Vaginal natural orifice transluminal endoscopic surgery versus conventional laparoscopy for sentinel lymph node mapping in early-stage endometrial cancer: a systematic review and meta-analysis.

OBJECTIVE: To compare the bilateral and unilateral sentinel lymph node detection rates, mapping failure rates, and perioperative outcomes of vaginal natural orifice transluminal endoscopic surgery versus conventional laparoscopy in women with early-stage endometrial cancer. METHODS: A systematic search of PubMed, Cochrane Central Register of Controlled Trials, Scopus, and Google Scholar was performed from inception to March 2026. Comparative studies of vaginal natural orifice transluminal endoscopic surgery versus laparoscopy for sentinel lymph node mapping in endometrial cancer were eligible. Risk of bias was assessed using the Risk of Bias in Non-randomized Studies of Interventions-I tool for non-randomized studies. Meta-analysis was performed using a random-effects model. RESULTS: Four comparative cohort studies comprising 349 patients (148 vaginal natural orifice transluminal endoscopic surgery; 201 laparoscopy) were included. Baseline age, parity, and comorbidity burden were broadly similar between groups, although body mass index differed between arms in 2 studies. The bilateral sentinel lymph node detection rate was 86.8% with vaginal natural orifice transluminal endoscopic surgery versus 88.3% with laparoscopy (odds ratio 0.87, 95% confidence interval 0.43 to 1.77, p = .71, I2 = 0%). Unilateral detection and mapping failure rates were comparable between groups. Operative time, estimated blood loss, post-operative pain scores, and complication rates did not differ significantly. Hospital stay was significantly shorter following vaginal natural orifice transluminal endoscopic surgery. The conversion rate was 2.7% in the vaginal natural orifice transluminal endoscopic surgery group. CONCLUSIONS: In carefully selected patients treated by surgeons experienced in transvaginal endoscopic surgery, vaginal natural orifice transluminal endoscopic surgery achieved bilateral and unilateral sentinel lymph node detection rates and mapping failure rates comparable to conventional laparoscopy in early-stage endometrial cancer, with comparable perioperative safety. Available evidence is limited to small non-randomized cohorts with substantial risk of bias; prospective randomized trials are needed to validate these findings and define the optimal patient selection criteria before widespread clinical adoption.