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A Case Control Study of vNOTES Versus Conventional Laparoscopic Salpingectomy for Ectopic Pregnancy
Wai Yoong1, Joachim Ho2, Vanessa Mathieu3
1Department of Obstetrics and Gynecology, North Middlesex University Hospital (Drs. Yoong, Wylie, Lodhi, and Rouabhi), London, United Kingdom.
Journal of Minimally Invasive Gynecology
|September 1, 2024
Summary
Vaginal Natural Orifice Transluminal Endoscopic Surgery (vNOTES) offers a safe and effective alternative to laparoscopic salpingectomy for ectopic pregnancy, resulting in shorter recovery times and less pain. Despite higher initial costs, vNOTES demonstrates overall benefits for patients.
Area of Science:
- Minimally Invasive Gynecological Surgery
- Reproductive Health Surgery
Background:
- Laparoscopic salpingectomy is the standard surgical treatment for ectopic pregnancy.
- Vaginal Natural Orifice Transluminal Endoscopic Surgery (vNOTES) is an emerging alternative with potential benefits like reduced abdominal incisions and improved visualization.
Purpose of the Study:
- To compare the outcomes of vNOTES salpingectomy with conventional laparoscopic (CL) salpingectomy for ectopic pregnancy management.
- To evaluate patient demographics, surgical outcomes, and recovery metrics between the two surgical approaches.
Main Methods:
- A case-control study was conducted at a London University hospital.
- Twenty-five women undergoing vNOTES salpingectomy were compared with 25 women undergoing CL salpingectomy for ectopic pregnancy.
- Patient demographics, intraoperative data, postoperative pain, and recovery were analyzed.
Main Results:
- Demographics including age, parity, BMI, and hCG levels were comparable between vNOTES and CL groups.
- vNOTES procedures resulted in significantly shorter operative times (35.8 vs 75.8 mins) and hospital stays (11.5 vs 19.7 hours).
- vNOTES patients experienced less postoperative pain (2.0 vs 4.0 VAS), required fewer opioids (9% vs 25%), and had a faster return to daily activities (11.3 days sooner).
Conclusions:
- vNOTES salpingectomy for ectopic pregnancy is safe and efficacious, offering reduced intraoperative time, shorter hospital stays, less pain, and quicker recovery.
- While vNOTES incurs higher initial costs due to specialized kits, these are offset by reduced resource utilization and faster patient recovery.
- Larger randomized controlled trials are recommended to further validate these findings and support broader adoption of vNOTES.
