Transvaginal natural orifice transluminal endoscopic surgery for ectopic pregnancy

Abstract

Aims: This study aims to describe our transvaginal natural orifice transluminal endoscopic surgery (vNOTES) technique for ectopic pregnancy that can be performed using conventional laparoscopic equipment with the addition of a self-constructed pessary port and to evaluate the safety, feasibility, and outcomes of the technique. Methods: This is a retrospective study evaluating outcomes of patients who underwent vNOTES for ectopic pregnancy (n = 21) between August 2019 and April 2021.Results: Twenty-one patients underwent vNOTES as intended without any intraoperative complications. Three patients (14.3%) were nulliparous, 16 patients (76.2%) had no history of vaginal delivery, and 13 patients (61.9%) had a history of at least one cesarean delivery. Eight patients (38.1%) had a history of previous abdominal surgery other than cesarean section. The mean duration of surgery was 43.4 AE 12.6 min. The mean visual analog scale scores for pain were 2.45 AE 1.13 at 2 h after surgery, 0.45 AE 0.83 at 12 h after surgery, and 0.18 AE 0.36 at 24 h after surgery. The median duration of postoperative hospital stay was 1 day (range, 1-2). There were no postoperative complications within 30 days after surgery. Conclusions: vNOTES can be performed in an existing laparoscopy setup with the addition of a selfconstructed pessary port. vNOTES is a safe and effective surgical treatment option for ectopic pregnancy, even in patients who have not had a vaginal delivery and have had multiple abdominal surgeries.

Enabling Technologies for Gynecologic Vaginal Surgery

“…Of these, 39 were excluded because they did not meet eligibility criteria. Thus, 116 studies were included in the final analysis, 11,23–137 including 15 RCTs, 17 nonrandomized comparative studies, and 84 single-group studies (Fig. 1).…”

“…Fifty-six studies (n=4,773) evaluated nonrobotic vaginal natural orifice transluminal endoscopic surgery for different surgical procedures, including three comparative studies (all retrospective nonrandomized comparative studies) 55,56,99 and 53 single-group studies, 11,58–99,101–109 with insufficient data for meta-analysis (Appendices 3 and 11–15, available online at http://links.lww.com/AOG/D576). Two comparative studies (two nonrandomized comparative studies) 56,57 and 28 single-arm studies 11,57–83 (n=1,801) evaluated vaginal natural orifice transluminal endoscopic surgery technology for vaginal hysterectomy (Appendix 11, http://links.lww.com/AOG/D576).…”

“…Fifteen single-arm studies (total n=921) evaluated ovarian cystectomy, 84–89 salpingo-oophorectomy, 89–94 and salpingectomy for ectopic pregnancy 95–97 or sterilization, 98 with number of study participants ranging from 10 92 to 125 87 (Appendix 12, http://links.lww.com/AOG/D576). One study (n=10) evaluated vaginal natural orifice transluminal endoscopic surgery adnexectomy after traditional vaginal hysterectomy using only a self-retaining retractor and gasless abdominal lift technique, 92 and another (n=45) evaluated vaginal natural orifice transluminal endoscopic surgery BSO after traditional vaginal hysterectomy using a self-constructed ring pessary and surgical glove port.…”

Analysis and suggestions on the complications in 2000 cases of transvaginal natural orifice transluminal endoscopic surgery: Can it be a conventional surgery?

“…Most current reports are limited to a specific procedure such as hysterectomy, making it difficult to identify common problems associated with vNOTES. [20][21][22][23] As vNOTES is a recently developed surgical approach, data from previous studies are relatively limited, and large-sample studies are lacking. [24][25][26][27] Therefore, the present study aimed to fully and objectively reflect on the complications of vNOTES, identify the corresponding risk factors, and provide caution to surgeons when performing these novel surgeries.…”

“…Moreover, the possibility of underreporting complications cannot be denied when a researcher evaluates his own surgical technique. Most current reports are limited to a specific procedure such as hysterectomy, making it difficult to identify common problems associated with vNOTES 20–23 . As vNOTES is a recently developed surgical approach, data from previous studies are relatively limited, and large‐sample studies are lacking 24–27 .…”