Safety and efficacy of transvaginal natural orifice endoscopic surgery (vNOTES) for gynecologic procedures in the elderly: A case series of 119 consecutive patients

Abstract

Introduction: This study evaluates the feasibility and safety of Transvaginal Natural Orifice Transluminal Endoscopic Surgery (vNOTES) in patients aged ≥ 65, focusing on early surgical outcomes for benign and malignant gynecological conditions.

Methods: A total of 119 patients aged 65 and older who underwent vNOTES procedures at Valais Hospital from May 2020 to November 2024 were included. Data collected encompassed demographic characteristics, intraoperative details (e.g., complications, operative time), and postoperative outcomes (e.g., pain scores, complications, length of hospital stay).

Results: The mean age was 72.5 years; 59.7 % underwent total hysterectomies, and 30.3 % had adnexal procedures. Mean operative time was 81.6 min (range: 15-221), and mean blood loss was 66.5 ml (range: 0-500). Conversion to conventional laparoscopy occurred in four cases (3.4 %). Intraoperative complications occurred in 14 cases (11.8 %), with higher rates in patients with BMI > 30 (p = 0.01). ASA III and IV patients experienced higher complications rates both intraoperatively (17.1 % vs. 9.5 %, p = 0.24) and postoperatively (28.6 % vs. 11.9 %, p = 0.03) compared to ASA I and II patients. Complication rates increased with surgical complexity, reaching 33.3 % for three or more concomitant procedures. The mean hospital stay was 2.8 days. Patients 75 years of age or older did not have significantly higher complication rates, operating times, or longer hospital stays.

Conclusion: Our study confirms the feasibility and safety of vNOTES in elderly patients. However, increased number of concomitant procedures seems to correlate with higher complication rates, especially in patients with a high ASA score and high BMI. These findings offer valuable data for preoperative discussions with elderly patients.