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    Evaluating the efficacy and benefits of vNOTES for ovarian cystectomy: a systematic review and meta-analysis
    (Elsevier Ireland Ltd, 2025) Kaya, Cihan; Aktoz, Fatih; Güneş, Ali Can; Tercan, Can; Saçıntı, Koray Görkem; Yassa, Murat; AlAli, Hussein
    This meta-analysis aims to evaluate the effectiveness and overall outcomes of vNOTES in ovarian cystectomy compared to conventional laparoscopy (CL). Study design: A systematic review and meta-analysis were conducted by searching PubMed/MEDLINE, EBSCO, Cochrane, and Embase databases for studies comparing vNOTES and laparoscopy for ovarian cystectomy. A comprehensive literature search was performed to identify relevant publications up to June 21, 2024. The search strategy utilized a combination of Medical Subject Headings (MeSH) terms and relevant keywords. Eligible studies included randomized controlled trials, cohort studies, and case-control studies, while case reports and studies lacking a direct comparison were excluded. Two independent reviewers assessed study eligibility and performed Risk of Bias evaluation. Quantitative synthesis was performed using meta-analysis techniques. The protocol was registered in the PROSPERO database (CRD42024560612). Results: Six studies reported operative times, with vNOTES showing a significantly shorter duration compared to CL (mean difference [MD]: −13.05 min, 95 % confidence interval [CI]: −19.04 to −7.07, I2 = 67 %). Five studies demonstrated that vNOTES was associated with shorter hospital stays (MD: −0.43 days, 95 % CI: −0.74 to −0.12, I2 = 90 %). Pain scores were also significantly lower in vNOTES patients (3 studies, MD: −1.25, 95 % CI: −1.49 to −1.01, I2 = 43 %). However, no significant differences were observed between the groups regarding hemoglobin drop, blood loss, or conversion rates. Conclusion: This systematic review and meta-analysis highlight the advantages of vNOTES ovarian cystectomy, including reduced operative times, faster recovery, lower postoperative pain, and shorter hospital stays. These findings support the wider adoption of vNOTES as an effective alternative to conventional laparoscopy for ovarian cystectomy, offering potential benefits for both patients and surgical efficiency.
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    Two-year follow-up on surgical outcomes of vnotes high uterosacral ligament suspension for the prophylaxis and treatment of pelvic organ prolapse: a multicenter prospective cohort study
    (Elsevier, 2025) Birol İlter, Pınar; Yassa, Murat; Doğan, Ozan; Tekin, Arzu Bilge; Günkaya, Osman Samet; Yassa, Mahmut; Saçıntı, Koray Görkem; Alsannan, Baydaa; Dağdeviren, Hediye; Tuğ, Niyazi; Kaya, Cihan
    Study objective: We aimed to evaluate the medium-term outcomes of high uterosacral ligament suspension (HUSLS) with vaginal-assisted natural orifice transluminal endoscopic surgery (vNOTES) in patients either suffering from pelvic organ prolapse (POP) or undergoing routine prophylaxis to prevent post-hysterectomy vaginal vault prolapse. Design: Multicenter prospective cohort study SETTING: Three tertiary care hospitals PATIENTS: Patients who received vNOTES-HUSLS between January 1, 2021 and January 1, 2023, were included in the study. Interventions: vNOTES-HUSLS MEASUREMENTS AND MAIN RESULTS: The data collected included surgery duration, intraoperative and postoperative complications, postoperative Visual Analog Scores (VAS), and Female Sexual Function Index (FSFI) pain subdomain scores. The changes in prolapse levels were measured using modified POP-Q scores, including the C, Ba, and Bp scores recorded prior to surgery and during the postoperative follow-up examination. Patient satisfaction was assessed using the Patient Global Impression of Improvement (PGI-I) questionnaire. The final analysis included 55 women. Of these, vNOTES-HUSLS was performed in 43 patients (78.2%) to treat apical prolapse, while the remaining 12 patients (21.8%) underwent prophylaxis following hysterectomy to prevent vaginal vault prolapse. The median follow-up period was 23.5 months, with a range of 12-37 months. Ba,C, and Bp points significantly improved in patients who underwent surgery for prolapse (p<0.001). There was no recurrence in the apical compartment following vNOTES-HUSLS for both performed prophylactic and treatment purposes after hysterectomy. Two (3.6%) patients were diagnosed with stage 3 anterior compartment prolapse. The overall vNOTES-HUSLS success rate was 96.4% at approximately two years follow-up. Bladder injury was detected as an intraoperative complication in one patient (1.8%). The overall satisfaction rate was 98.1% at the final follow-up. Conclusion: vNOTES-HUSLS was effective in the treatment and prophylaxis of apical prolapse, demonstrating high anatomical success rates. The procedure demonstrated a low complication rate, with intraoperative and postoperative complications each observed in 1.8%(n=1) of patients. Synopsis: The Medium-Term Outcomes of vNOTES High Uterosacral Ligament Suspension.