Antimicrobial prophylactic strategies in vNOTES: No consensus, but what do we know?

Area of Science:

• Gynecologic Surgery
• Minimally Invasive Surgery
• Infectious Disease Prophylaxis

Background:

• Vaginal natural orifice transluminal endoscopic surgery (vNOTES) is an emerging gynecologic surgical technique combining vaginal and laparoscopic approaches.
• Standardized guidelines for antibiotic prophylaxis in vNOTES procedures are currently lacking.
• Evaluating infection rates and current prophylactic practices is crucial for optimizing patient outcomes.

Purpose of the Study:

• To review and evaluate infection rates associated with vNOTES procedures.
• To assess current antibiotic prophylactic practices in vNOTES surgery.
• To provide recommendations for antibiotic prophylaxis in vNOTES.

Main Methods:

• A comprehensive literature search was performed in PubMed/MEDLINE and the Cochrane Library.
• Studies were categorized by procedure type: vNOTES hysterectomy, adnexal surgery, and other vNOTES procedures.
• Data extracted included infection rates, antimicrobial use, and patient demographics.

Main Results:

• Analysis of 9,173 vNOTES cases revealed low infection rates across various procedures, including hysterectomy, adnexal surgery, and others.
• Infection rates for vNOTES hysterectomy were generally lower than for non-vNOTES procedures.
• Antibiotic prophylaxis regimens were inconsistently reported, with first-generation cephalosporins or cephalosporin combinations being most common.

Conclusions:

• There is no established consensus on antibiotic prophylaxis for vNOTES procedures.
• Current evidence suggests vNOTES does not confer an increased risk of postoperative infections.
• Further prospective studies are needed to establish definitive prophylactic guidelines.