vNOTES versus laparoscopic chromopertubation for tubal factor and unexplained infertility: a comparative study

As vaginal natural orifice transluminal endoscopic surgery (vNOTES) is gaining momentum and consolidating its position in minimally invasive surgery for various benign gynecologic conditions, we aimed to evaluate the feasibility, acceptability, and safety of vNOTES chromopertubation compared to laparoscopic chromopertubation in women with suspected tubal factor or unexplained infertility.

Women who underwent vNOTES or laparoscopic chromopertubation between January 2022 and June 2024 were retrospectively studied. After applying exclusion criteria, 58 eligible patients were identified and analyzed. The primary outcomes were surgical complications, overall satisfaction with the procedure, and postoperative pain. Secondary outcomes included the duration of the procedure and participants' postoperative experience of sexual discomfort or pain during intercourse.

The basic preoperative demographic and clinical characteristics were comparable. No complications occurred in either surgical group (0/24 vs. 0/34). The duration of surgery (including additional interventions) and length of hospital stay were significantly shorter in the vNOTES CP group (p = 0.015 and 0.044, respectively). These differences were not observed when diagnostic-only cases were considered. The 6- and 12-h postoperative visual analogue scale (VAS) pain scores, as well as the total dose of non-narcotic analgesic used, were significantly lower in the vNOTES CP group (p = 0.004, <0.001, and 0.009, respectively). Changes in pre- and postoperative Female Sexual Function Index (FSFI) pain domain scores showed no statistically significant difference between the groups (p = 0.242). There were no differences in satisfaction with the method.

vNOTES chromopertubation appears to be an effective and feasible alternative to laparoscopy for chromopertubation, with greater operability in obese women, better esthetic outcomes, less postoperative pain, and a comparable impact on female sexual life. Larger, multicenter, prospective studies that also report subsequent fertility outcomes are needed to further quantify and determine the safety and broad applicability of vNOTES chromopertubation.