The Erkilinc Technique for vNOTES Hysterectomy: A Speculum-Assisted Approach Without Prior Vaginal Dissection: A 163-Case Series.

OBJECTIVE: To describe a novel speculum-assisted glove-port technique for vNOTES hysterectomy (Erkilinc technique) and to evaluate its feasibility, safety, and learning curve in patients undergoing surgery for benign indications. DESIGN: Retrospective Case Series. SETTING: Tertiary referral center. PARTICIPANTS: A total of 163 consecutive women undergoing vNOTES hysterectomy for benign indications between January 2019 and November 2023. INTERVENTIONS: vNOTES hysterectomy using a speculum-integrated glove-port system allowing complete laparoscopic execution without prior vaginal dissection. MEASUREMENTS AND MAIN RESULTS: The mean surgical time was 70.6 ± 24.5 minutes. The mean uterine weight was 280.9 ± 214 g. The mean decrease in hemoglobin was 0.9 ± 1.4 g/dL. The overall complication rate was 3.1%, with no ureteric or bowel injuries observed. The mean VAS scores were 4.7 at 4 hours and 3.3 at 24 hours. Learning curve analysis demonstrated a significant reduction in surgical time over successive cases, with procedural proficiency achieved after approximately 45 cases based on CUSUM analysis. Surgical times were comparable to those reported for Alexis-based systems. CONCLUSION: The Erkilinc technique represents a reproducible and efficient vNOTES approach that avoids prior vaginal dissection and eliminates the need for internal wound retractors. This technique may expand the applicability of vNOTES to non-prolapsed uteri while maintaining safety and operative efficiency.