Introduction/Background The standard treatment for Endometrial Cancer at initial stages is the performance of an hysterectomy and double anexectomy, with or without the evaluation of pelvic sentinel nodes, often done through a laparotomic or laparoscopical approach. However, when the surgical risk is high, such as in obese patients, allternative surgical approaches should be taken into account in these patients. VNOTES (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 An 81-year-old female was referred to our center on suspicion of Endometrial Neoplasia. She presented with a 5-month history of postmenopausal bleeding and exhibited several comorbidities, including morbid obesity (BMI 41.62). During the physical examination, the gynecological assessment revealed a uterus with mild prolapse (POPQ Grade I). Endometrial biopsy yielded Grade 1 Endometrioid Carcinoma. Magnetic Resonance Imaging revealed a 61mm uterus with a partially occupied endometrial cavity with a 23 mm lesion displaying an irregular interface and myometrial infiltration not exceeding 50%. No distant disease was identified. The diagnosis was FIGO IA Endometrial Neoplasia. Considering the patient‘s comorbidity, an ASA Score of III, and a Charlson Score of 5, the abdominal route was ruled out as the surgical approach, and the vaginal route was chosen through Vaginal Natural Orifice Transluminal Endoscopic Surgery (VNOTES).

Results The patient was discharged 1 day after surgery and non intraoperative complications or medium to long-term postoperative complications were reported. Final FIGO IA stage was confirmed after pathological examination of the surgical specimen.

Conclusion VNOTES is an alternative for the surgical treatment of endometrial cancer in selected patients.

Disclosures No conflict of interest.