Preoperative ultrasound-estimated uterine weight predicts operative complexity in v-NOTES hysterectomy: A multicenter retrospective study
4 affiliations
- 1Affiliated Hospital of Southwest Jiaotong University, The Third People's Hospital of Chengdu, Chengdu, China
- 2Sichuan Jinxin Xinan Women& Children Hospital, Chengdu, China; Corresponding author. Sichuan Jinxin Xinan Women& Children Hospital, Chengdu, 610066, Sichuan, China.
- 3The First People ‘s Hospital of Longquanyi District Chengdu, Chengdu, China
- 4Affiliated Hospital of Southwest Medical University, Luzhou, China
Abstract
Objectives: The purpose of the present study was to validate the accuracy of preoperative ultrasound-estimated uterine weight (UWT) versus actual pathologic weight (AWT) and to determine if sonographic parameters, especially transverse uterine diameter, can predict operative complexity and postoperative recovery in vaginal natural orifice transluminal endoscopic surgery (v-NOTES) total hysterectomy (TH). Methods: In this multicenter retrospective cohort study, a total of 268 women who underwent v-NOTES TH for benign indications between January 2021 and June 2025 of four tertiary hospitals in Sichuan, China were included. UWT was calculated by transvaginal ultrasonography and the prolate-ellipsoid formula. Patients were divided into three groups: <500g, 500-1000g and ≥1000g. Correlation and Bland-Altman analyses were performed to assess agreement between UWT and AWT. Multivariable regression models were used to determine independent predictors of operative time and postoperative recovery. Results: UWT showed a good correlation with AWT ( r = 0.84, P < 0.001) with a low level of systematic error (+3.9%, 95% limits of agreement, −14.7% to +22.5%). Both UWT category and transverse uterine diameter were independent predictors of operative time ( β = 41.36 min per tier, 95% CI 28.44-54.28, P < 0.001; and β = 9.68 min per cm, 95% CI 5.10-14.26, P = 0.001). Prolonged operative time was significantly related to delayed bowel recovery ( β = 6.12 h, P = 0.009). Estimated blood loss, conversion rate, transfusion requirement and postoperative complication rates were not significantly different between groups. Conclusion: Preoperative ultrasonography is an accurate method of estimating uterine weight and, when combined with transverse diameter, is a simple and reproducible predictor of surgical complexity and postoperative recovery after v-NOTES TH. The proposed three-tier UWT classification (<500 g, 500-1000 g, ≥1000 g) may be useful for individualized preoperative planning and risk stratification.
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BibTeX
@article{li2026preoperative,
title = {{Preoperative ultrasound-estimated uterine weight predicts operative complexity in v-NOTES hysterectomy: A multicenter retrospective study}},
author = {Junqiang Li and Duona Ma and Mengru Shi and Feng Pan and Tao Li and Yang Liu},
journal = {Asian Journal of Surgery},
year = {2026},
month = oct,
doi = {10.1016/j.asjsur.2026.02.205},
url = {https://doi.org/10.1016/j.asjsur.2026.02.205},
note = {CC BY},
}
RIS
TY - JOUR
TI - Preoperative ultrasound-estimated uterine weight predicts operative complexity in v-NOTES hysterectomy: A multicenter retrospective study
AU - Junqiang Li
AU - Duona Ma
AU - Mengru Shi
AU - Feng Pan
AU - Tao Li
AU - Yang Liu
PY - 2026
DA - 2026/10/31
JO - Asian Journal of Surgery
DO - 10.1016/j.asjsur.2026.02.205
UR - https://doi.org/10.1016/j.asjsur.2026.02.205
AB - Objectives: The purpose of the present study was to validate the accuracy of preoperative ultrasound-estimated uterine weight (UWT) versus actual pathologic weight (AWT) and to determine if sonographic parameters, especially transverse uterine diameter, can predict operative complexity and postoperative recovery in vaginal natural orifice transluminal endoscopic surgery (v-NOTES) total hysterectomy (TH). Methods: In this multicenter retrospective cohort study, a total of 268 women who underwent v-NOTES TH for benign indications between January 2021 and June 2025 of four tertiary hospitals in Sichuan, China were included. UWT was calculated by transvaginal ultrasonography and the prolate-ellipsoid formula. Patients were divided into three groups: <500g, 500-1000g and ≥1000g. Correlation and Bland-Altman analyses were performed to assess agreement between UWT and AWT. Multivariable regression models were used to determine independent predictors of operative time and postoperative recovery. Results: UWT showed a good correlation with AWT ( r = 0.84, P < 0.001) with a low level of systematic error (+3.9%, 95% limits of agreement, −14.7% to +22.5%). Both UWT category and transverse uterine diameter were independent predictors of operative time ( β = 41.36 min per tier, 95% CI 28.44-54.28, P < 0.001; and β = 9.68 min per cm, 95% CI 5.10-14.26, P = 0.001). Prolonged operative time was significantly related to delayed bowel recovery ( β = 6.12 h, P = 0.009). Estimated blood loss, conversion rate, transfusion requirement and postoperative complication rates were not significantly different between groups. Conclusion: Preoperative ultrasonography is an accurate method of estimating uterine weight and, when combined with transverse diameter, is a simple and reproducible predictor of surgical complexity and postoperative recovery after v-NOTES TH. The proposed three-tier UWT classification (<500 g, 500-1000 g, ≥1000 g) may be useful for individualized preoperative planning and risk stratification.
SN - 1015-9584
ER -