Search Results (91)

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

Objective: The objective of our study was to assess the oncological safety of uterine manipulators (UMs) in apparent early-stage (FIGO I-II 2009) endometrial cancer treated by minimally invasive surgery (MIS). Methods: Our single-center retrospective study includes patients who underwent endometrial cancer surgery for apparent early-stage disease by either laparoscopy or by robotic or laparoscopic-assisted vaginal hysterectomy from November 2012 to December 2020. Data on UMs, isolated tumor cells (ITCs), cytology, lymphovascular space invasion, free cancer cells in fallopian tubes, stage, histology and grade were collected. Primary and secondary outcomes were cancer recurrence and disease-specific death. Kaplan–Meier curves and multivariate logistic regression were used for statistical analysis. Results: A total of 930 women with early-stage endometrial cancer were included; 789 (84.8%) had hysterectomy with a uterine manipulator and 141 (15.2%) without. A total of 88% had endometrioid histology, 71.6% were grade 1 and 95.7% had stage I disease. A higher risk of recurrence was observed with the Hohl manipulator (HR: 2.83. 95% CI: 1.004–7.98 p = 0.0492) on univariate analysis. On multivariate analysis, neither UM was associated with recurrence. With a mean follow-up of 48 months (range 3–118), no effect was seen on disease-specific death in either Hohl or V-Care (HR: 1.66. 95% CI: 0.48–5.70 and HR:1.29. 95% CI: 0.33–4.98). In high-grade histologies, UMs were strongly associated with recurrence (HR: 12.1. 95% CI: 1.52–96.6 p = 0.019) and disease-specific death (HR: 10.2. 95% CI: 1.12–92.1 p = 0.032). Conclusions: The use of UMs in MIS for endometrial cancer was associated with higher rates of recurrence without affecting disease-specific death, except in high-grade histologies. 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 and Objective: Cervical pregnancy, as a rare type of ectopic pregnancy, can lead to life-threatening complications. Early diagnosis is crucial for optimal management and fertility-sparing strategies. However, despite advances in imaging and early detection, standardized guidelines for management are still lacking. Materials and Methods: This narrative review is based on the collection of case reports of CEP, published in PubMed and Google Scholar in the period 1984–2025. We also included heterotopic cervical pregnancy as it poses even greater challenge to the clinicians. Results: Twenty-two articles reporting a total of twenty-four case reports specifically focus on different management techniques and their corresponding success rates. Currently, there is no consensus regarding the optimal management of this type of ectopic pregnancy, and therapeutic decisions are largely influenced by the clinical presentation, available resources, and the expertise of the treating clinicians and institutions. Conclusions: Conservative approaches should be prioritized as first-line therapy in hemodynamically stable patients where fertility preservation is desired. Minimally invasive procedures may be considered as second-line options following failure of conservative management. Hysterectomy remains the last resort for patients with refractory disease or life-threatening hemorrhage. The proposed algorithm provides an expert-based framework for the management of cervical ectopic pregnancy, emphasizing hemodynamic stability, β-hCG levels, and fertility preservation as key determinants of treatment selection. Full article

Background/Objectives: Obesity is a well-established risk factor for endometrial cancer and presents challenges for surgical management. Robotic-assisted surgery offers a minimally invasive approach with potential benefits for obese patients. This study sought to assess the impact of body mass index (BMI) on surgical performance and short-term outcomes in patients undergoing robotic surgery for early-stage endometrial cancer, focusing on follow-up and perioperative treatment. Methods: A retrospective analysis was conducted on 54 patients with early-stage endometrial cancer who underwent a robotic total hysterectomy, bilateral salpingo-oophorectomy, and indocyanine green sentinel lymph node biopsy between January 2021 and December 2024 at two tertiary centers. Patients were stratified by body mass index. Surgical variables, sentinel lymph node detection rates, peri- and postoperative complications, length of hospital stay, and short-term oncologic outcomes were assessed. Statistical comparisons were performed using ANOVA, chi-square tests, and Pearson’s correlation analysis. Results: The mean patient age was 59.7 years, with a mean BMI of 31.1 kg/m². Bilateral sentinel lymph node detection was successful in 87% of cases, with no significant differences between BMI groups. Console time, hospital stay, and complication rates were comparable across BMI categories. Console time positively correlated with the number of lymph nodes removed (r = 0.302, p = 0.026), but not with BMI. At a mean follow-up of 24.4 months, no recurrences were observed. Conclusions: Robotic surgery for early-stage endometrial cancer is safe and effective regardless of BMI, including in patients with Class III obesity. BMI does not negatively impact surgical or short-term oncologic outcomes, supporting robotic surgery as an optimal approach in obese endometrial cancer patients. Full article

Background and Objectives: Minimally invasive surgery is considered the standard of care for early-stage endometrial cancer. However, the oncological safety of intrauterine manipulator (IUM) use during laparoscopic hysterectomy remains controversial. The aim of this study was to evaluate the impact of intrauterine manipulator use during laparoscopic hysterectomy on oncological outcomes in patients with clinically early-stage endometrial cancer. Materials and Methods: In this retrospective cohort study, 612 patients with FIGO 2009 stage I–III endometrial cancer who underwent staging surgery at a tertiary center between January 2010 and May 2025 were included. Clinical and pathological characteristics were compared between laparoscopy (n = 168) and laparotomy (n = 444). To reduce selection bias, propensity score matching (PSM) was performed based on age, histological subtype, and FIGO stage. Kaplan–Meier survival analysis and Cox regression modeling were utilized to evaluate disease-free survival (DFS) and overall survival (OS). Results: After matching, groups were balanced except for higher rates of para-aortic lymphadenectomy and adjuvant therapy in the laparotomy group. IUM use was not associated with increased LVSI or positive peritoneal cytology. Recurrence was more frequent after laparoscopy (10.1% vs. 6.0%, p = 0.028), with inferior 5-year DFS (87.6% vs. 97.4%, HR 5.60, p = 0.0006), while OS was similar (82.0% vs. 87.6%, p = 0.842). In multivariate Cox analysis, independent predictors of worse DFS were non-endometrioid histology (HR 3.57), FIGO stage III (HR 3.06), grade 3 tumors (HR 2.63), and laparoscopic surgery (HR 0.51). For OS, non-endometrioid histology (HR 5.12), stage III disease (HR 2.98), and grade 3 tumors (HR 4.51) were independent adverse factors, whereas surgical approach was not. Conclusions: The use of an intrauterine manipulator in laparoscopic hysterectomy for early-stage endometrial cancer was linked to worse DFS but not OS. These findings suggest caution regarding the routine use of IUMs and highlight the need for prospective randomized trials to clarify their oncological safety. Full article

Background and Objectives: Laparoscopic surgery has evolved with the integration of robotic systems, offering enhanced precision and ergonomic benefits. However, conventional robotic systems often lack haptic feedback and are associated with high cost. The Saroa surgical system is a compact, pneumatically driven robot that integrates real-time haptic feedback, potentially addressing the limitations associated with conventional robotic systems. This preliminary study reports the first clinical use of the Saroa system in gynecologic surgery, aiming to assess its feasibility, safety, and usability in robot-assisted hysterectomy. Materials and Methods: Five patients underwent robot-assisted total laparoscopic hysterectomy using the Saroa surgical system. The clinical outcomes, setup and console times, estimated blood loss, and subjective surgeon evaluation were recorded. Results: All surgeries were successfully completed without any intraoperative complications or the need for conversion to conventional surgery. The median setup time was 12 min, the console time was 211 min, and the median blood loss was 80 mL. Surgeons subjectively noted that the system’s real-time haptic feedback substantially improved precision during vaginal cuff tissue manipulation, based on their tactile sensation and real-time force display, thereby reducing the perceived risk of traction-related tissue injuries. Conclusions: This study represents the first clinical application of the Saroa surgical system in gynecologic surgery. The findings suggest that the system is feasible and safe for robot-assisted hysterectomy. Despite limitations such as small sample size and the absence of objective force data, the favorable surgeon-reported experience highlights the potential value of haptic feedback in improving surgical performance. These results support further investigation through larger, controlled studies and quantitative performance evaluation. Full article

Background/Objectives: Laparoscopic gynecologic surgery is widely utilized due to its minimally invasive nature. Postoperative discomfort, including intra-abdominal and referred shoulder pain, remains a challenge. This study evaluates the impact of deep neuromuscular blockade (NMB) reversed with sugammadex compared to moderate NMB reversed with neostigmine on postoperative pain, recovery, and surgical conditions in patients undergoing laparoscopic hysterectomy. Methods: This double-blind, randomized controlled trial included 228 patients undergoing laparoscopic hysterectomy under standardized pneumoperitoneum pressure (12 mmHg). Participants were randomized into two groups: deep NMB with sugammadex (SUG) and moderate NMB with neostigmine (NEO). Primary outcomes included postoperative pain (NRS) and neuromuscular recovery time (TOF ratio ≥ 0.9). Secondary outcomes were surgical conditions, surgeon satisfaction, extubation and recovery times, incidence of postoperative nausea and vomiting (PONV), and analgesic consumption. Results: The SUG group exhibited lower pain scores up to 24 h compared to the NEO group (p < 0.05). Pain reductions remained statistically significant up to 6 h postoperatively after Bonferroni correction, while differences beyond this time were not significant after adjustment. Neuromuscular recovery was markedly faster in the SUG group (147.58 ± 82.26 s vs. 488.02 ± 223.07 s, p < 0.05). Patients in the SUG group had shorter extubation (ΔT1), awakening (ΔT2), and recovery room transfer times (ΔT3). PONV was significantly lower in the SUG group. Deep NMB did not contribute to the improvement of surgical workspace conditions. Conclusions: Deep NMB with sugammadex enhances postoperative pain control and accelerates neuromuscular recovery in laparoscopic hysterectomy. These findings support the adoption of deep NMB with sugammadex as a valid anesthetic approach in laparoscopic hysterectomy procedures. Full article

Background and Objectives: Hysterectomy is a common non-obstetric procedure. Minimally invasive techniques, such as laparoscopy and robot-assisted surgery, have replaced open surgery for benign gynecologic conditions. Robotic surgery offers reduced blood loss and shorter hospital stays but is limited by high costs. Articulating laparoscopic instruments aim to replicate robotic dexterity cost-effectively. However, comparative data on these two approaches in hysterectomy are limited. Materials and Methods: This multicenter study analyzed the outcomes of hysterectomies for benign gynecological diseases using articulating laparoscopic instruments (prospectively recruited) and robot-assisted surgery (retrospectively reviewed). The surgeries were performed by minimally invasive gynecological surgeons in South Korea, Japan, and Taiwan. The baseline characteristics, operative details, and outcomes, including operative time, blood loss, complications, and hospital stay, were compared. Statistical significance was set at p < 0.05. Results: A total of 151 patients were analyzed, including 67 in the articulating laparoscopy group and 84 in the robot-assisted group. The operating times were comparable (114.9 vs. 119.9 min, p = 0.22). The articulating group primarily underwent dual-port surgery (79.1%), whereas the robot-assisted group required four or more ports in 71.4% of the cases (p < 0.001). Postoperative complications occurred in both groups, without a significant difference (9.0% vs. 3.6%, p = 0.17). No severe complications or significant differences in the 30-day readmission rates were observed. Conclusions: Articulating laparoscopic instruments provide outcomes comparable to robot-assisted surgery in hysterectomy while reducing the number of ports required. Further studies are needed to explore the learning curve and long-term impact on surgical outcomes. Full article

Background: Total laparoscopic hysterectomy (TLH) is widely accepted as the preferred minimally invasive technique for the treatment of benign gynecologic conditions. However, significant heterogeneity persists in the literature regarding the operative sequence, particularly for steps such as uterine artery ligation, ureteral identification, and vaginal cuff closure. This lack of standardization may affect complication rates, reproducibility in surgical training, and procedural efficiency. The objective of this study was to develop and evaluate a standardized, anatomically justified surgical protocol for TLH primarily designed for training purposes but applicable to most clinical cases. Methods: This retrospective observational study analyzed 109 patients who underwent TLH between January 2016 and July 2020 at a single tertiary care center. A fixed sequence of surgical steps was applied in all cases, emphasizing early uterine artery ligation at its origin, broad ligament fenestration above the ureter, and laparoscopic figure-of-eight vaginal cuff closure. Patient demographics, operative data, and perioperative outcomes were extracted and analyzed. Results: The mean operative time was 67.2 ± 18.4 min, and the mean uterine weight was 211.9 ± 95.3 g. Intraoperative complications were observed in 3.7% of cases and included bladder injury in 1.8% and small bowel injury in 1.8%, all of which were managed laparoscopically without conversion. Vaginal cuff dehiscence occurred in 1.8%, and postoperative vaginal bleeding in 3.7% of patients. One patient (0.9%) required reoperation due to a vaginal cuff hematoma/abscess. No postoperative infections requiring intervention were reported. The mean hemoglobin drop on the first postoperative day was 1.2 ± 0.9 g/dL. Conclusions: Our findings support the feasibility, reproducibility, and safety of a structured TLH protocol based on anatomical landmarks and early vascular control. Widespread adoption of similar protocols may improve consistency and training, with broad applicability in routine surgical practice and potential adaptation in severely complex cases; however, further validation in multicenter studies is warranted. Full article

Background/Objectives: The aim of this case series is to evaluate the outcomes and safety of video-assisted mastectomy, illustrating the harmonious collaboration of oncologic and plastic surgery. This novel minimally invasive technique allows immediate prosthetic reconstruction and represents a cost-effective alternative to robotic breast surgery. Methods: Video-assisted, single-port nipple-sparing mastectomies were performed in patients with small to medium-sized breasts, followed by immediate direct-to-implant reconstruction with either prepectoral or dual plane implant placement. The patients’ electronic medical records were analyzed, including demographic characteristics, operative times and histopathology reports. Results: A total of 18 patients underwent successful video-assisted mastectomy, without conversion to traditional open procedure. Fifteen of the operations were risk-reducing mastectomies. Twelve patients had complementary procedures performed concurrently on the previously operated contralateral breast (delayed reconstruction/expander-to-implant exchange). Moreover, three patients benefited from additional minimally invasive techniques during the same surgery (prophylactic laparoscopic hysterectomy). Immediate breast reconstruction with polyurethane or microtextured breast implants up to 450 cc was performed, with satisfactory aesthetic outcomes and no cancer recurrences at 6 to 12 months postoperative follow-up. Early complications included transient hypercapnia, areolar congestion and cellulitis. No skin necrosis or implant-related complications were reported. The most frequently encountered late issues were contour irregularities. Conclusions: Video-assisted mastectomy facilitates the safe removal of proven pathologic or healthy breast tissue with minimal damage to the breast’s skin envelope, facilitating single-stage breast reconstruction. Full article

In postmenopausal women with high-grade cervical intraepithelial neoplasia (CIN3), hysterectomy is frequently performed after loop electrosurgical excision procedure (LEEP) due to the concern for residual disease or occult carcinoma. However, the decision to proceed with hysterectomy is often made without validated predictive criteria, increasing the risk of overtreatment or underdiagnosis. The aim of this study is to identify independent predictors of residual CIN2+ (CIN2, CIN3, adenocarcinoma in situ, invasive carcinoma) or invasive disease in hysterectomy specimens following LEEP in this high-risk population. Methods: We conducted a multicenter retrospective study including 154 postmenopausal women (aged 50–75) who underwent total hysterectomy within 12 months after LEEP for histologically confirmed CIN3. Data collected included human papillomavirus (HPV) genotyping (pre- and post-LEEP), endocervical curettage (ECC), cone margin status, transformation zone type, and histopathological outcomes of the hysterectomy specimen. Logistic regression and ROC curve analysis were used to assess predictive factors. Results: Residual disease (CIN2+, AIS, or carcinoma) was found in 38 patients (24.7%), including 7 cases (4.5%) of occult carcinoma. Persistent high-risk HPV post-LEEP was the strongest independent predictor (adjusted OR for HPV 16/18: 74.0; p < 0.001), followed by positive ECC (OR: 3.64; p = 0.028). Cone margin status was not independently associated. The multivariate model showed good discriminative performance (AUC = 0.860; sensitivity 67.2%, specificity 72.8%). Conclusions: Our findings suggest that persistent high-risk HPV infection and positive ECC are reliable predictors of residual or occult disease. These markers should be integrated into post-LEEP follow-up protocols to better identify candidates for hysterectomy and minimize unnecessary surgeries. Full article

The recommended treatment for early-stage cervical cancer (FIGO 2018 stages IA–IB2 and selected IIA1) is surgery, followed by either observation or adjuvant therapy, based on individual risk factors. Surgical management has evolved from extensive radical procedures to more conservative strategies, allowing for fertility-preserving options in appropriately selected patients. In 2018, a landmark study (LACC trial) evaluated the surgical approach to radical hysterectomy, comparing open vs. minimally invasive surgery. The results demonstrated that minimally invasive surgery was associated with worse disease-free and overall survival, leading to guidelines changes that recommend the open radical hysterectomy as the new standard of care. More recently, results from the prospective randomized SHAPE trial demonstrated that in well-selected patients with low-risk early-stage cervical cancer, recurrence rates are comparable between simple hysterectomy and radical hysterectomy. An ongoing study, the CONTESSA trial, is evaluating the role of neoadjuvant chemotherapy in the setting of fertility preservation for lesions measuring 2–4 cm. In addition, ongoing studies are evaluating different surgical approaches for both simple hysterectomy (LASH trial) and radical hysterectomy (ROCC/GOG-3043 and RACC trials), with a focus on comparing oncologic outcomes. Attention has also turned to refining lymph node assessment. Sentinel lymph node biopsy has become a standard staging strategy with reduced morbidity. The SENTICOL I-II and SENTIX/ENGOT-Cx2 trials support its safety and diagnostic accuracy in early-stage disease. This article offers a comprehensive overview of recently published prospective trials that have shaped clinical practice in the management of early-stage cervical cancer. It focuses on surgical approaches and radicality, the role of sentinel lymph node mapping, and fertility-sparing treatments. The review further draws attention to ongoing investigations and novel studies that may influence future directions in the field. Full article

Background: Hereditary cancer syndromes such as BRCA1/2 and Lynch syndrome significantly increase the lifetime risk of ovarian, fallopian tube, and endometrial cancers. Risk-reducing salpingo-oophorectomy (RRSO) and hysterectomy are standard preventive strategies. Vaginal natural orifice transluminal endoscopic surgery (vNOTES) has recently emerged as a minimally invasive, scarless alternative that may enhance patient acceptance while maintaining oncologic safety. Objective: This narrative review aims to synthesize the current evidence regarding the role of vNOTES in risk-reducing gynecologic surgery for women with hereditary cancer syndromes, focusing on surgical feasibility, technical considerations, oncologic safety, and patient-reported outcomes. Methods: A structured literature search was conducted in PubMed and Web of Science for studies published between January 2000 and April 2025, using terms related to vNOTES, prophylactic gynecologic surgery, BRCA mutations, and Lynch syndrome. Inclusion criteria focused on studies reporting outcomes of vNOTES in risk-reducing or oncologic contexts. A total of eight studies were included for qualitative synthesis. Results: vNOTES has demonstrated technical feasibility and favorable surgical outcomes in risk-reducing procedures such as RRSO and hysterectomy in BRCA and Lynch syndrome carriers. Comparative studies report lower postoperative pain, faster recovery, and high patient satisfaction, with oncologic standards maintained through specimen containment, peritoneal inspection, and adherence to the SEE-FIM protocol. Limitations include the learning curve and restricted access to the upper abdomen, which may necessitate hybrid approaches in selected cases. Conclusions: vNOTES offers a promising, patient-centered surgical approach for hereditary cancer prevention, combining oncologic safety with enhanced recovery and cosmetic benefits. Further research is needed to standardize protocols, evaluate long-term outcomes, and define its role within broader personalized cancer prevention strategies. Full article