Postoperative pain after vNOTES versus laparoscopic hysterectomy: A procedure-specific comparative study

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.