While vaginal hysterectomy (VH) has historically been considered the preferred surgical approach for benign indications, retrospective studies have suggested vaginal-assisted natural orifice transluminal endoscopic surgery hysterectomy (VANH) as an alternative. However, comparative evidence remains limited. To address this gap, a multicenter randomized controlled trial compared the two procedures as day-care surgeries in 113 patients. Same-day discharge was significantly more frequent with VANH than with VH (87.3% vs 71.4%).

VANH was also associated with a shorter operative time (55 vs 65 minutes), lower blood loss (50 vs 150 mL), and a higher rate of elective opportunistic salpingectomy (100% vs 77.4%). Postoperative pain scores during the first hour were significantly lower with VANH than with VH (1 vs 3). However, differences in postoperative complications (15.5% vs 9.5%) and…