To compare the feasibility, safety and advantages of transvaginal-natural orifice transluminal endoscopic surgery (vNOTES) in the surgical treatment of benign gynecological diseases.

From Sep. 2019 to Feb. 2022, the clinical data of patients admitted to the First People′s Hospital of Yunnan Province who underwent vNOTES, trans-umbilical single-port laparoscopic surgery and traditional laparoscopic surgery, including total hysterectomy, hysteromyoma stripping and ovarian cyst stripping, were retrospectively analyzed. Total hysterectomy was performed in 34 cases by vNOTES, 40 cases by trans-umbilical single-port laparoscopy and 40 cases by conventional laparoscopy. vNOTES hysteromyoma stripping were performed in 23 cases, trans-umbilical single-port laparoscopy and traditional laparoscopy in 30 cases respectively. There were 25 cases of vNOTES ovarian cyst exfoliation, 30 cases in trans-umbilical single-port laparoscopy and 30 cases in conventional laparoscopy. The clinical data were compared, including general information, operative time, intraoperative blood loss, hemoglobin difference before and after surgery, postoperative hospital stay (excluding the day of surgery), postoperative drainage days, postoperative anal exhaust time, postoperative first ambulation time, visual analogue scale (VAS) for pain 12 and 24 h after surgery, postoperative peak temperature, hospitalization costs, and intraoperative or postoperative complications.

Among patients undergoing ovarian cyst exfoliation by three different methods, age difference was statistically significant (P<0.05).There was statistically significant difference in operation time in total hysterectomy and hysteromyoma stripping using three different methods (P<0.05). As for the blood loss, no statistically significant difference was found (P>0.05).There were no significant differences in hemoglobin difference before and after surgery, postoperative hospital stay, postoperative drainage time, postoperative peak temperature, VAS score at 12 and 24 hours after operation and hospitalization costs among patients undergoing total hysterectomy, hysteromyoma stripping and ovarian cyst stripping by three different approaches (P>0 .05). But the differences in postoperative anal exhaust time, postoperative first ambulation time were statistically significant (P<0.05). All included patients had successfully completed surgery, no intraoperative or postoperative complications, no blood transfusion or other organ injuries. All of the patients had benign gynecological diseases and healed well.

The surgical effect of vNOTES is comparable to that of single-port laparoscopic surgery and traditional laparoscopic surgery, and vNOTES is safe and feasible in the surgical treatment of benign gynecological diseases. Although VNOTE takes a long operation time, but it has the advantage of scar free and rapid recovery.