Transvaginal Hybrid-NOTES procedures—do they have a negative impact on pregnancy and delivery?

Abstract

Purpose We conducted a retrospective observational study in order to identify negative effects of NOTES procedures (Natural Orifice Transluminal Endoscopic Surgery) with transvaginal specimen removal on pregnancy and delivery. Methods From the total population of 299 patients in our NOTES registry, we tried to contact the 121 patients who were of reproductive age (≤ 45 years) at the time of a transvaginal NOTES procedure. They were interviewed by telephone regarding their desire for children, post NOTES-operation pregnancies, and type of delivery using a structured questionnaire. The collected data was analyzed and compared with current data. Results We were able to contact 76 patients (follow-up rate: 62.8%) with a median follow-up of 77 months after surgery (33–129 months). Twenty of 74 participating patients had a desire for children (27.0%). One of them and another's male partner were diagnosed as infertile. Regarding the remaining 18 patients, 14 became pregnant, and three of them became pregnant twice. Considering these 17 pregnancies, there was one miscarriage (5.9%) and one twin birth (5.9%). On average, childbirth occurred 44 months after the NOTES procedure. With regard to the type of delivery, 10 vaginal births (58.8%) and 7 caesarean sections (41.2%) occurred. Thus, the rate of fulfilled desire for children was 77.8%. Compared with the literature, no difference to the normal course could be detected. Conclusion There is no sign that the transvaginal approach in Hybrid-NOTES, with removal of the specimen through the vagina, has a negative effect on conception, the course during pregnancy, or the type of delivery.

Repeated transvaginal natural orifice transluminal endoscopic surgery: An initial Chinese experience

“…19,20 Regarding the impact of vNOTES on childbirth, several cases of successful vaginal delivery among patients who underwent the first vNOTES, including ovarian cystectomy, tubal ligation, and myomectomy, have been reported, primarily revealing the relative safety of vNOTES concerning childbirth. 21,22 However, no evidence of the impact of repeated vNOTES on childbirth has been reported in the literature. Unfortunately, due to the relatively short postoperative follow-up period and small cohort size in our study, after the second vNOTES, none of the patients had delivered vaginally or via cesarean section.…”

“…Regarding the impact of vNOTES on childbirth, several cases of successful vaginal delivery among patients who underwent the first vNOTES, including ovarian cystectomy, tubal ligation, and myomectomy, have been reported, primarily revealing the relative safety of vNOTES concerning childbirth 21,22 . However, no evidence of the impact of repeated vNOTES on childbirth has been reported in the literature.…”

Safety and Feasibility of Vaginal Delivery in Full-Term Pregnancy After Transvaginal-Natural Orifice Transluminal Endoscopic Surgery: A Case Series

“…Therefore, we are concerned about the possible long-term effects of vNOTES on vaginal delivery in term pregnancies. It has been reported that full-term delivery can lead to rupture of the vaginal vault ( 13 ), but whether vNOTES will receive long-term benefits on vaginal delivery of full-term pregnancy and female sexual function has been less reported ( 14 , 15 ).…”

Women’s Perception of Transgastric and Transvaginal Natural Orifice Transluminal Endoscopic Surgery (NOTES) – Impact of Medical Education, Stage of Life and Cross-Cultural Aspects

“… 28 Regarding pregnancy, very recent data exist showing that future pregnancies are not affected by NOTES procedures. 29 …”

“…28 Regarding pregnancy, very recent data exist showing that future pregnancies are not affected by NOTES procedures. 29 Women less than 40 years are less likely to choose the transvaginal cholecystectomy. This connection between younger as well as nulliparous women and their cautious acceptance for transvaginal NOTES is also reported by other authors.…”