Diagnosing and Treating Infertility via Transvaginal Natural Orifice Transluminal Endoscopic Surgery versus Laparoendoscopic Single-Site Surgery: A Retrospective Study

Abstract

Objective: To evaluate the efficacy and safety of transvaginal natural orifice transluminal endoscopic surgery (vNOTES) in the treatment of female infertility. Materials and methods: This study includes 174 female patients with a history of long-standing female infertility. We retrospectively reviewed 41 patients who underwent hysterolaparoscopy (HL) via transvaginal natural orifice transluminal endoscopic surgery (vNOTES) and 133 patients who underwent laparoendoscopic single-site surgery (LESS). Demographic data, operation records, and pregnancy outcomes were collected and analyzed. The deadline for postoperative follow-up was June 2022. All the included patients were followed up for at least 18 months after surgery. Results: Compared with the LESS group, the vNOTES group had a shorter postoperative bowel movement time and less pain at 4 and 12 h (p = 0.004 vs. 0.008); no differences were found in other perioperative indicators. The clinical pregnancy rates of the vNOTES and LESS groups were 87.80% and 74.43% (p = 0.073), respectively. Conclusions: vNOTES represents a new, less invasive approach for infertility diagnosis and treatment that is particularly suitable for women who have special esthetic requirements. vNOTES is safe and practical and may be an ideal choice for scarless infertility surgery.

Sexual quality of life and postoperative deep dyspareunia after vNOTES benign adnexal procedures

“…vNOTES appears to be associated with reduced blood loss, shorter operative time, less postoperative pain, and better cosmetic results. [1][2][3] Despite these promising results, little is known about the impact of vNOTES adnexal surgery on women's sexual quality of life and the risk of developing postoperative dyspareunia. 4 During vNOTES adnexal procedures, access to the peritoneal cavity is achieved with an Alexis vaginal retractor inserted into the Douglas pouch through a posterior colpotomy.…”

“…Over the past few years, vNOTES has increasingly been used for adnexal procedures, generally showing better perioperative outcomes when compared to CL and LESS. vNOTES appears to be associated with reduced blood loss, shorter operative time, less postoperative pain, and better cosmetic results 1–3 . Despite these promising results, little is known about the impact of vNOTES adnexal surgery on women's sexual quality of life and the risk of developing postoperative dyspareunia 4 …”

Molecular Screening of the Thrombophilic Variants Performed at G-141 Laboratory among Saudi Infertile Women

“…Infertility is a human disease of the male and female reproductive systems, and according to the World Health Organization (WHO), infertility affects around 15% of couples of reproductive age [1]. The American Society for Reproductive Medicine defines infertility as being characterized by the inability to conceive after having unvarying and unguarded vaginal sex for a minimum of 365 days in a year [2], which affects around 48.5 million couples globally [3]; however, it varies by ethnic region and 8-12% is an estimation of the infertility among reproductive-aged couples [4]. Pelvic adhesions, endometriosis, ovulatory disorders, hyperprolactinemia and tubal anomalies are considered the female factors and account for 35% of infertility cases, while male factors are responsible for 30% and 20% is based on a combination of factors from both the genders.…”

Minimally invasive approach is preferred for clinical stage 1 endometrioid-type endometrial cancer

“…In recent years, minimally invasive surgery (MIS) has become one of the leading advanced therapeutic technology in the management of patients with various types of benign diseases, not only due to successful transformation of the treatment landscape but also clear demonstration of many advantages, such as small wound, better cosmetics, less wound pain, sooner recovery, and easy fulfillments of enhanced recovery after surgery (ERAS) programs compared to conventional exploratory laparotomic approach. 1–6 However, for the management of patients with malignant tumors, there are many debated issues and controversies, although many studies have confirmed that MIS can be successfully in place of traditional exploratory laparotomy in the management of many kinds of malignancies, based on the validated effectiveness and safety of MIS. 7–12 Among the aforementioned cancers, the gynecological organ-related cancers may be one of highly debated issues, because the preferred surgical therapy for endometrioid-type endometrial cancer (E-EC) is an MIS (laparoscopic surgery or robotic surgery) and the choice of treatment for epithelial ovarian cancer (EOC) is a standard midline incision-based exploratory laparotomy.…”