Objective:To investigate the feasibility and safety of transvaginal natural orific transluminal endoscopic surgery(vNOTES)in elderly women with adnexectomy.Methods:Using a prospective randomized controlled study method, 90 patients with benign ovarian tumors who met the study inclusion criteria and were treated in the Department of Gynecology of Beijing Hospital from January 2019 to December 2021 were randomly assigned to the experimental group(vNOTES group)according to 1∶1.The conventional laparoscopy group(CL group)and the control group underwent ovarian cystectomy.Preoperative baseline conditions, surgical success rate, operation time, intraoperative blood loss, postoperative complications, visual analogue scale(VAS)within 24 hours and one week after operation, postoperative scar score, and postoperative sexual function score were compared between the two groups.and other related data.Results:The operation of 90 patients was successfully completed, and there was no intraoperative and postoperative complications.There were no significant differences in preoperative general condition, operation time, intraoperative blood loss, health status score and sexual function evaluation between the two groups( P>0.05).The peak airway pressure of mechanical ventilation(21.9±1.8)cmH 2O(1 cmH 2O=0.098 kPa), end-expiratory CO 2 partial pressure(36.6±1.4)mmHg(1 mmHg=0.133 kPa), postoperative exhaust time(8.8±1.7)h, and VAS pain score within 24 hours after surgery(1.3±1.2 points)and scar scores at 1 month, 3 months and 6 months after surgery(1.7±1.1、0.4±0.3、0.0±0.0)were all lower than the control group(29.7±2.6)cmH 2O; (39.9±2.0)mmHg; (21.9±2.7)h; 4.6±2.8、6.5±2.0、4.0±1.6、2.5±1.0), ( P<0.01). 6 months after the operation, the health condition score of the experimental group(124.8±10.6)was higher than that of the TL group.(119.9±10.7)points( P<0.05). Conclusions:For elderly women, transvaginal laparoscopic adnexectomy is safe and feasible, with unique advantages such as less impact on cardiopulmonary function, less pain, less scarring, and faster physical recovery.It is a more minimally invasive method of surgery.It can be used as a surgical modality for adnexectomy in older women.