Impact of Obesity on Clinical Outcomes of v-NOTES Hysterectomy: A Retrospective Study

Qilin Wang¹Yang Liu²Haiying LIAN¹Feng PAN³Tao Li²JunQiang LI^2*

• ¹West China Longquan Hospital Sichuan University, The First People 's Hospital of Longquanyi District, Chengdu, Sichuan Province, China
• ²Affiliated Hospital of Southwest Jiaotong University, The Third People's Hospital of Chengdu, Chengdu, China
• ³The Affiliated Hospital of Southwest Medical University, Luzhou, Sichuan, China

Background: Obesity is a global health challenge that complicates gynecological surgery. Vaginal natural orifice transluminal endoscopic surgery (v-NOTES) offers a minimally invasive approach for total hysterectomy (TH), but its safety and efficacy in obese patients remain underexplored.Objective: To assess the impact of obesity on perioperative and clinical outcomes of v-NOTES hysterectomy, accounting for potential confounders. Methods: This retrospective cohort study analyzed 211 patients who underwent v-NOTES TH between January 2021 and September 2024. Patients were categorized into two groups based on BMI: control group (BMI < 28 kg/m 2 , n = 112) and obesity group (BMI ≥ 28 kg/m 2 , n = 99). Intraoperative indicators and postoperative outcomes during hospitalization, including operative time, intraoperative blood loss, gastrointestinal recovery, hospital stay, and postoperative complications, were compared.Multivariable regression analysis was used to adjust for confounders. All patients were followed up during hospitalization and at 2 and 6 weeks postoperatively.Obese patients had significantly longer operative times (β = 39.2, P < 0.001), delayed gastrointestinal recovery (time to first flatus: β = 5.8, P = 0.018), and prolonged hospital stays (β = 1.3, P = 0.002).Obese patients had significantly longer operative times (β = 39.2, P < 0.001), delayed gastrointestinal recovery (time to first flatus: β = 5.8, P = 0.018), and prolonged hospital stays (β = 1.3, P = 0.002). No significant differences were found in intraoperative blood loss, conversion rates, blood transfusion, postoperative complication rates, or total hospitalization costs (limited to the inpatient period) (all P > 0.05).v-NOTES hysterectomy is a safe and effective option for obese patients, with comparable complication rates to non-obese patients. However, obesity independently contributes to longer operative times and delayed recovery. Targeted perioperative strategies, particularly for improving gastrointestinal recovery, could enhance outcomes in this population.