Vaginal NOTES adnexal surgery: Results of a retrospective cohort study in The Netherlands

Vaginal natural orifice transluminal endoscopy (vNOTES) is a minimally invasive technique gaining popularity for several gynaecological procedures. This study presents the first 81 adnexal cases, performed in The Netherlands.

This retrospective cohort study included patients who underwent vNOTES adnexal surgery for benign indications at Zuyderland Medical Centre between March 2020 and August 2024. Baseline characteristics, surgical outcomes, and per- and postoperative outcomes were analysed. Two expert vaginal and endoscopic gynaecological surgeons performed all procedures.

A total of 81 patients underwent adnexal surgery using vNOTES. Indications were definitive contraception (60.5 %; n = 49), ovarian cysts (18.5 %; n = 15), risk-reducing surgery for gene mutation carriers (16.0 %; n = 13), ectopic pregnancy (3.7 %; n = 3), and request for artificial menopause due to complaints (1.2 %; n = 1). Procedures performed were bilateral salpingectomy (60.5 %; n = 49), bilateral salpingo-oophorectomy (28.4 %; n = 23), unilateral salpingo-oophorectomy (4.9 %; n = 4), unilateral salpingectomy (3.7 %; n = 3), unilateral ovariectomy (1.2 %; n = 1), and unilateral salpingo-oophorectomy with unilateral salpingectomy (1.2 %; n = 1). The mean surgical time was 38.7 min (SD 17.9 min), with a mean blood loss of 26 mL (SD 42.4 mL). There was one (1.2 %) conversion to laparoscopy, and two (2.5 %) intra-operative complications without re-interventions. Most patients (88.8 %) were treated in a day-care setting. Four postoperative complications (4.9 %) were reported within six weeks after surgery.

This study shows that vNOTES is a safe and feasible, less invasive and scarless alternative to laparoscopic and open surgery for benign adnexal pathology. More evidence is needed to compare vNOTES adnexal surgery with laparoscopy.

vNOTES is a safe and feasible, less invasive alternative without abdominal scars compared to laparoscopic and open abdominal surgery for benign adnexal pathology.