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

Abstract

Introduction Despite that NOTES produces at least matchable clinical long-term results when compared to laparoscopy, still a restraint within the medical community and among patients is evident. Consequently, it might be meaningful to evaluate factors of patient’s NOTES perception to promote its acceptance. NOTES is still quite novel and questionnaires regarding its perception by the public is still lacking even so in the Middle East. Aim of our survey is to investigate the viewpoint of female healthcare staff on NOTES. Materials and Methods A total of 350 questionnaires along with written information about Minimally Invasive Surgery and NOTES were distributed among the female staff in a Tertiary-care Hospital in Abu Dhabi, 257 were returned completely anonymously and voluntarily and entered into a database with a response rate of 73%. We surveyed factors like religion, medical background, age as well as history of previous laparoscopy, endoscopy, birth and other aspects that may impact a woman’s perception of both transgastric and transvaginal NOTES for cholecystectomy and ovariectomy, respectively. Results Univariate analyses revealed the majority of Muslim women to be more receptive to NOTES as a choice of surgical technique for cholecystectomy and for ovariectomy, respectively, when compared to Christians and Hindus. However, when compared to Muslims, Christian and Hindu groups had a larger share of medical professions. Women with a medical background would opt significantly less for NOTES. Among younger women, NOTES cholecystectomy was refused due to anxiety concerning future pregnancies and sexual dysfunction. Multinomial logistic regression analysis determined medical background and with independent predictive value for the overall choice of interventional technique (p<0.001). Marital status played a significant role only in the comparison of laparoscopy vs transgastric NOTES when performing cholecystectomy and ovariectomy (p<0.01). Conclusion In this first study emanating from the Middle East, medical education and partly life stage rather than cross-cultural differences seem to influence NOTES perception in women.

Laparoscopic-Assisted Transvaginal Cholecystectomy – the US Military Experience With Long-Term Follow Up

“…43 Patient concerns, including those of male partners, have primarily centered on uncertainty regarding the effect on future pregnancies and sexual function particularly among younger women. [44][45][46][47][48] Interestingly, patients with a medical education have been shown to be significantly less likely to choose NOTES procedures than those without. 44 In a survey of 600 resident and attending surgeons, 91.5% reported they would not choose a single-incision or NOTES procedure for themselves.…”

“…[44][45][46][47][48] Interestingly, patients with a medical education have been shown to be significantly less likely to choose NOTES procedures than those without. 44 In a survey of 600 resident and attending surgeons, 91.5% reported they would not choose a single-incision or NOTES procedure for themselves. 49 The primary patient concerns regarding sexual health and future pregnancies have been largely disproven in the literature.…”

The learning curve of laparoscopic single-site salpingectomy with conventional laparoscopic instruments: A retrospective cohort study

“…[ 16 ] However, some young patients may refuse this approach due to concerns about future pregnancy and sexual dysfunction. [ 17 ] Cihan Kaya et al [ 18 ] used conventional surgical equipment and added an additional 10 mm trocar 3 cm above the midline of the pubic symphysis to perform surgery for EP, achieving favorable outcomes. This technique less invasive and less costly but leaving postoperative abdominal scarring.…”