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Updated: Jul 3, 2026

Transvaginal Mesh Insertion in the Ovine Model

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Published on: July 27, 2017

How do gynecologists feel about transvaginal NOTES surgery?

F Thele¹, M Zygmunt, A Glitsch

¹Department of Gynecology and Obstetrics, Greifswald University Hospital, Ernst-Moritz-Arndt University of Greifswald, Germany.

|July 9, 2008

Summary

Gynecologists view transvaginal natural orifice transluminal endoscopic surgery (NOTES) as ethical but experimental. Concerns include infection, visceral lesions, infertility, and adhesions, impacting patient recommendations for this scarless surgery approach.

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Area of Science:

Minimally Invasive Surgery
Gynecological Surgery
Surgical Innovation

Background:

Natural orifice transluminal endoscopic surgery (NOTES) is considered safer and less invasive than traditional laparoscopy.
Limited data exists on experienced gynecologists' perspectives regarding transvaginal access indications, contraindications, risks, and complications.

Purpose of the Study:

To investigate the opinions of experienced gynecologists on the ethical considerations, perceived risks, and potential complications of transvaginal NOTES for extrapelvic abdominal surgery.

Main Methods:

A questionnaire was distributed to heads of gynecological departments in 181 major hospitals across Germany, Austria, and Switzerland.
Fifty-two (28.7%) questionnaires were returned and analyzed, featuring a mix of yes/no, multiple-choice, and open-ended questions.

Main Results:

69.2% of respondents deemed transvaginal access ethical, while 30.8% considered it experimental.
Only 28.8% would recommend NOTES if surgical risks matched laparoscopy; key concerns included infection (73.1%), visceral lesions (61.5%), infertility (44.2%), and adhesions (34.6%).
Long-term concerns focused on dyspareunia and infertility, with scarless outcome deemed unimportant by 57.6% of respondents.

Conclusions:

Transvaginal NOTES is a promising approach for scarless surgery, but gynecologists highlight potential complications like infection, visceral lesions, infertility, and adhesions.
Long-term data is lacking, leaving concerns about dyspareunia, infertility, and endometriosis spread as significant potential issues.