The feasibility of natural orifice transluminal endoscopic surgery in gynecology practice: Single-surgeon experience

Abstract

Objectives: Natural orifice transluminal endoscopic surgery (NOTES) has been performed in gynecology practice for the surgical treatment of ovarian cysts, uterine fibroids, ectopic pregnancies, adnexal masses, and pelvic organ prolapse. The aim of this study is to evaluate the intraoperative and postoperative outcomes of patients who underwent NOTES for gynecological diseases. Materials and Methods: This study was a retrospective clinical study. The data of 50 patients who had been treated via NOTES procedure for benign gynecological indications such as ectopic pregnancy, adnexal mass, uterine fibroid, and treatment-resistant heavy menstrual bleeding during the time period between January 2016 and 2019 were included. All procedures were performed by a single surgeon (C.K.) using a self-constructed glove port, and a sealing device in addition to conventional laparoscopic (CL) equipment. Descriptive analysis of the patients' data was performed. Results: The initial two of the adnexectomy procedures were performed via hybrid NOTES technic and four of them were performed via total vaginal NOTES technic. The remaining procedures, namely hysterectomies, adnexectomies, salpingectomies, and myomectomy were performed via vaginally assisted NOTES (VaNOTES) technic. The mean operation time for the hysterectomy ± bilateral salpingo-oophorectomy (BSO) and salpingo-oophorectomy patients was 85.25 min and 53.15 min, respectively. For those patients who underwent VaNOTES procedure, the median postoperative visual analog scale pain score at the 6 th h was six and at the 24 th h was two. The mean length of the hospital stay was 2.07 days in the hysterectomy ± BSO patients and 1.63 days in the salpingo-oophorectomy patients. Conclusion: The NOTES procedure is a feasible technic in regards to the duration of surgery, postoperative pain scores, and cosmetic outcomes.

Gynecological natural orifice transluminal endoscopic surgeries from an anesthesiologist’s perspective: A retrospective cohort study

“…The VAS scores at the 12 th and 24 th hours did not differ between groups, but the operation time and hospital stay were lower in the VaNOTES group [12]. The change in VAS scores in our study is similar to that reported by Kaya et al [4]. Santos et al [13] reported that only the closure of the vaginal cuff in VaNOTES caused this difference in VAS scores compared to the closure of 3-4 trocar accesses in the abdomen in conventional laparoscopy.…”

“…The largest hysterectomy series treated with VaNOTES in the literature was reported by Lee et al In this study, the average operative time was 88 minutes, and the mean hospital stay was 2.8 days [6]. In the study of Kaya et al [4] comparing the patients who underwent hysterectomy/BSO and adnexectomy with VaNOTES, the mean uterine weight, operation time, and hospital stay were 298 g, 85 minutes, and 2 days, respectively. To the best of our knowledge, our study is the second largest series in the literature, and similar findings were found in the VaNOTES protocol among hysterectomy patients.…”

“…From the viewpoint of anesthesiologists, this new technique provides benefit to respiratory functions perioperatively due to less intraabdominal pressure requirement, shortening of the operation time, decreased need of perioperative analgesia, and a lower angular Trendelenburg angle. In a randomized controlled trial, the results of the NOTES technique in patients undergoing hysterectomy were strong enough to be compared with total laparoscopic hysterectomy [4]. However, there is still limited information about the feasibility, intraoperative complication, postoperative pain scores, and duration of surgery of the VaNOTES procedure in gynecologic practice.…”

Surgical outcomes of transvaginal natural orifice transluminal endoscopy in treating ovarian cysts and risk factors for surgical conversions

“…The clinical feasibility of vNOTES was demonstrated in 2007 [ 5 ]. Since then, this minimally invasive surgical technique has been successfully performed for many gynecological pathologies, reportedly resulting in superior cosmetic outcomes and faster postoperative recovery compared to those obtained by TU-LESS, despite relatively restricted visualization and operative space [ [6] , [7] , [8] , [9] , [10] ]. However, because the literature regarding the outcomes of ovarian vNOTES is scant, and none of the existing studies have reported on sufficiently large cohorts [ 3 , 7 ], clinical evidence of its outcomes is lacking, and there are many concerns regarding the technical difficulty, safety, and feasibility of this procedure [ 11 ].…”

Transvaginal natural Orifical transluminal Endoscopy for sacrocolpopexy: A case series report

“…Laparoscopy initiated the era of minimally invasive surgery, while transvaginal natural orifice transluminal endoscopic surgery (V-NOTES) was a further step to the field. Nowadays, V-NOTES have been successfully applied in gynecological benign lesions, even malignant diseases [ [5] , [6] , [7] , [8] , [9] , [10] , [11] ] [ [5] , [6] , [7] , [8] , [9] , [10] , [11] ]. According to the recommendations of American College of Obstetricians and Gynecologists, V-NOTES should be performed “whenever is feasible” [ 12 ].…”