Vaginal NOTES adnexal surgery: Results of a retrospective cohort study in The Netherlands

Objective: Vaginal natural orifice transluminal endoscopy (vNOTES) is a minimally invasive technique gaining popularity for several gynaecological procedures. This study presents the first 81 adnexal cases, performed in The Netherlands. Design, setting, participants, and intervention: This retrospective cohort study included patients who underwent vNOTES adnexal surgery for benign indications at Zuyderland Medical Centre between March 2020 and August 2024. Baseline characteristics, surgical outcomes, and per-and postoperative outcomes were analysed. Two expert vaginal and endoscopic gynaecological surgeons performed all procedures. Results: A total of 81 patients underwent adnexal surgery using vNOTES. Indications were definitive contraception (60.5 %; n = 49), ovarian cysts (18.5 %; n = 15), risk-reducing surgery for gene mutation carriers (16.0 %; n = 13), ectopic pregnancy (3.7 %; n = 3), and request for artificial menopause due to complaints (1.2 %; n = 1). Procedures performed were bilateral salpingectomy (60.5 %; n = 49), bilateral salpingooophorectomy (28.4 %; n = 23), unilateral salpingo-oophorectomy (4.9 %; n = 4), unilateral salpingectomy (3.7 %; n = 3), unilateral ovariectomy (1.2 %; n = 1), and unilateral salpingo-oophorectomy with unilateral salpingectomy (1.2 %; n = 1). The mean surgical time was 38.7 min (SD 17.9 min), with a mean blood loss of 26 mL (SD 42.4 mL). There was one (1.2 %) conversion to laparoscopy, and two (2.5 %) intra-operative complications without re-interventions. Most patients (88.8 %) were treated in a day-care setting. Four postoperative complications (4.9 %) were reported within six weeks after surgery. Conclusion: This study shows that vNOTES is a safe and feasible, less invasive and scarless alternative to laparoscopic and open surgery for benign adnexal pathology. More evidence is needed to compare vNOTES adnexal surgery with laparoscopy. Summation: vNOTES is a safe and feasible, less invasive alternative without abdominal scars compared to laparoscopic and open abdominal surgery for benign adnexal pathology.