
  • Anahtar Kelimeler: robotic hysterectomy, V-NOTES, learning curve
  • Açık Arşiv Koleksiyonu: AVESİS Açık Erişim Koleksiyonu
  • Sağlık Bilimleri Üniversitesi Adresli: Evet

Özet

Objectives: To compare perioperative outcomes and learning curves of robotic hysterectomy and transvaginal natural orifice transluminal endoscopic surgery (V-NOTES) hysterectomy performed for benign gynecological conditions in a high-volume tertiary center. Methods: This retrospective cohort study included 100 patients who underwent either robotic hysterectomy (n = 44) or V-NOTES hysterectomy (n = 56) between January 2024 and July 2025. Demographic data, perioperative parameters, and postoperative outcomes were collected. Learning curves were analyzed using cumulative sum (CUSUM) and quadratic regression models. Results: A total of 100 patients were included (44 robotic, 56 V-NOTES). Baseline demographics were comparable between groups. The postoperative hemoglobin decrease was significantly lower in the robotic group (0.96 ± 0.64 g/dL vs. 1.33 ± 0.93 g/dL, p < 0.05), whereas uterine weight was higher in the V-NOTES cohort (182.6 ± 125.9 vs. 123.2 ± 60.4 g, p < 0.05). Complication rates, including three bladder injuries in the V-NOTES group and one in the robotic group, showed no significant difference. Hospital stay was similar across groups. Conclusions: Both techniques are safe and effective. Robotic hysterectomy offers shorter operative time and less blood loss, while V-NOTES provides cosmetic and recovery advantages. Learning curve analysis indicates a longer adaptation period for V-NOTES, with anterior colpotomy as the most critical step, whereas robotic hysterectomy demonstrates a shorter and more straightforward learning process.