Outcomes and cost-effectiveness of vNOTES vs conventional laparoscopic ovarian cystectomy for ovarian teratoma (dermoid cysts): A comparison of two minimal access routes of surgery

Abstract

Objective

Laparoscopic ovarian cystectomy is the benchmark surgical treatment for ovarian teratoma but vNOTES is emerging as an alternative with avoidance of abdominal scars, less pain and more rapid recovery. This study aimed to compare outcome data and expenditure for two minimally invasive routes in the surgical management of ovarian teratoma.

Study design

Case control study of vNOTES vs laparoscopic ovarian cystectomy (n = 21 in each group).

Methods

Data collected included age, BMI, teratoma size, duration of surgery, estimated blood loss, length of stay and peri-operative complications. Expenditure for the procedures were calculated using unit costs verified with NHS England Cost Collection website.

Results

Mean age (38.42 vs 39.80 yrs), BMI (29.38 vs 27.90 kg/m³), parity (0.91 vs 1.20), EBL (110.10 vs 93.60 mL) and teratoma size (7.60 vs 7.20 cm) were statistically similar but vNOTES patients had shorter mean theatre duration (48.33 vs 92.10 mins), length of stay (3.94 vs 13.2 hrs) and VAS at 24 h (1.90 vs 4.00) with less requiring opioids (14.3 vs 33.3 %) (all p < 0.05). vNOTES patients returned to normal daily activity quicker (8.0 vs 20.0 days) and had less intra-peritoneal spillage (0 vs 33 %) (both p < 0.05). Expenditure for laparoscopic ovarian cystectomy is approximately 1.5 times that of vNOTES cases (£3303.76 vs £2147.76) due to longer theatre and recovery bed occupancy, need for additional assistant and use of endoscopic bags.

Conclusion

Shorter theatre duration and length of stay, better cosmesis, less pain and rapid recovery, allied with lower cost support the adoption of vNOTES as a viable option for minimally invasive adnexectomy for ovarian teratoma.