Search Results (46)

Background/Objectives: Vaginal natural orifice transluminal endoscopic surgery (vNOTES) is increasingly being used to avoid abdominal incisions; however, its mid-term oncological safety in endometrial cancer remains unclear. Methods: This single-center retrospective cohort study included patients with International Federation of Gynecology and Obstetrics (FIGO) clinical stage IA endometrioid endometrial carcinoma undergoing simple hysterectomy between January 2014 and December 2023. Patients were treated with either total laparoscopic hysterectomy (TLH) or vNOTES. Patients who underwent lymph node assessment were excluded. Follow-up assessed mid-term oncological outcomes. Recurrence-free survival (RFS) was evaluated using the Kaplan–Meier method and compared between the groups, and Cox proportional hazards models were used to identify prognostic factors for RFS. Results: In total, 130 patients were included: 109 underwent TLH and 21 vNOTES. The median follow-up period was 48 and 33 months in the TLH and vNOTES groups, respectively. Postoperative adjuvant therapy was more frequent in the vNOTES group. The operative time was significantly shorter with vNOTES. Postoperative complications were low and similar between the groups. The 3-year RFS was 92.8% and 94.4% in the TLH and vNOTES groups, respectively, without a significant difference (p = 0.874). Lymphovascular space invasion was significantly associated with worse RFS, whereas surgical approach was not significantly associated with RFS. Conclusions: No statistically significant difference in mid-term RFS was observed between vNOTES hysterectomy and conventional TLH in this highly selected low-risk cohort. However, the study was underpowered and subject to residual confounding; therefore, these findings should be considered preliminary and hypothesis-generating. Full article

Background: Endometrial cancer is the most common gynecologic malignancy in developed countries. Sentinel lymph node (SLN) mapping has emerged as a less invasive alternative to systematic lymphadenectomy and is increasingly incorporated into surgical staging algorithms. Vaginal natural orifice transluminal endoscopic surgery (vNOTES) provides transvaginal access to the retroperitoneum and may facilitate SLN mapping while potentially reducing postoperative morbidity, including lower extremity lymphedema (LEL). Objective: This study aimed to evaluate the feasibility of vNOTES hysterectomy with bilateral salpingo-oophorectomy (BSO) and retroperitoneal SLN mapping and to report early postoperative lymphedema outcomes in patients with newly diagnosed endometrial cancer. Methods: This retrospective cohort study included 113 patients who underwent vNOTES-assisted hysterectomy with BSO and SLN mapping using methylene blue dye at a tertiary referral center between January 2022 and January 2023. Lymphedema was evaluated using the Gynecologic Cancer Lymphedema Questionnaire at 6 and 12 months postoperatively, supported by clinical examination. Descriptive statistical analyses were performed to summarize clinical characteristics and symptom profiles. Results: The mean patient age was 55.0 ± 10.5 years and the mean BMI was 30.94 ± 2.54 kg/m². Endometrioid adenocarcinoma was the most common histological subtype (75.5%), and most tumors were grade 1 (57.1%). SLN mapping was successful in 102 of 113 patients (overall detection rate 90.3%), with bilateral detection in 79.6% and unilateral detection in 10.6% of cases. Limb swelling was reported in 4.1% of patients, while only one patient (1.0%) met the criteria for self-reported mild lymphedema. No clinical signs of inguinal lymphedema were detected. Conclusions: vNOTES hysterectomy combined with retroperitoneal SLN mapping was associated with a low incidence of postoperative lower extremity lymphedema in this single-arm cohort. These findings suggest that vNOTES-assisted SLN mapping may represent a feasible minimally invasive approach for nodal assessment in selected patients with endometrial cancer. Prospective comparative studies are required to confirm these findings and to evaluate long-term oncologic and lymphatic outcomes. Full article

Background: Delays in diagnosis are unfortunately quite common in most health systems. It is apparent that timely diagnosis is more likely to have a favourable outcome. However, there may be many reasons why timely diagnosis is not always achieved. The aim of our study was to report on the impact of delays on IBD-related adverse outcomes (AOs). Methods: New patients referred for suspected IBD to a single tertiary care centre between January 2013 to December 2017 were identified using EMR. For purposes of the study, a cut-off time was set by investigators for each delay-type based on best average hospital waiting times. The reasons for delays in patient journey until start of treatment and data on pre-defined AOs (steroid & other rescue therapies, hospitalisations, surgery) were recorded for each patient until end of June 2021. The data were analysed using multiple Pearson correlations and Cox proportional Hazard model to determine whether there is a difference in survival without AOs between patients with and without a delay. Results: Total of 105 patients were identified using stringent criteria (M = 58; median age = 32 y) with a long median follow-up of 55 months. 65, 27 and 13 patients had final diagnosis of Ulcerative colitis, Crohn’s disease and Unclassified colitis respectively, and analysed collectively. In our cohort, the longest delay-types noted were—patients seeking medical attention (median = 4 months; range 1 to 84 months), arranging gastroenterology clinic review after referral from primary care (median = 5 weeks; range 1 to 30 weeks), and waiting for index endoscopy (median = 3 weeks; 1 to 36 weeks). Patient stratification based on delay-type using specific cut-off times for each showed a statistically significant difference in survival without AOs for all (when comparing delay v/s no delay). Conclusions: In our cohort we report that delays, and subsequent untreated chronic inflammation, leads to poor outcomes in patients with newly diagnosed IBD regardless of whether delays are patient-related or health-system-related. Also, cumulative delays in the hospital appear to increase the use of biologics in consecutive years. Understanding these factors help rectify and offer long-term solutions. Full article

Background and Objectives: Vaginal natural orifice transluminal endoscopic surgery, vNOTES, has become an increasingly preferred minimally invasive option for benign hysterectomy. General anesthesia is still the routine choice, yet regional methods such as combined spinal epidural anesthesia may support a smoother postoperative course. Although the use of vNOTES is expanding, comparative information on anesthetic approaches remains limited, and its unique physiologic setting requires dedicated evaluation. To compare combined spinal epidural anesthesia with general anesthesia for benign vNOTES hysterectomy, focusing on postoperative nausea and vomiting, recovery quality, and intraoperative physiologic safety. Materials and Methods: This retrospective cohort study was conducted in a single center and identified women who underwent benign vNOTES hysterectomy between March 2024 and August 2025 from electronic medical records. Participants received either combined spinal epidural anesthesia or general anesthesia according to routine clinical practice. All patients were managed within an enhanced recovery pathway that incorporated standardized analgesia and prophylaxis for postoperative nausea and vomiting. The primary outcome was the incidence of postoperative nausea and vomiting during the first day after surgery. Secondary outcomes included time to discharge from the recovery unit, pain scores at set postoperative intervals, early functional recovery, patient satisfaction and physiologic parameters extracted from intraoperative monitoring records. Analyses were performed according to the anesthesia group documented in the medical files. Results: One hundred forty patients met inclusion criteria and were included in the analysis. Combined spinal epidural anesthesia was linked to a lower incidence of postoperative nausea and vomiting, a shorter stay in the post-anesthesia care unit, and reduced pain scores in the first 24 h (adjusted odds ratio 0.32, ninety five percent confidence interval 0.15 to 0.68). Early ambulation and oral intake were reached sooner in the combined spinal epidural group, with higher overall satisfaction also noted. Adherence to ERAS elements was similar between groups, with no meaningful differences in early feeding, mobilization, analgesia protocols or PONV prophylaxis. During the procedure, combined spinal epidural anesthesia produced more episodes of hypotension and bradycardia, while general anesthesia was linked to higher airway pressures and lower oxygen saturation. Complication rates within the first month were low in both groups. Conclusions: In this observational cohort study, combined spinal epidural anesthesia was associated with lower postoperative nausea, earlier recovery milestones and greater patient comfort compared with general anesthesia. Hemodynamic instability occurred more often with neuraxial anesthesia but was transient and manageable. While these findings point to potential recovery benefits for some patients, the observational nature of the study and the modest scale of the differences necessitate a cautious interpretation. They should be considered exploratory rather than definitive. The choice of anesthesia should therefore be individualized, weighing potential recovery benefits against the risk of transient hemodynamic effects. Larger and more diverse studies are needed to better define patient selection and clarify the overall risk benefit balance. These findings should be interpreted cautiously and viewed as hypothesis-generating rather than definitive evidence supporting one anesthetic strategy over another. Full article

Background and Objectives: Sentinel lymph node (SLN) mapping is an established alternative to systematic lymphadenectomy for early-stage endometrial cancer (EC). While retroperitoneal vNOTES affords direct access to pelvic nodes without abdominal incisions, data regarding its oncologic validity remain sparse. This study evaluates the SLN detection rates, perioperative outcomes, and 12-month oncologic outcomes oncologic results of retroperitoneal vNOTES mapping in presumed early-stage EC. Materials and Methods: This single-center retrospective cohort study analyzed consecutive patients undergoing retroperitoneal vNOTES staging (hysterectomy, BSO, and SLN mapping) for presumed EC between February 2023 and January 2024. Eligible patients had radiologically uterine-confined disease and were candidates for transvaginal surgery. Following cervical methylene blue injection, SLN mapping was executed via the retroperitoneal vNOTES route. Mapped and suspicious nodes were excised, with side-specific lymphadenectomy performed for failed mapping per algorithm. While perioperative outcomes were assessed for the full cohort, oncologic analyses (FIGO 2023 staging, nodal metastasis) were restricted to patients with confirmed carcinoma. Results: Of 98 patients (median age 54; BMI 31 kg/m²), final pathology confirmed carcinoma in 78 (73 endometrioid, 5 serous) and EIN in 20. Bilateral SLN mapping succeeded in 87.8% (86/98), necessitating side-specific lymphadenectomy in the remaining 12.2%. The obturator fossa was the predominant nodal basin (43.9%). Within the carcinoma cohort (n = 78), 57.7% were Grade 1 and 74.4% FIGO Stage I. Nodal metastases (FIGO IIIC1) were identified in 12.8% (10/78), all prompting adjuvant therapy. At a median follow-up of 12 months, no disease recurrences were observed. The complication rate was 6.1% (5.1% Clavien–Dindo ≥ III), with no conversions required. At 12-month follow-up, no recurrences were detected, though the absence of systematic lymphadenectomy precluded formal sensitivity analysis. Conclusions: Retroperitoneal vNOTES represents a feasible and safe strategy for SLN mapping in early-stage EC, demonstrating high bilateral detection with minimal morbidity. However, reliance on methylene blue and limited follow-up necessitate caution. Broader implementation requires validation through prospective, comparative trials utilizing indocyanine green and long-term oncologic surveillance. Full article

Introduction: Natural Orifice Transluminal Endoscopic Surgery (NOTES) via the vagina (vNOTES) has recently appeared on the gynecology horizon as a fresh minimally invasive approach. Although vNOTES for benign adnexal conditions is being increasingly employed, very limited experiences exist for its application in ovarian tumors. In this review, the current state of vNOTES applicability for borderline ovarian tumors (BOTs) and estimated early-stage epithelial ovarian cancer (EOC) is assessed. Methods: A narrative literature review was performed to examine operative viability, perioperative safety and functional outcomes, and oncologic details as documented for patients with ovarian tumors undergoing vNOTES. Results: In the current literature, vNOTES has been utilized for adnexectomy, hysterectomy, infracolic omentectomy, peritoneal biopsies, and sampling of selective pelvic lymph nodes in carefully selected patients. The perioperative parameters—bleeding, perioperative pain, and length-of-stay indicators—have been satisfactory with minimal complications. For BOT, vNOTES can meet the requirements for all surgical goals except lymphadenectomy for metastasis evaluation for systemic management. In this context, lymphadenectomy is not necessary for BOT and therefore is no contraindication for vNOTES. However, for invasive EOC, this is a significant drawback as there is no lymphadenectomy for the evaluation and management for this complex subgroup. The oncology follow-up is prematurely limited and is heterogeneous and underpowered. Conclusions: Based on current available data, vNOTES is possible in a selected group of patients with borderline ovarian tumors and in patients with adnexal lesions that are believed to be in early-stage disease based upon imaging studies. For the treatment of invasive epithelial ovarian cancer, vNOTES should not be considered an independent staging procedure at any FIGO stage, but it might find a supplemental place in the setting of a hybrid procedure in a highly selected group of patients in an experienced center. Full article

Objectives: To compare perioperative outcomes and learning curves of robotic hysterectomy and transvaginal natural orifice transluminal endoscopic surgery (V-NOTES) hysterectomy performed for benign gynecological conditions in a high-volume tertiary center. Methods: This retrospective cohort study included 100 patients who underwent either robotic hysterectomy (n = 44) or V-NOTES hysterectomy (n = 56) between January 2024 and July 2025. Demographic data, perioperative parameters, and postoperative outcomes were collected. Learning curves were analyzed using cumulative sum (CUSUM) and quadratic regression models. Results: A total of 100 patients were included (44 robotic, 56 V-NOTES). Baseline demographics were comparable between groups. The postoperative hemoglobin decrease was significantly lower in the robotic group (0.96 ± 0.64 g/dL vs. 1.33 ± 0.93 g/dL, p < 0.05), whereas uterine weight was higher in the V-NOTES cohort (182.6 ± 125.9 vs. 123.2 ± 60.4 g, p < 0.05). Complication rates, including three bladder injuries in the V-NOTES group and one in the robotic group, showed no significant difference. Hospital stay was similar across groups. Conclusions: Both techniques are safe and effective. Robotic hysterectomy offers shorter operative time and less blood loss, while V-NOTES provides cosmetic and recovery advantages. Learning curve analysis indicates a longer adaptation period for V-NOTES, with anterior colpotomy as the most critical step, whereas robotic hysterectomy demonstrates a shorter and more straightforward learning process. Full article

Background/Objectives: The ascending pharyngeal artery (APA) exhibits considerable variability in origin. Understanding its anatomy is essential for head and neck surgery, endovascular procedures, and skull base approaches. This study aimed to (1) systematically characterize APA origin sites, (2) evaluate bilateral patterns, and (3) establish a comprehensive sequential classification system for external carotid artery (ECA) branching. Methods: Bilateral computed tomography angiography assessment was performed in 85 patients (170 carotid axes; 54 men, 31 women; mean age 69 ± 10 years). APA origins were classified into six types: Type 0 (absent), Type I (ECA medial wall), Type II (ECA posterior wall), Type III (occipitopharyngeal trunk), Type IV (internal carotid artery), and Type V (other origins). A novel sequential classification system (S-types) documented the complete ECA branching order. Results: APA was absent in 14.71% of cases; APA’s absence or internal carotid origin was noted in 19.41% of cases. Type I occurred in 26.47%, Type II in 35.88%, Type III in 17.06%, Type IV in 4.71%, and Type V in 1.18%. Forty distinct S-types were identified, representing the most comprehensive documentation of ECA branching diversity. No statistically significant side-related (χ² = 42.12, p = 0.379) or gender-related (χ² = 49.81, p = 0.138) differences were found. Twenty-three types occurred in fewer than five cases each. Conclusions: This first comprehensive sequential classification system reveals extraordinary anatomical diversity in ECA branching patterns. The absence of predictable side or gender patterns necessitates bilateral preoperative imaging for surgical planning. Full article

Background/Objectives: Durable apical support after hysterectomy is crucial to prevent subsequent vaginal vault prolapse. Abdominal sacrocolpopexy remains the gold standard but carries risks of visceral injury and wound morbidity. The vaginal natural orifice transluminal endoscopic surgery (vNOTES) approach provides a scarless, minimally invasive alternative, but data on vNOTES-assisted sacrocolpopexy (vNOTES-SC) performed concurrently with hysterectomy remain limited. Methods: A retrospective cohort of 30 women with stage II uterine prolapse underwent concomitant hysterectomy and vNOTES-assisted sacrocolpopexy between January 2023 and January 2024. Anatomical outcomes were evaluated using the Pelvic Organ Prolapse Quantification (POP-Q) system preoperatively and at 12 months postoperatively. The primary endpoint was anatomical success (C ≤ −1 cm); the secondary endpoint used the IUGA criterion (C < −TVL/2). Complications were graded using the Clavien–Dindo classification. Statistical analyses included Wilcoxon signed-rank tests, effect-size estimation, ROC analysis, logistic regression, and Spearman correlation. Results: Mean operative time was 100.2 ± 11.7 min, mean blood loss 155.3 ± 74.8 mL, and mean hospital stay 1.5 ± 0.7 days. Significant improvements were seen in Aa, Ba, C, and Bp points (p < 0.001). Anatomical success (C ≤ −1 cm) was achieved in 73.3% and clinical success in 93.3% of patients. Two patients exhibited anatomical recurrence (6.7%), whereas one patient reported symptomatic recurrence (3.3%). Using the IUGA definition, anatomical success increased to 83.3%. The difference between strict success (C ≤ −1 cm) and IUGA success (C < −TVL/2) reflects definitional sensitivity, particularly in post-hysterectomy vaginal length. All complications were minor (Grade I–II). ROC analysis showed age as a weak predictor (AUC = 0.67). Effect sizes were large for apical and anterior compartments (Cohen’s d = 1.84 for C-point). Conclusions: Concomitant hysterectomy with vNOTES-assisted sacrocolpopexy is a feasible, safe, and effective scarless approach for apical support restoration. The procedure provides significant anatomical correction and rapid recovery with low morbidity. Patients had symptomatic stage II prolapse with risk factors for early failure after native-tissue repair, supporting the selection of sacrocolpopexy for durable apical support. Larger prospective trials are needed to confirm long-term efficacy and functional outcomes. Full article

Background/Objectives: Tumors of the cerebellopontine angle (CPA) encompass a limited range of histologies, predominantly vestibular schwannomas (VSs), meningiomas, and paragangliomas (PGLs). Their growth region threatens the cranial nerves (V–XII), brainstem, and cerebellum, possibly causing functional deficits. This review aims to synthesize clinical features and multidisciplinary treatment strategies for CPA tumors with brainstem involvement, emphasizing functional preservation alongside tumor control. Methods: A systematic PubMed search identified studies on VSs, CPA meningiomas, and intradural PGLs. Eligibility criteria included studies reporting tumor management and cranial nerve outcomes. Data extraction focused on tumor size, neurological presentation, surgical approach, adjunctive therapies, and postoperative cranial nerve function. Multidisciplinary involvement and rehabilitation strategies were noted. Results: Twenty studies (3311 patients) analyzed large VSs, showing facial nerve dysfunction in 8–53%, trigeminal neuropathy in 20–77%, and cerebellar signs in up to 79%. Microsurgery (MS) achieved variable gross total resection, while stereotactic radiosurgery (SRS) preserved facial nerve function but carried trigeminal and hydrocephalus risks. CPA meningiomas demonstrated cranial nerve displacement patterns critical for surgical planning, with transient deficits common and recovery linked to baseline function. In 388 intradural PGL cases, staged surgery combined with preoperative embolization was standard; functional preservation of lower cranial nerves was often limited. Across all histologies, multidisciplinary management and targeted rehabilitation were essential. Conclusions: Optimal CPA tumor management balances tumor control with functional preservation. VSs benefit from individualized MS or SRS based on size and mass effect. Meningioma surgery prioritizes cranial nerve preservation over radical resection. Intradural PGLs require staged vascular-conscious approaches. Multidisciplinary care and structured rehabilitation are pivotal to improving outcomes and quality of life. Full article

Objectives: Transvaginal Natural Orifice Transluminal Endoscopic Surgery (vNOTES) offers significant benefits in hysterectomy, including reduced postoperative pain, minimal scarring, and faster recovery. However, the cost and accessibility of surgical ports can be limiting factors. This study aimed to evaluate the feasibility, outcomes, and cost-effectiveness of using the Lagis LapBase Cap as an alternative port system in 107 vNOTES hysterectomy cases at a single institution. Methods: A retrospective analysis was conducted on 107 patients who underwent vNOTES hysterectomy between January 2017 and April 2022. Patients with benign gynecologic conditions and no suspected malignancy or deep infiltrating endometriosis were included. The Lagis LapBase Cap was used for access via an Alexis wound retractor. Surgical parameters—including operation time, estimated blood loss, and length of hospital stay—were analyzed by uterine weight, BMI, and obstetric history. Results: Of the 107 cases, 104 were completed using vNOTES, with only 3 conversions to laparoscopy. The average operation time was 88 min, and the mean estimated blood loss was higher in patients with larger uteri or BMI ≥ 24. Nulliparous women and those with a history of multiple cesarean sections also had longer operation times. There were no major complications, and most patients were discharged within three days postoperatively. Conclusions: The Lagis LapBase Cap is a practical and cost-efficient tool for vNOTES hysterectomy. It provides reliable sealing and instrument access, while maintaining favorable surgical outcomes. Patient selection based on uterine size, BMI, and delivery history may help optimize procedural efficiency. Full article

The management of severely comminuted acetabular posterior wall fractures in young, active patients presents a significant surgical challenge. When anatomical open reduction and internal fixation (ORIF) is not feasible, primary total hip arthroplasty (THA) is often considered but is a suboptimal solution due to concerns over long-term implant survivorship and the inevitability of revision surgery. This single-patient technical note presents a novel joint-preserving technique for managing unreconstructible acetabular posterior wall fractures using with cement-augmented screw fixation via the Kocher–Langenbeck approach. A 28-year-old male sustained a left posterior hip dislocation with a comminuted acetabular posterior wall fracture involving >30% of the articular surface, alongside a tibial shaft fracture, following a high-energy motorcycle collision. Intraoperative assessment confirmed the posterior wall was unreconstructible, with six non-viable osteochondral fragments. A joint-preserving salvage procedure was performed. After debridement, a stable metallic framework was created using three screws anchored in the posterior column. Polymethylmethacrylate (PMMA) bone cement was then applied over this framework in its doughy phase, meticulously contoured to reconstruct the articular surface. The hip was reduced, and the tibia was fixed with an intramedullary nail. The patient was mobilized with weight-bearing as tolerated on postoperative day 3. At the 21-month follow-up, the patient reported no pain during daily activities and only mild discomfort during deep squatting. Radiographic and CT evaluations demonstrated a stable hip joint, concentric reduction, well-maintained joint space, and no evidence of implant loosening or osteolysis. Level of Evidence: V (Technical Note/single-patient Case report). For unreconstructible, comminuted fractures of the non-weight-bearing portion of the acetabular posterior wall in young patients, cement-augmented screw fixation offers a viable joint-preserving alternative to primary THA. This technique provides immediate stability, facilitates early mobilization, and preserves bone stock. While long-term outcomes require further study, this case demonstrates excellent functional and radiographic results at 21 months, presenting a promising new option for managing these complex injuries. Full article

Background and clinical significance: Paget’s disease of bone involves anomalies of the bone metabolism; however, the presence of tumor-derivate abnormal parathyroid hormone (PTH) levels does not represent one of these disturbances. To our best knowledge, the association with normocalcemic variant of primary hyperparathyroidism has been limitedly reported, and here we introduce such an unusual overlap in a male suffering from osteoporosis. Case presentation: A 71-year-old, non-smoker man was hospitalized for mild, nonspecific dysphagia, asthenia, decreased appetite, and mild weight loss during the latest 2 months. His medical history included cardiovascular conditions and an abnormal PTH level with normal serum calcium under daily cholecalciferol supplements (tested twice during latest 12 months). The lab findings pointed out a normocalcemic primary hyperparathyroidism (PTH of maximum 163 pg/mL, and total calcium of 9.3 mg/dL) caused by a right parathyroid tumor of 1.2 cm, as confirmed by computed tomography (CT). Additionally, CT showed a left humerus lesion suggestive of Paget’s disease of bone, a confirmation that also came from the whole-body bone scintigraphy. The subject presented increased P1NP and osteocalcin, CrossLaps as bone formation, and resorption markers, with normal total alkaline phosphatase. CT scan also detected multiple vertebral fractures and small kidney stones. Zoledronate i.v. (3 mg, adjusted for creatinine clearance) was administered, taking into consideration all three bone ailments (Paget’s disease, high PTH/calcium, and osteoporosis) with further follow-up. Conclusions: This case highlights the following technical notes based on a real-life setting: 1. Despite the mentioned bone diseases, no bone pain was present. Loss of appetite, dysphagia, and asthenia may be a consequence of mineral metabolism disturbances. 2. The panel of blood bone turnover markers levels might be related to both hyperparathyroidism and Paget’s disease; notably, rare cases of Paget’s disease with normal alkaline phosphatase were prior reported. 3. A meticulous differentiation between secondary and primary hyperparathyroidism is required. In this instance, lack of hypocalcaemia and vitamin D deficiency was suggestive of the diagnosis of a primary variant. 4. Kidney stones, osteoporosis, and osteoporotic fractures may be correlated with both conditions, as well, while a dual perspective of the therapy, since the patient was not a parathyroid surgery candidate, included a first dose of zoledronate with consecutive long-term follow-up. To our best knowledge, the co-presence of normocalcemic variant of primary hyperparathyroidism represents an exceptional finding in a patient synchronously diagnosed with Pagetic lesions and osteoporosis complicated with vertebral fractures. Full article

Background/Objectives: Sentinel lymph node (SLN) mapping has become a standard approach in the surgical staging of early-stage endometrial cancer, aiming to reduce the morbidity associated with full lymphadenectomy while preserving diagnostic accuracy. Vaginal Natural Orifice Transluminal Endoscopic Surgery (V-NOTES) represents a novel, minimally invasive approach for SLN mapping that may offer specific benefits in terms of access, cosmetics, and recovery, particularly in select patient populations. Methods: A comprehensive literature search was conducted in the main databases for studies evaluating the use of V-NOTES for sentinel lymph node mapping in patients with endometrial cancer. Results: Of the 12 included studies, three were observational cohort studies, while the remaining were case reports and series. The mean patient age was 59.6 years, with a majority being overweight or obese. V-NOTES was performed using both transperitoneal and retroperitoneal approaches, with indocyanine green (ICG) being the most used tracer. The overall mean SLN detection rate was 98.19%, with a bilateral detection rate of 93.7%. The average operative time was 155 min, the mean blood loss was 72.03 mL, and the average hospital stay was 2.4 days. The complication rate was low (3.9%), with no conversions to laparotomy reported. Conclusions: V-NOTES appears to be a feasible and safe alternative for SLN mapping in early-stage endometrial cancer, with high detection rates and favourable perioperative outcomes. However, due to the limited number of comparative studies and small sample sizes, further prospective research is needed to establish its efficacy relative to traditional minimally invasive techniques and to determine the optimal patient selection criteria. Full article

Aim: This study was conducted to determine the feasibility, safety, and clinical outcomes of the vaginal natural-orifice transluminal endoscopic surgery (vNOTES) approach in gynecology for obese patients. Methods: PubMed, Cochrane Library, and Google Scholar were searched, from inception to April 2025. A systematic review was performed following the PRISMA guidelines. Studies assessing the use of vNOTES for gynecological procedures in obese women were included. The quality of included articles was evaluated according to the Newcastle–Ottawa Scale. Results: The search yielded three retrospective cohort studies, one cross-sectional, and ten case series. The patients in the vNOTES group (n = 99) had statistically significant shorter operative times, reduced hospitalization, lower postoperative pain scores, fewer perioperative complications, and improved quality of life when compared to the laparoscopy group (n = 84). A study compared obese women to non-obese women undergoing vNOTES and found that operative times were longer in the obese group. Conversion to laparoscopy or laparotomy occurred in fewer than 5% of cases, and intraoperative and postoperative complication rates were low across all studies. Conclusions: vNOTES appears to be safe and potentially superior to other minimally invasive techniques. The small sample size of the case series and the lack of a sufficient number of comparative studies limit the strength of the conclusions. Full article