Skip to main page content
U.S. flag

An official website of the United States government

Dot gov

The .gov means it’s official.
Federal government websites often end in .gov or .mil. Before sharing sensitive information, make sure you’re on a federal government site.

Https

The site is secure.
The https:// ensures that you are connecting to the official website and that any information you provide is encrypted and transmitted securely.

Access keys NCBI Homepage MyNCBI Homepage Main Content Main Navigation
. 2023 Apr;307(4):1007-1013.
doi: 10.1007/s00404-022-06859-9. Epub 2022 Nov 29.

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

Arzu Bilge Tekin  1 , Murat Yassa  2 , Cihan Kaya  3 , Dogus Budak  4 , Pinar Birol Ilter  4 , Memis Ali Mutlu  4 , Canberk Usta  4 , Osman Samet Gunkaya  4 , Emre Yavuz  4 , Niyazi Tug  4
Affiliations

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

Arzu Bilge Tekin et al. Arch Gynecol Obstet. 2023 Apr.

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.

Keywords: Adnexal surgeries; Gynecological surgeries; Hysterectomy; vNOTES.

PubMed Disclaimer

References

    1. Lee C-L, Wu K-Y, Su H, Ueng S-H, Yen C-F (2012) Transvaginal natural-orifice transluminal endoscopic surgery (NOTES) in adnexal procedures. J Minim Invasive Gynecol 19(4):509–513. https://doi.org/10.1016/j.jmig.2012.02.005 - DOI - PubMed
    1. Kapurubandara S, Lowenstein L, Salvay H, Herijgers A, King J, Baekelandt J et al (2021) Consensus on safe implementation of vaginal natural orifice transluminal endoscopic surgery (vNOTES). Eur J Obstet Gynecol Reprod Biol 263:216–222. https://doi.org/10.1016/j.ejogrb.2021.06.019 - DOI - PubMed
    1. Zakhari A, Papillon-Smith J, Mansour FW, Krishnamurthy S (2021) Transvaginal natural orifice transluminal endoscopic surgery (vNOTES) hysterectomy-first experiences at a canadian academic centre (2021). J Obstet Gynaecol Canada JOGC 43(12):1359–1360. https://doi.org/10.1016/j.jogc.2021.07.011 - DOI
    1. Chrysostomou A, Djokovic D, Edridge W, van Herendael BJ (2018) Evidence-based guidelines for vaginal hysterectomy of the International Society for Gynecologic Endoscopy (ISGE). Eur J Obstet Gynecol Reprod Biol 231:262–267. https://doi.org/10.1016/j.ejogrb.2018.10.058 - DOI - PubMed
    1. Yassa M, Kaya C, Kalafat E, Tekin AB, Karakas S, Mutlu MA et al (2022) The comparison of transvaginal natural orifice transluminal endoscopic surgery and conventional laparoscopy in opportunistic bilateral salpingectomy for permanent female sterilization. J Minim Invasive Gynecol 29(2):257–264. https://doi.org/10.1016/j.jmig.2021.08.009 - DOI - PubMed

LinkOut - more resources