In recent years, transluminal endoscopic surgery through a natural orifice has been used in gynecological operations.
The purpose of the study is to describe the experience of performing transluminal endoscopic hysterectomy (vNOTES) in patients with genital prolapse and Undescended-Enlarged Uteri.

The study involved 31 patients with Undescended-Enlarged Uteri and 23 patients with genital prolapse, aged 48 to 59 years. Patients with suspected rectovaginal endometriosis and extensive adhesions in the pelvis, after inflammatory diseases and operations on the pelvic organs were excluded from the study. The results of the operations were assessed using indicators such as the occurrence of intraoperative and postoperative complications, the intensity of postoperative pain on the VAS scale, the duration of the operation, the activation time of patients after surgery, the time spent in the hospital, and compared them with literature data.

In all cases, hysterectomy was performed using the vNOTES method. Of these, 41 patients underwent hysterectomy with removal of tubes, 10 had hysterectomy with unilateral salpingo-oophorectomy, 3 had hysterectomy and bilateral salpingo-oophorectomy, and 23 patients had the vaginal vault suspended from the uterosacral ligaments.
The average age of the patients was 52.3±5.5 years.
The mean total operative time was 96.0 (70, 130) minutes. The mean operative time for vaginal hysterectomy and vNOTES uterosacral ligament suspension was 25.0 ± 8.2 minutes, respectively. No intraoperative or postoperative complications were observed. The mean postoperative 24-hour visual analogue scale score was 2.2. ± 1.1 for patients with Undescended-Enlarged Uteri and 2.4 ± 0.9 for patients with vNOTES uterosacral ligament suspension. The maximum weight of the removed uterus was 863 g.
At the laparoscopic stage, the vNOTES technique made it possible to clearly visualize the peristalsis of the ureter, which reduced the risk of damage to it. Verticalization of the patients occurred within an hour after surgery, which had a beneficial effect on postoperative rehabilitation. For this purpose, the principles of fast-track surgery were used.
Patients were discharged on days 3-4, with laboratory, instrumental and clinical examination methods. Upon further observation for 12 months, no recurrence of prolapse was detected.

The advantage of vNOTES hysterectomies is early activation, reduction of postoperative pain, speedy recovery and reduction of possible complications in the early postoperative period, faster recovery of patients after surgery, reduction of hospital stay. vNOTES is the preferred choice of surgical treatment for obese patients who refuse traditional laparoscopy, as well as in the presence of chronic pelvic pain syndrome after previous surgical interventions.

Transluminal endoscopic surgery vNOTES represents a new approach in pelvic surgery, combines good access and visualization provided by endoscopy, maximum cosmetic effect, and can be considered as an alternative to other minimally invasive procedures in patients with chronic pelvic pain and a history of open surgery.