A randomized controlled trial comparing the vaginal, vNOTES ( vaginal natural orifice transluminal surgery) or laparoscopic approach for hysterectomy in women with benign gynaecological disease

Multi-center pragmatic non-blinded RCT including 1000 women 18-75 years in need of hysterectomy for benign disease; comparing VH vs vNOTES or LH vs vNOTES.

Inclusion Criteria:

• Women aged 18 to 75 years regardless of parity with benign indication for hysterectomy

Exclusion Criteria:

• Women with a stage II+ prolapse in need of a hysterectomy as part of vaginal prolapse repair
• hysterectomy due to suspected endometriosis
• subtotal hysterectomy
• history of rectal surgery
• suspected malignancy
• suspected obliteration of the pouch of Douglas following severe PID or other causes
• active lower genital tract infection
• pregnancy
• failure to provide written informed consent prior to surgery
• requirement of in-patient care due to other co-morbidities