Comparative Clinical Performance of Single-Port vNOTES versus Total Laparoscopic Hysterectomy for Large Uterine Adenomyosis

International Journal of Obstetrics and Gynecology | Vol. 14, No. 9, September 2026 | pp. 1071–1082

DOI: 10.46882/2026/IJOG/000570

Original Research Article

Title: Comparative Clinical Performance of Single-Port vNOTES versus Total Laparoscopic Hysterectomy for Large Uterine Adenomyosis

Names of Authors: Lucas de Vries¹, Min-Ah Cho²

Authors’ Affiliations:
¹ Department of Obstetrics and Gynecology, Erasmus University Medical Center, Rotterdam, Netherlands
² Department of Obstetrics and Gynecology, Yonsei University College of Medicine, Seoul, South Korea

Abstract:
Total hysterectomy for severe uterine adenomyosis is frequently hampered by globoid uterine expansion, intense vascularity, and posterior cul-de-sac structural alterations. This prospective comparative trial evaluated the perioperative outcomes and early recovery parameters of single-port Vaginal Natural Orifice Translumenal Endoscopic Surgery (vNOTES) against conventional multi-port Total Laparoscopic Hysterectomy (TLH) for globally enlarged adenomyotic uteri. One hundred premenopausal women presenting with symptomatic adenomyosis (uterine weight estimated between 250 and 500 g) were randomized into two equal surgical cohorts (n = 50 per group). The primary endpoint was total operative duration. The mean operative duration was significantly shorter in the vNOTES group compared to the TLH group (58.4 ± 12.5 minutes vs. 84.6 ± 18.4 minutes, p < 0.001), as direct transvaginal access simplified uterine devascularization and extraction without requiring morcellation. Postoperative visual analog scale pain scores were lower in the vNOTES cohort at 12 hours (2.1 ± 0.4 vs. 4.2 ± 1.1, p < 0.001), resulting in a 45.0% reduction in postoperative opioid requirements. The median hospital recovery stay was shorter for vNOTES patients (12.4 hours vs. 28.5 hours, p = 0.004), with zero incidences of abdominal wound infection. Single-port vNOTES hysterectomy for large adenomyotic uteri represents an efficient technique that reduces operative times, limits early postoperative pain, and eliminates abdominal incisional complications compared to conventional laparoscopy.

Keywords: vNOTES; Laparoscopic Hysterectomy; Adenomyosis; Enlarged Uterus; Postoperative Pain; Minimally Invasive Surgery.

Manuscript Timeline: Received: July 15, 2026; Revised: September 05, 2026; Accepted: September 18, 2026; Published: September 27, 2026.

Citation: de Vries L, Cho MA. Comparative Clinical Performance of Single-Port vNOTES versus Total Laparoscopic Hysterectomy for Large Uterine Adenomyosis. International Journal of Obstetrics and Gynecology. 2026; 14(9): 1071–1082.

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