A Randomized Controlled Trial of Single-Port vNOTES versus Conventional Laparoscopy for Total Hysterectomy in Severe Endometriosis

International Journal of Obstetrics and Gynecology | Vol. 14, No. 9, September 2026 | pp. 711–722

DOI: 10.46882/2026/IJOG/000540

Original Research Article

Title: A Randomized Controlled Trial of Single-Port vNOTES versus Conventional Laparoscopy for Total Hysterectomy in Severe Endometriosis

Names of Authors: Olayinka O. Cole¹, Nesta C. Chuka¹

Authors’ Affiliations:
¹ Gynecologic Oncology Unit, Department of Obstetrics and Gynecology, National Hospital, Abuja, Nigeria

Abstract:
Executing minimally invasive total hystectomies in patients with advanced endometriosis is frequently complicated by dense pelvic adhesions, frozen pelvis characteristics, and altered anatomical planes. This prospective randomized clinical trial evaluated the surgical parameters, complication rates, and pain patterns of Vaginal Natural Orifice Translumenal Endoscopic Surgery (vNOTES) against conventional multi-port Laparoscopy (CL) for hysterectomies in women with severe pelvic endometriosis. One hundred and twenty patients presenting with revised American Society for Reproductive Medicine (rASRM) stage IV endometriosis requiring total hysterectomy were randomized to either the vNOTES group (n = 60) or the CL group (n = 60). The primary outcome was total operative duration. The mean operative time was significantly shorter in the vNOTES cohort compared to the CL cohort (68.4 ± 14.5 minutes vs. 92.6 ± 18.2 minutes, p < 0.001), as direct access to the pouch of Douglas facilitated efficient dissection of posterior cul-de-sac obliterating lesions. Visual analog scale pain scores at 24 hours postoperatively were lower in the vNOTES group (1.8 ± 0.4 vs. 3.6 ± 1.1, p < 0.001), resulting in a 40.0% drop in ward opioid use. Incidence of accidental bladder or rectal injuries did not show structural divergence between the arms (p > 0.05). Total hysterectomy via vNOTES for stage IV pelvic endometriosis is an effective approach that shortens operational intervals and accelerates postoperative recovery timelines compared to conventional multi-port laparoscopy.

Keywords: vNOTES; Endometriosis; Total Hysterectomy; Pelvic Adhesions; Postoperative Pain; Minimally Invasive Surgery.

Manuscript Timeline: Received: July 28, 2026; Revised: August 22, 2026; Accepted: September 05, 2026; Published: September 10, 2026.

Citation: Cole OO, Chuka NC. A Randomized Controlled Trial of Single-Port vNOTES versus Conventional Laparoscopy for Total Hysterectomy in Severe Endometriosis. International Journal of Obstetrics and Gynecology. 2026; 14(9): 711–722.

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