Repeat Vaginal Natural Orifice Transluminal Endoscopic Surgery: A First Feasibility Study

Area of Science:

• Minimally Invasive Surgery
• Gynaecology
• Surgical Innovation

Background:

• Vaginal natural orifice transluminal endoscopic surgery (vNOTES) is an emerging technique for benign gynaecologic procedures.
• Experience with repeat vNOTES procedures is limited in current literature.
• Previous vNOTES cases have not been described in repeat settings.

Purpose of the Study:

• To demonstrate the feasibility of performing a vNOTES hysterectomy in patients with a history of previous vNOTES adnexal surgery.
• To evaluate the outcomes of repeat vNOTES procedures in gynaecology.

Main Methods:

• A retrospective cohort study of 11 patients undergoing repeat vNOTES hysterectomy after prior vNOTES adnexal surgery.
• All procedures were performed by a single surgeon between March 2016 and May 2020.
• Data on patient characteristics and outcomes were collected after informed consent.

Main Results:

• Repeat vNOTES hysterectomy was technically feasible in all 11 patients.
• All procedures were successfully completed without conversion to laparoscopy or laparotomy.
• Three minor complications occurred, including two cases of cystitis and one anesthesia-related event. No serious injuries were reported.

Conclusions:

• vNOTES hysterectomy following prior vNOTES adnexal surgery is a safe and feasible procedure.
• Further large-scale prospective trials with long-term follow-up are necessary to confirm safety and feasibility of multiple consecutive vNOTES procedures.