Vaginal natural orifice transluminal endoscopic surgery versus conventional laparoscopy for sentinel lymph node mapping in early-stage endometrial cancer: a systematic review and meta-analysis
In brief
Vaginal NOTES shortens hospital stay while matching laparoscopy node detection rates
A meta-analysis of four cohort studies (349 women) found that transvaginal natural orifice endoscopic surgery achieved bilateral sentinel lymph node detection of 87% versus 88% with conventional laparoscopy, with similar unilateral detection, mapping failure, operative time, blood loss, pain and complications. Hospitalization was noticeably shorter after the vaginal approach, but evidence comes from small, non-randomized series, so larger trials are needed before routine adoption.
- Journal
- International journal of gynecological cancer : official journal of the International Gynecological Cancer Society (Q1)
- Published
- 19 August 2026
- Study design
- Systematic review / meta-analysis of RCTs
- Evidence level
- Level 1, High (CEBM 1a)
- Authors
- Ozan Karadeniz, Gizem Nur Koyan Karadeniz, Mahjouba Soltani, Buse Can, Emre Kar
- PMID
- 42716908
- DOI
- 10.1016/j.ijgc.2026.104985
Why clinicians should know about it
- Picked for Obstetrics and Gynecology (top studies of the week, 13 September 2026): Sentinel lymph node mapping, early-stage endometrial cancer
- Picked for Surgical Oncology (top studies of the week, 13 September 2026): Systematic review, sentinel lymph node mapping, surgical technique
Abstract
OBJECTIVE: To compare the bilateral and unilateral sentinel lymph node detection rates, mapping failure rates, and perioperative outcomes of vaginal natural orifice transluminal endoscopic surgery versus conventional laparoscopy in women with early-stage endometrial cancer. METHODS: A systematic search of PubMed, Cochrane Central Register of Controlled Trials, Scopus, and Google Scholar was performed from inception to March 2026. Comparative studies of vaginal natural orifice transluminal endoscopic surgery versus laparoscopy for sentinel lymph node mapping in endometrial cancer were eligible. Risk of bias was assessed using the Risk of Bias in Non-randomized Studies of Interventions-I tool for non-randomized studies. Meta-analysis was performed using a random-effects model. RESULTS: Four comparative cohort studies comprising 349 patients (148 vaginal natural orifice transluminal endoscopic surgery; 201 laparoscopy) were included. Baseline age, parity, and comorbidity burden were broadly similar between groups, although body mass index differed between arms in 2 studies. The bilateral sentinel lymph node detection rate was 86.8% with vaginal natural orifice transluminal endoscopic surgery versus 88.3% with laparoscopy (odds ratio 0.87, 95% confidence interval 0.43 to 1.77, p = .71, I2 = 0%). Unilateral detection and mapping failure rates were comparable between groups. Operative time, estimated blood loss, post-operative pain scores, and complication rates did not differ significantly. Hospital stay was significantly shorter following vaginal natural orifice transluminal endoscopic surgery. The conversion rate was 2.7% in the vaginal natural orifice transluminal endoscopic surgery group. CONCLUSIONS: In carefully selected patients treated by surgeons experienced in transvaginal endoscopic surgery, vaginal natural orifice transluminal endoscopic surgery achieved bilateral and unilateral sentinel lymph node detection rates and mapping failure rates comparable to conventional laparoscopy in early-stage endometrial cancer, with comparable perioperative safety. Available evidence is limited to small non-randomized cohorts with substantial risk of bias; prospective randomized trials are needed to validate these findings and define the optimal patient selection criteria before widespread clinical adoption.
Abstract as published, via PubMed.
For healthcare professionals. The summary is generated by AI from the published abstract, and the evidence level is assigned automatically from the study design on the Oxford CEBM hierarchy. Neither is medical advice. Read the full paper before changing practice.