Introduction/Background The standard treatment for Endometrial Cancer at initial stages is the performance of an hysterectomy and double anexectomy. However, when the surgical risk is high, such as in obese patients, alternative surgical approaches should be taken into account. VNOTES surgery (Vaginal Natural Orifice Transluminal Endoscopic Surgery) refers to a surgical approach that utilizes natural body orifices, such as the vagina, to perform minimally invasive endoscopic procedures.

Methodology A Retrospective Case Series of patients diagnosed of Early-stage Endometrial cancer, severe obesity and high anesthetic risk surgically treated by VNOTES technique. Gynecological examination was conducted by a highly proficient surgeon with expertise in this specific technique.

Results Four cases of patients diagnosed with early-stage endometrial cancer were treated using this technique. The average age was 74.5 years (SD 3.9). All patients had morbid obesity, with an average BMI of 47.25 (SD 4.8). Anesthetic risk for all patients was categorized as ASA III, and the average Charlson Score was 5. The mean length of the extracted uterus was 97.75 mm (SD 32.4). Every patient had had at least one vaginal birth, thus a mild grade of uterine prolapse (POPQ Grade I-II). The average surgical time was 104.25 minutes (SD 23.9). No intraoperative complications or medium-term postoperative complications were registered. Every patient was discharged 24 hours after surgery. Two patients had FIGO IA final stage, whether the other two had a FIGO IB final stage. The latter received adjuvant Radiotherapy. In all cases, the procedure was successfully completed. We endeavored to conduct a VNOTES on one patient with the same clinical characteristics. Unfortunately, the procedure had to be discontinued due to a bladder perforation. Posterior pathological study confirmed tumoral bladder infiltration.

Conclusion The VNOTES approach is a feasible option for the surgical treatment of endometrial cancer in patients with a high BMI and elevated anesthetic risk.

Disclosures No conflicts of interest.