Single center experience of transvaginal natural orifice transluminal endoscopic surgery (vNOTES) as a new approach in gynecologic and gender affirming surgery

Study objective: To evaluate feasibility and advantages of transvaginal natural orifice transluminal endoscopic surgery (vNOTES) as a surgical method for hysterectomies with concomitant bilateral salpingo-oophorectomy, in both cisgender women and transgender men, in comparison with laparoscopy. Materials and methods: This retrospective study compared hysterectomies performed using the vNOTES technique with TLH. Cisgender women were operated between 2021 and 2022, and were selected based on specific criteria, principally being diagnosed with a benign gynecological disease. Transgender men coming from the CIDIGeM (Center for Gender and Identity dysphoria) in Turin were all selected. Results: In hysterectomies regarding female patients, all were completed successfully, the transvaginal endoscopic surgery had lower hemoglobin loss (median 1,3 vs median 2,6 points lost) and shorter hospitalization (median 1,75 vs median 2,5 days hospitalized). In the operations regarding AFAB (assigned female at birth) patients, which were also all successfully completed, the vaginal route had shorter operative time (median 82,7 vs median 90,4), lower post-operative hemoglobin loss (median 2,66 vs median 2,69) and shorter hospital stay (median 2,8 vs median 3,8). Conclusion: vNOTES could represent a new safe alternative to laparoscopy for hysterectomy both in females and transgender men, the latter for which the outcomes seem especially ideal.