vNOTES vs Laparoscopic Hysterectomy: Randomized Trial on Pain and Recovery"

NCT ID: NCT07306507

Last Updated: 2025-12-29

Study Results

Results pending

The study team has not published outcome measurements, participant flow, or safety data for this trial yet. Check back later for updates.

Basic Information

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Recruitment Status

NOT_YET_RECRUITING

Clinical Phase

NA

Total Enrollment

56 participants

Study Classification

INTERVENTIONAL

Study Start Date

2025-12-16

Study Completion Date

2025-12-30

Brief Summary

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This study is a prospective, randomized controlled trial comparing two different minimally invasive hysterectomy techniques: vaginal natural orifice transluminal endoscopic surgery (vNOTES) and conventional total laparoscopic hysterectomy (TLH). The aim is to evaluate whether vNOTES provides better postoperative comfort and recovery by reducing pain, lowering opioid analgesic requirements, and improving early recovery outcomes.

Approximately 80 women undergoing elective hysterectomy will be randomly assigned to either vNOTES or TLH. All surgeries will be performed under standardized general anesthesia by the same experienced surgical team. Postoperative pain management will follow an identical protocol for all patients.

Primary outcomes include postoperative pain scores (at 12 and 24 hours) and total opioid consumption. Secondary outcomes include Quality of Recovery-15 (QoR-15) scores, fatigue scores, time to first mobilization, time to first flatus, and length of hospital stay. The results of this study may help identify which hysterectomy technique offers better patient-centered recovery and postoperative comfort.

Detailed Description

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This study is a single-center, prospective, randomized controlled clinical trial designed to compare two minimally invasive hysterectomy techniques: vaginal natural orifice transluminal endoscopic surgery (vNOTES) and conventional total laparoscopic hysterectomy (TLH). The aim is to determine whether vNOTES offers advantages in postoperative pain control, opioid requirements, and early recovery outcomes by eliminating abdominal wall incisions and reducing pneumoperitoneum-related physiological effects.

Eligible ASA I-II female patients aged 18-75 scheduled for elective hysterectomy are randomly assigned in a 1:1 ratio to the vNOTES or TLH group using a computer-generated sequence with sealed opaque envelopes for allocation concealment. All procedures are performed by the same experienced surgical and anesthesia team using a standardized general anesthesia protocol. Postoperative analgesia and recovery care are identical for both groups to ensure uniformity of perioperative management.

In the vNOTES group, hysterectomy is performed via transvaginal access using a self-retaining vaginal port, with pneumoperitoneum pressure kept at or below 15 mmHg. In the TLH group, a standard laparoscopic approach using a 10 mm umbilical port and two 5 mm accessory trocars is applied, with pneumoperitoneum maintained between 12-15 mmHg. Trendelenburg positioning is used in both techniques but is expected to be less steep and shorter in duration in the vNOTES group.

Outcome assessment is conducted by nurses and clinicians blinded to group allocation. Primary endpoints include postoperative pain scores at 12 and 24 hours (measured using a 0-10 Visual Analog Scale) and total opioid consumption within the first 24 hours. Secondary endpoints include Quality of Recovery-15 (QoR-15) scores, Fatigue Assessment Scale (FAS) scores, time to first mobilization, time to first flatus, length of hospital stay, and postoperative complications such as nausea/vomiting, shoulder pain, and respiratory discomfort. The study is powered based on a one-tailed hypothesis expecting lower postoperative discomfort in the vNOTES group.

The findings of this trial may help clarify whether vNOTES provides superior postoperative comfort and enhanced recovery compared to standard laparoscopic hysterectomy, contributing evidence to guide technique selection in minimally invasive gynecologic surgery.

Conditions

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Hysterectomy

Keywords

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vNOTES Total Laparoscopic Hysterectomy Postoperative Pain Enhanced Recovery

Study Design

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Allocation Method

RANDOMIZED

Intervention Model

PARALLEL

Participants will be randomly assigned in a 1:1 ratio to undergo either vNOTES hysterectomy or conventional total laparoscopic hysterectomy. Each participant receives only one of the two surgical interventions, and both groups are followed in parallel for outcome assessment.
Primary Study Purpose

TREATMENT

Blinding Strategy

DOUBLE

Investigators Outcome Assessors
Investigators responsible for postoperative data collection and analysis and outcome assessors were blinded to group allocation. These investigators were not involved in the surgical or anesthetic management of the patients. Due to the nature of the surgical procedures, blinding of participants and care providers was not feasible.

Study Groups

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vNOTES Group

Patients undergo vaginal natural orifice transluminal endoscopic hysterectomy (vNOTES) using a transvaginal access port with a maximum pneumoperitoneum pressure not exceeding 15 mmHg.

Group Type EXPERIMENTAL

vNOTES Hysterectomy

Intervention Type PROCEDURE

Transluminal endoscopic hysterectomy is performed through a vaginal natural opening via transvaginal access using a self-adhering vaginal port.

TLH Group

Patients undergo conventional total laparoscopic hysterectomy using a camera port and accessory trocars from the umbilicus, and pneumoperitoneum is maintained at a pressure not exceeding 15 mmHg.

Group Type ACTIVE_COMPARATOR

Total Laparoscopic Hysterectomy

Intervention Type PROCEDURE

It is a conventional total laparoscopic hysterectomy performed using an umbilical cord port and two accessory trocars.

Interventions

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vNOTES Hysterectomy

Transluminal endoscopic hysterectomy is performed through a vaginal natural opening via transvaginal access using a self-adhering vaginal port.

Intervention Type PROCEDURE

Total Laparoscopic Hysterectomy

It is a conventional total laparoscopic hysterectomy performed using an umbilical cord port and two accessory trocars.

Intervention Type PROCEDURE

Eligibility Criteria

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Inclusion Criteria

* Female patients aged 18 to 75 years
* ASA physical status I-II
* Scheduled for elective laparoscopic hysterectomy (benign indications such as myoma uteri, adenomyosis, endometrial hyperplasia)
* Able to understand study procedures and provide written informed consent
* Able to complete postoperative questionnaires (QoR-15 and Fatigue Assessment Scale)

Exclusion Criteria

* ASA III-IV status
* Severe cardiopulmonary disease or contraindication to general anesthesia
* Coagulopathy or bleeding disorders
* Active pelvic infection
* History of extensive pelvic or abdominal surgery complicating minimally invasive access
* Cognitive impairment or inability to complete questionnaires
* Conversion to laparotomy
* Known allergy or intolerance to study medications (paracetamol, tramadol)
Minimum Eligible Age

18 Years

Maximum Eligible Age

75 Years

Eligible Sex

FEMALE

Accepts Healthy Volunteers

No

Sponsors

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Saglik Bilimleri Universitesi Gazi Yasargil Training and Research Hospital

OTHER

Sponsor Role lead

Responsible Party

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Fatma Acil,MD

Principal Investigator

Responsibility Role PRINCIPAL_INVESTIGATOR

Principal Investigators

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Fatma Acil, M.D.

Role: PRINCIPAL_INVESTIGATOR

Saglik Bilimleri Universitesi Gazi Yasargil Training and Research Hospital

Locations

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Saglik Bilimleri Universitesi Gazi Yasargil Training and Research Hospital

Diyarbakır, , Turkey (Türkiye)

Site Status

Countries

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Turkey (Türkiye)

Central Contacts

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Fatma Acil, M.D.

Role: CONTACT

Phone: +905337225225

Email: [email protected]

Hülya Tosun Söner, M.D.

Role: CONTACT

Phone: +905352792102

Email: [email protected]

Facility Contacts

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Fatma Acil, M.D.

Role: primary

Hülya Tosun Söner, M.D.

Role: backup

References

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Fang S, Xia Y, Jin J, Zhang J, Lu L. Comparison of Surgical Outcomes Between Vaginally Assisted NOTES Hysterectomy and Laparoscopic Hysterectomy in Primary Hospitals: A Prospective Cohort Study. J Invest Surg. 2025 Dec;38(1):2515054. doi: 10.1080/08941939.2025.2515054. Epub 2025 Jun 10.

Reference Type BACKGROUND
PMID: 40492370 (View on PubMed)

Other Identifiers

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11/7/2025-705

Identifier Type: -

Identifier Source: org_study_id