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  • Kapalı Erişim
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    Outcomes of first 60 vaginal myomectomies by one gyn surgeon with 20 years of extensive vaginal surgical expertise
    (BioMed Central, 2026) Şahin, Eda Adeviye; Şahin, Turan; Ağlamış, Savaş Özgür; Tekin, Arzu Bilge; Şahin, Hanifi
    Introduction This retrospective single-center study based on prospectively collected data aimed to evaluate changes in operative performance during the initial experience with vaginal myomectomy. Methods Sixty consecutive patients who underwent VM between January 2021 and December 2023 were included. Demographic features, FIGO-classified myoma characteristics, operative variables, and postoperative outcomes were recorded prospectively. To assess the LC, patients were divided chronologically into four groups of 15 cases. The primary objective was to evaluate changes in operative performance across consecutive cases. Operative time, estimated blood loss, hematocrit decrease, and hospitalization duration were used as measurable indicators of surgical progression, while the occurrence of major complications was assessed as a safety outcome. Groups were compared in terms of preoperative characteristics, intraoperative parameters, and postoperative outcomes. Results The mean age and BMI of the patients were 38.1 years and 28.2 kg/m², respectively. Myoma number, diameter, and FIGO-based localization were similar across all groups (p > 0.05). No major intraoperative or postoperative complications occurred. Hematocrit drop and estimated blood loss were significantly higher in the first 15 cases compared to subsequent groups (p = 0.033 and p = 0.005). Operative time significantly decreased after the first 30 cases (p = 0.001), while length of hospital stay significantly shortened after the first 15 cases (p = 0.001). Transfusion rates did not differ between groups (p = 0.923). Conclusion The findings suggest that improvements in bleeding parameters and hospitalization duration became apparent after approximately 15 procedures, whereas operative efficiency improved and appeared to stabilize after approximately 30–34 procedures. These observations should be interpreted within the context of the initial experience of an experienced vaginal surgeon rather than as universally applicable thresholds.
  • Küçük Resim
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    Postoperative pain after vNOTES versus laparoscopic hysterectomy: A procedure-specific comparative study
    (Turkish Society of Obstetrics and Gynecology, 2026) Şahin, Turan; Şahin, Eda Adeviye; Perkyürek, Buse Sahra; Güzeltaş, Gökan; Tekin, Arzu Bilge; Gök, Koray; Şahin, Hanifi
    Objective: Vaginal natural orifice transluminal endoscopic surgery (vNOTES) is associated with lower postoperative pain, reduced analgesic requirements, and faster early postoperative recovery compared with laparoscopy in patients undergoing hysterectomy for benign indications. To compare postoperative pain and early recovery outcomes between vNOTES and conventional laparoscopy in patients undergoing hysterectomy for benign gynecologic indications. Materials and Methods: This single-center retrospective cohort study included 192 patients who underwent hysterectomy between March 2021 and September 2025. Patients were grouped according to surgical approach (vNOTES vs. laparoscopy). Postoperative pain was assessed using the visual analog scale at 6 and 24 hours. Primary outcomes were pain intensity and the requirement for additional analgesia. Secondary outcomes included operative time, change in hemoglobin, time to first flatus, and length of hospital stay. Multivariable logistic regression analysis was performed to identify predictors of analgesic requirement. Results: Of 192 patients, 75 (39.1%) underwent laparoscopy and 117 (60.9%) underwent vNOTES. Baseline characteristics were similar between groups. The vNOTES group had significantly lower pain scores at 6 and 24 hours (p=0.001) and a reduced need for additional analgesia (23.9% vs. 60.0%, p=0.001). Operative time was shorter and recovery outcomes, including time to first flatus and length of hospital stay, were significantly improved in the vNOTES group (p=0.001). Surgical approach, uterine weight, and operative time were independent predictors of analgesic requirement. Conclusion: In this retrospective cohort study, vNOTES was associated with lower postoperative pain scores, reduced analgesic requirement, and earlier recovery than conventional laparoscopy. These findings should be confirmed in prospective randomized studies.