Early experience with the gasless vNOTES technique for adnexal surgery

Area of Science:

• Minimally Invasive Gynecologic Surgery
• Natural Orifice Transluminal Endoscopic Surgery (NOTES)

Background:

• Evaluating the feasibility, safety, and outcomes of gasless vNOTES for benign adnexal surgeries.
• Assessing a novel surgical approach minimizing abdominal intervention.

Purpose of the Study:

• To determine the efficacy and safety of gasless vNOTES in adnexal surgery.
• To compare outcomes with conventional surgical methods.

Main Methods:

• Observational, retrospective study across two centers with established vNOTES experience.
• Standardized gasless vNOTES technique using posterior colpotomy, mesh, and transvaginal access.
• Exclusion of pneumoperitoneum and abdominal parietal materials.

Main Results:

• Fifty patients underwent gasless vNOTES for adnexal surgery.
• Median operative time was 21 minutes; 90% were managed ambulatory.
• Low postoperative pain scores and no bleeding complications were reported; one abscess occurred.

Conclusions:

• Gasless vNOTES is a feasible and safe option for experienced surgeons performing adnexal surgery.
• Potential for reduced postoperative pain and analgesic requirements.
• Viable alternative to pneumoperitoneum-assisted vNOTES, warranting further prospective evaluation.