ArticleFrontiers in medicine2026
Prioritizing vaginal hysterectomy: a stepped algorithm with vNOTES support for benign indications.
Article in Frontiers in medicine, 2026. The graph could read no effect estimate from its abstract, so it casts no vote on the map. Not yet cited in PubMed.
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11 authors.
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Abstract
Objective: This prospective study aimed to evaluate the clinical outcomes of a standardized surgical algorithm adopting a "vaginal-first" approach in patients with non-descensus uteri. It sought to redefine vNOTES as an "educational bridge" and a "safety valve" within this framework. Materials and methods: This single-center, prospective cohort study included 165 consecutive patients scheduled for hysterectomy for benign indications. A standardized stepwise algorithm was implemented: pure vaginal hysterectomy (VH) as the primary target; transition to vNOTES (second tier) in case of failure to progress; and laparoscopy or laparotomy as a final resort. All procedures were performed by a single surgeon. Results: Vaginal completion without abdominal incision was achieved in 157 patients (95.2%). Pure VH was successful in 87.9% ( Conclusion: A "vaginal-first" approach should be the standard of care for non-descensus uteri. vNOTES functions not just as a routine method, but as an educational catalyst that enhances surgical proficiency and a critical safety valve that prevents abdominal conversion. This stepped approach optimizes resource utilization while maximizing minimally invasive benefits.
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