Ectopic pregnancies: laparoscopic versus vNOTES approach. Surgical and obstetric outcomes

Extrauterine pregnancy (EP), represents a significant challenge in reproductive medicine, manifesting in approximately 2% of all pregnancies, primarily implanting within the fallopian tubes (95%). Surgery remains a cornerstone in the therapeutic options for ectopic pregnancies. The most common surgical approach at the moment is laparoscopy. However a relatively new surgical technique, vaginal Natural Orifice Transluminal Endoscopic Surgery (vNOTES) has evolved which is a vaginal entry to the abdomen in conjunction with endoscopy via the vagina. In this study we compare the surgical and obstetrical outcomes of these two techniques.

The operation time using the vNOTES approach was significantly shorter when compared to a laparoscopic approach, mean surgical time was 35 versus 47 min (p < 0.001). Both techniques had a very low complication and postoperative infection rate. Duration of hospital stay was not significantly lower in the vNOTES group but a trend was seen (p = 0.06). No significant differences were observed in the obstetric outcomes.

This study shows that the vNOTES approach is a good and safe technique to operate ectopic pregnancies and can provide shorter operating time and duration of hospitalisation. Early data shows promising results on safety for future pregnancies but further research is warranted.