Repeated transvaginal natural orifice transluminal endoscopic surgery: An initial Chinese experience

A Case Control Study of vNOTES Versus Conventional Laparoscopic Salpingectomy for Ectopic Pregnancy

STUDY OBJECTIVE

While the laparoscopic approach is the surgical treatment of choice for ectopic pregnancy, vaginal Natural Orifice Transluminal Endoscopic Surgery (vNOTES) is emerging as an alternative route with its good optical visibility and avoidance of abdominal incisions. The authors compare demographics and outcome data of vNOTES vs conventional laparoscopic (CL) salpingectomy for the surgical management of ectopic pregnancy.

DESIGN

Case-control study.

SETTING

A London University hospital.

PATIENTS

Women with ectopic pregnancy unsuitable for medical management who underwent surgical management.

INTERVENTION

Twenty-five cases of vNOTES vs 25 CL salpingectomy.

MEASUREMENTS AND MAIN RESULTS

The mean patient age (29.7 ± 53 vs 31.4 ± 6.7 days), parity (1.2 ± 1.1 vs 1.6 ± 2.1), body mass index (26.7 ± 5.3 vs 27.2 ± 5.4 kg/m3), gestation age (8.44 ± 2.1 vs 7.3 ± 1.7 weeks) and β human chorionic gonadotrophin (βhCG) levels (3725.4 ± 3674.8 vs 4376.5 ± 6493.4 IU/liter) were comparable (p >.05, t test) between patients having vNOTES vs CL salpingectomy. While estimated blood loss was similar (218.2 ± 491.7 vs 173.5 ± 138.7 mL) (p >.001), vNOTES patients had a statistically shorter duration of surgery (35.8 ± 14.4 vs 75.8 ± 19.7 mins) (p <.001, t test) and length of stay (median: 11.5 vs 19.7 hours) (U = 72, p <.05, Mann-Whitney U test). Less patients in the vNOTES group required postoperative opioids (9% vs 25%), and the median visual analog score (/10) for pain at 24 hours was significantly lower (2.0 vs 4.0) (U = 75, p <.05, Mann-Whitney U test). Patients from the vNOTES group were able to return to normal daily activity 11.3 days quicker (5.8 ± 4.3 vs 17.1 ± 8.2 days) (p <.05, t test). vNOTES cases cost approximately USD150 more due to the price of the commercial kits but this is offset by reduced intraoperative time, length of stay and need for postprocedure analgesia.

CONCLUSION

Patients undergoing vNOTES have shorter intraoperative times and length of stays, less postoperative pain, and more rapid recovery, which help mitigate higher costs incurred by commercial kits. While the vNOTES approach for ectopic pregnancy appears safe and efficacious, more robust data from larger randomized studies are needed.

Transvaginal natural orifice transluminal endoscopic surgery for myomectomy: A more suitable surgical approach for enhanced recovery after surgery

OBJECTIVE

Vaginal natural orifice transluminal endoscopic surgery (vNOTES) is widely recognized for its potential benefits, including reducing post-surgical pain and leaving no discernible scarring. However, the anatomical specificity of the vNOTES approach may elevate the risk of nearby organ damage, such as the rectum and bladder. Thus, this study aims to demonstrate the safety and relative merits of vNOTES over transumbilical laparoendoscopic single-site surgery (LESS).

METHODS

The Longitudinal Vaginal Natural Orifice Transluminal Endoscopic Surgery Study (LovNOTESS), which was conducted in Chengdu, China. A total of 110 patients who underwent myomectomy in vNOTES or LESS from January 2021 to December 2022. This study prospectively collected and compared perioperative and follow-up data of the two groups.

RESULTS

In the vNOTES group, patients had shorter postoperative anal exhaust time, lower pain medications use rate, shorter hospital stay but higher intraoperative conversion rate, and higher postoperative fever rate. vNOTES decreased the anal exhaust time by approximately 8.7 h (95 %CI: -16.182, -1.262, p = 0.007). Moreover, vNOTES reduces pain medication use risk by 73.1 % (OR: 0.269, 95 %CI: 0.172, 0.318, p = 0.016).

CONCLUSION

Relative to LESS, vNOTES can make patients mitigate postoperative discomfort, accelerate the recovery of gastrointestinal function, curtail hospitalization duration, and enable a more rapid return to daily activities in myomectomy. However, vNOTES has a higher risk of surgical conversion and adjacent organ injury. Therefore, larger scale prospective studies are needed to prove its security and promote the widespread application of vNOTES in myomectomy.