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Implementing the transvaginal natural orifice transluminal endoscopic surgery (vNOTES) “first” strategy in benign gynecological surgeries

  • General Gynecology
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Abstract

Purpose

The use of transvaginal natural orifice transluminal endoscopic surgery (vNOTES) as the first choice of surgical route for patients scheduled to undergo conventional laparoscopy is still being debated. We aimed to evaluate and compare the outcomes of the “vNOTES first” strategy in benign gynecological cases.

Methods

All benign gynecological surgeries were initiated using vNOTES during the study period, regardless of the difficulty. Surgical outcomes, short-term patient satisfaction and sexual pain were compared between hysterectomies, adnexal and diagnostic procedures. Visual Analog Score (VAS), Patients Global Impressions of Improvements scale (PGI-I) and Female Sexual Function Index (FSFI) were used to assess the postoperative pain, satisfaction and sexual pain, respectively.

Results

A total of 105 vNOTES procedures were performed during the study period: 63 (60.58%) adnexal procedures, 36 (34.62%) hysterectomies, 5 (4.81%) diagnostic procedures and one (0.96%) myomectomy. The median 24th hour VAS scores for adnexal, hysterectomy, and diagnostic procedures were 1.29 ± 1.41, 2.06 ± 2.08, and 2.6 ± 2.41, respectively. The satisfaction rate was 96.19% at the 1st postoperative week and 97.14% at the first month. There was either no change or a slight improvement in the patients’ total score on the FSFI/pain domain before and after surgery. There were two conversions (1.9%) from vNOTES to laparoscopy and laparotomy, and two (5.56%) bladder injuries in hysterectomy cases.

Conclusion

Implementing the vNOTES technique as an initial approach for all benign gynecological surgeries seems feasible, safe and satisfactory, even in those with a non-prolapsed or enlarged uterus and those that have previously undergone abdominal surgery. The pain scores were found to be low and patients stated a high satisfaction with no or better change in their sexual life.

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Data availability

Data are available from the corresponding author on request.

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Funding

The authors declare that no funds, Grants, or other support were received during the preparation of this manuscript.

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Authors and Affiliations

  1. Department of Obstetrics and Gynecology, Sehit Prof Dr Ilhan Varank Sancaktepe Training and Research Hospital, University of Health Sciences, Emek Mahallesi, Namık Kemal Caddesi, No: 54, Sancaktepe, 34785, Istanbul, Turkey

    Arzu Bilge Tekin, Dogus Budak, Pinar Birol Ilter, Memis Ali Mutlu, Canberk Usta, Osman Samet Gunkaya, Emre Yavuz & Niyazi Tug

  2. Department of Obstetrics and Gynecology, VM Medical Park Maltepe Hospital, Bahcesehir University, Istanbul, Turkey

    Murat Yassa

  3. Department of Obstetrics and Gynecology, Acibadem Bakirkoy Hospital, Acibadem Mehmet Ali Aydinlar University, Istanbul, Turkey

    Cihan Kaya

Authors
  1. Arzu Bilge Tekin
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  2. Murat Yassa
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Contributions

All authors contributed to the study conception and design. Material preparation, data collection and analysis were performed by ABT, MY, DB, Pinar BI, MAM, EY, OSG and NT. The first draft of the manuscript was written by ABT, MY, CK, CU, NT and all authors commented on previous versions of the manuscript. All authors read and approved the final manuscript.

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Correspondence to Arzu Bilge Tekin.

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Tekin, A.B., Yassa, M., Kaya, C. et al. Implementing the transvaginal natural orifice transluminal endoscopic surgery (vNOTES) “first” strategy in benign gynecological surgeries. Arch Gynecol Obstet 307, 1007–1013 (2023). https://doi.org/10.1007/s00404-022-06859-9

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