Vaginal natural orifice transluminal endoscopic surgery for malignant ovarian tumors: a single-institution study

Abstract

Background: Vaginal natural orifice transluminal endoscopic surgery (vNOTES) is an established access technique for gynecological surgeries, but its utility in ovarian cancer surgery is not well-established.

Methods: This was a single-institution retrospective cohort study of patients who underwent vNOTES surgery and had malignant tumors arising from or involving the ovary on final histology. Preoperative, intraoperative and immediate postoperative outcomes were collected. Oncological outcomes of recurrence and overall survival were also analyzed.

Results: A total of 19 patients were included for analysis: 4 patients had fertility-sparing surgery, 12 had primary staging surgery, 1 had restaging surgery and 2 patients had interval debulking surgery. In the primary staging surgery group, hysterectomy was performed in all patients, omentectomy in a third of the patients, and pelvic lymph node dissection in a quarter of the patients. Only one intraoperative complication of high blood loss was seen, in a patient who was a known hemophilia carrier. Pain scores were mostly zero at 12 and 24 h post-operatively, and most patients were discharged on postoperative day 1 or 2. There were no readmissions for postoperative complications or disease recurrence within 30 days. Median follow-up time was 26.4 months in the whole cohort (interquartile range, 6.3 to 30 months), during which there were 4 cases of recurrence and no deaths.

Conclusions: vNOTES is a feasible and versatile technique for ovarian cancer surgery, with low rates of intraoperative and postoperative complications, short length of stay, and favorable short- to medium-term oncological outcomes.

Keywords: Gynaecologic oncology; Minimally invasive surgery; Ovarian cancer; vNOTES.

Fig. 1

vNOTES glove method setup

Fig. 2

Kaplan–Meier curve of recurrence