Novel Application of the Lagis LapBase Cap in Transvaginal NOTES Hysterectomy: Surgical Outcomes and Cost-Effectiveness in 107 Cases

Transvaginal Natural Orifice Transluminal Endoscopic Surgery (vNOTES) offers significant benefits in hysterectomy, including reduced postoperative pain, minimal scarring, and faster recovery. However, the cost and accessibility of surgical ports can be limiting factors. This study aimed to evaluate the feasibility, outcomes, and cost-effectiveness of using the Lagis LapBase Cap as an alternative port system in 107 vNOTES hysterectomy cases at a single institution. Methods: A retrospective analysis was conducted on 107 patients who underwent vNOTES hysterectomy between January 2017 and April 2022. Patients with benign gynecologic conditions and no suspected malignancy or deep infiltrating endometriosis were in-cluded. The Lagis LapBase Cap was used for access via an Alexis wound retractor. Surgical parame-ters—including operation time, estimated blood loss, and length of hospital stay—were analyzed by uterine weight, BMI, and obstetric history. Results: Of the 107 cases, 104 were completed using vNOTES, with only three conversions to laparoscopy. The average operation time was 88 minutes, and the mean estimated blood loss was higher in patients with larger uteri or BMI ≥24. Nulliparous women and those with a history of multiple cesarean sections also had longer operation times. There were no major com-plications, and most patients were discharged within three days postoperatively. Conclusions: The Lagis LapBase Cap is a practical and cost-efficient tool for vNOTES hysterectomy. It provides reliable sealing and instrument access, while maintaining favorable surgical outcomes. Patient selection based on uterine size, BMI, and delivery history may help optimize procedural efficiency.