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

IF 1.7 Q3 OBSTETRICS & GYNECOLOGY

European Journal of Obstetrics and Gynecology and Reproductive Biology: X Pub Date : 2025-08-05 DOI:10.1016/j.eurox.2025.100422

Rebecca Henschen , Anouk J.M. Bus , Nicol A.C. Smeets , Marlies Y. Bongers , Martine M.L.H. Wassen

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引用次数: 0

Abstract

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 salpingo-oophorectomy (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.

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阴道附体手术：荷兰一项回顾性队列研究的结果

目的阴道自然孔腔内窥镜（vNOTES）是一种微创技术，在许多妇科手术中越来越受欢迎。本研究介绍了在荷兰进行的首批81例附件病例。设计、环境、参与者和干预本回顾性队列研究包括在2020年3月至2024年8月期间在Zuyderland医疗中心因良性适应症接受vNOTES附件手术的患者。分析基线特征、手术结果、术前和术后结果。两名专家阴道和内窥镜妇科外科医生进行了所有手术。结果81例患者采用vNOTES进行了附件手术。适应症为明确避孕(60.5 %；N = 49)，卵巢囊肿(18.5 %；N = 15)，基因突变携带者的降低风险手术(16.0 %；N = 13)，异位妊娠(3.7 %；N = 3)，因抱怨要求人工绝经(1.2 %；n = 1)。手术包括双侧输卵管切除术(60.5 %；N = 49)，双侧输卵管卵巢切除术(28.4 %；N = 23)，单侧输卵管卵巢切除术(4.9 %；N = 4)，单侧输卵管切除术(3.7 %；N = 3)，单侧卵巢切除术(1.2 %；N = 1)，单侧输卵管卵巢切除术合并单侧输卵管切除术(1.2 %；n = 1)。平均手术时间38.7 min (SD 17.9 min)，平均失血量26 mL （SD 42.4 mL）。有1例（1.2 %）转为腹腔镜检查，2例（2.5 %）术中并发症，无再次干预。大多数患者（88.8% %）在日托环境中接受治疗。术后6周内出现4例术后并发症（4.9 %）。结论vNOTES是一种安全可行、创伤小、无疤痕的替代腹腔镜和开放手术治疗良性附件病变的方法。比较vNOTES附件手术与腹腔镜手术需要更多的证据。总结：与腹腔镜和开腹手术相比，vnotes是一种安全可行、无腹部疤痕的微创手术。

本文章由计算机程序翻译，如有差异，请以英文原文为准。

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