Ruptured Tubal Ectopic Pregnancy Managed by Salpingectomy: vNOTES versus Conventional Laparoscopy

Ruptured tubal ectopic pregnancy continues to pose a critical challenge in gynecologic emergencies. While conventional laparoscopy (CL) has long been the preferred operative method, transvaginal natural orifice transluminal endoscopic surgery (vNOTES) is increasingly recognized for its minimally invasive characteristics. However, comparative data between these techniques in acute cases remain scarce.

The present retrospective analysis reviewed women treated with salpingectomy for ruptured tubal ectopic pregnancy between Sep 2023 and Jan 2025. Twenty-four patients were evaluated, of whom 12 underwent vNOTES and 12 underwent CL. Baseline clinical and demographic features were similar across both groups. Perioperative and short-term postoperative outcomes were systematically analyzed.

The vNOTES technique demonstrated a significantly reduced operative time (30 ± 10 minutes) compared to CL (41 ± 14 minutes, p < 0.05). Insufflation pressure averaged lower in the vNOTES group (8 mmHg) than in the CL group (13 mmHg), with a statistically significant difference (p < 0.05), whereas hematocrit variations and postoperative opioid requirements remained comparable between the two methods. Pain evaluations at 1, 6, and 24 hours postsurgery indicated lower pain levels in the vNOTES cohort versus the CL cohort (p < 0.05). Shoulder tip discomfort was reported by 17% of vNOTES patients, in contrast to 83% of CL patients (p < 0.05). Hospital stay duration was markedly shorter for vNOTES recipients (36 ± 13 hours) compared to CL patients (55 ± 14 hours, p < 0.01). Pelvic drains were needed in 8 out of 12 CL cases, but none were required in the vNOTES group (p < 0.01). Neither group experienced intraoperative complications or required conversion to laparotomy. This single-center, retrospective study has limitations due to its small sample size (n = 24), limited generalizability, and reduced statistical power to detect rare complications.

In this cohort, vNOTES demonstrated shorter operative times, reduced insufflation pressures, and enhanced postoperative recovery compared with conventional laparoscopy. The results indicate that vNOTES could serve as a promising surgical alternative for selected patients presenting with ruptured ectopic pregnancy. Future multicenter investigations involving larger populations and extended follow-up periods-including assessments of fertility and quality of life-will be crucial to validate these findings.