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). 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. 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. 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.
Li et al. (Sun,) studied this question.