Introduction/Background Since multiport laparoscopy replaced open surgery, surgeons started looking for ways to innovate. As a result, laparoendoscopic single-site surgery (LESS) emerged. MIS in endometrial and cervical cancer has been associated with improved quality of life, less blood loss, and similar cancer-related outcomes. To further reduce the morbidity and scarring related to laparoscopic surgery, and improve visualization, closure, and healing, the transvaginal natural orifice transluminal endoscopic surgery (vNOTES), was developed. A series of studies demonstrating the feasibility of vNOTES were conducted in benign gynecologic diseases but have not been confirmed in operations involving malignant tumors. The aim of this study was to evaluate the feasibility of vNOTES surgery for endometrial and cervical cancer, including SLN assessment. The secondary objective was to determine the intraoperative and postoperative surgical complications.

Methodology This is a retrospective and observational study of 2022, including 27 patients with early stages of endometrial/cervical malignancy and premalignancy (endometrial complex atypical hyperplasia, Lynch syndrome, BRCA mutations). They all underwent surgery via vNOTES, 10 of them including SLN assessment.

Results 10 patients underwent bilateral SLNB followed by total hysterectomy and bilateral salpingooforectomy. The median operative time was 120min and the estimated blood loss 50mL. No intraoperative complications occurred and none of the patients required blood transfusions. Moreover, all surgeries were completed without conversion to laparoscopy. The median postoperative stay was one night, without postoperative complications.

Conclusion Our study suggests that vNOTES could be a safe and feasible approach to perform oncological procedures in early stage cervical and endometrial cancer, including the SNLB assessment. However, prospective studies with longer follow-up periods are needed to demonstrate the benefits and oncological outcomes.