Transvaginal surgery: do women want it?

Area of Science:

• Minimally invasive surgery
• Surgical innovation
• Patient-reported outcomes

Background:

• Conflicting results exist comparing transvaginal Natural Orifice Translumenal Endoscopic Surgery (NOTES) to laparoscopic surgery.
• Previous studies show varied patient preferences for NOTES, including transgastric approaches or outright rejection.
• Disparities in results necessitate identifying factors influencing patient opinions on NOTES.

Purpose of the Study:

• To identify demographic and clinical factors affecting women's opinions on transvaginal NOTES.
• To analyze the impact of infection risk, post-surgical abstinence, and infertility risk on patient choice.
• To compare patient preference for transvaginal NOTES versus standard laparoscopic surgery.

Main Methods:

• 142 women completed surveys on transvaginal NOTES opinions and surgical concerns at general surgery clinics.
• Concerns were rated on a 5-point Likert scale; demographic, social, and medical history data were collected.
• Fisher's exact test and logistic regression analyzed associations between concerns and choice of transvaginal NOTES over laparoscopy.

Main Results:

• Age was a significant factor: 35% of women <36 years chose NOTES, compared to 63% (36-55) and 61% (>55).
• Cosmesis concern increased NOTES preference, particularly in women aged 36-55 and ≥56.
• Older age (≥36), concern for adhesions and cosmesis favored NOTES; concern for hernia risk and abstinence reduced preference.

Conclusions:

• Women generally perceive Natural Orifice Translumenal Endoscopic Surgery (NOTES) positively.
• Despite positive perceptions and potential benefits, NOTES procedures are not widely utilized.
• Further research is needed to understand the underutilization of NOTES despite favorable patient opinions.