To evaluate the feasibility and perioperative safety of vaginal natural orifice transluminal endoscopic surgery (vNOTES) hysterectomy with sentinel lymph node biopsy (SLNB) for surgical staging of endometrial neoplasia.

We conducted a retrospective consecutive case series at a tertiary gynecologic oncology center between May 2024 and December 2025. All patients undergoing hysterectomy and SLNB for staging of suspected or confirmed early-stage endometrial neoplasia using the vNOTES approach were included. Demographic characteristics, operative parameters, conversions, and intra- and postoperative complications were recorded. Primary outcomes were feasibility—defined as completion of the procedure without conversion—, detection rate and perioperative safety. Secondary outcomes included operative time, blood loss, hospital stay, and factors influencing operative performance.

Thirty-six patients were included. Median age was 63 years (IQR 57–69) and median BMI was 30 kg/m² (IQR 27–36). The procedure was completed by vNOTES in 33 patients (89%), with 1 conversion to laparoscopy (3%) and 2 conversions to laparotomy (6%) for specimen extraction. Median operative time was 125 min (IQR 115–150). Median hospital stay was 1 day (IQR 1–2; range 1–21). Estimated blood loss was <100 mL in 69% of procedures. Intraoperative complications occurred in 4 patients (11%), all bladder injuries recognized and repaired intraoperatively. Bilateral detection rate was 89% and unilateral detection rate was 100%. Operative time did not differ significantly between the first 10 cases and the subsequent procedures (median 125 vs 120 min, p = 0.86). No variable was significantly associated with the occurrence of complications, and BMI was not associated with operative duration.

vNOTES hysterectomy with SLNB for endometrial cancer staging is feasible and demonstrates acceptable perioperative morbidity in a consecutive series. Further studies are required to assess long-term oncologic outcomes.