vNOTES sentinel lymph node biopsy and hysterectomy for endometrial cancer staging: perioperative outcomes from a consecutive series.

OBJECTIVE: To evaluate the feasibility and perioperative safety of vaginal natural orifice transluminal endoscopic surgery (vNOTES) hysterectomy with sentinel lymph node biopsy (SLNB) for surgical staging of endometrial neoplasia. METHODS: We conducted a retrospective consecutive case series at a tertiary gynecologic oncology center between May 2024 and December 2025. All patients undergoing hysterectomy and SLNB for staging of suspected or confirmed early-stage endometrial neoplasia using the vNOTES approach were included. Demographic characteristics, operative parameters, conversions, and intra- and postoperative complications were recorded. Primary outcomes were feasibility-defined as completion of the procedure without conversion-, detection rate and perioperative safety. Secondary outcomes included operative time, blood loss, hospital stay, and factors influencing operative performance. RESULTS: Thirty-six patients were included. Median age was 63 years (IQR 57-69) and median BMI was 30 kg/m² (IQR 27-36). The procedure was completed by vNOTES in 33 patients (89%), with 1 conversion to laparoscopy (3%) and 2 conversions to laparotomy (6%) for specimen extraction. Median operative time was 125 minutes (IQR 115-150). Median hospital stay was 1 day (IQR 1-2; range 1-21). Estimated blood loss was <100 mL in 69% of procedures. Intraoperative complications occurred in 4 patients (11%), all bladder injuries recognized and repaired intraoperatively. Bilateral detection rate was 89% and unilateral detection rate was 100%. Operative time did not differ significantly between the first 10 cases and the subsequent procedures (median 125 vs 120 minutes, p=0.86). No variable was significantly associated with the occurrence of complications, and BMI was not associated with operative duration. CONCLUSION: vNOTES hysterectomy with SLNB for endometrial cancer staging is feasible and demonstrates acceptable perioperative morbidity in a consecutive series. Further studies are required to assess long-term oncologic outcomes.