Comparison of Transvaginal Natural Orifice Surgery (vNOTES) and Laparoscopic Tubal Ligation: Effects on Postoperative Pain, Sexual Functions, and Surgical Outcomes.
Mehmet Genco, Merve Genco, Feyza Azmak Çinaz, Semih Çinaz
{"title":"Comparison of Transvaginal Natural Orifice Surgery (vNOTES) and Laparoscopic Tubal Ligation: Effects on Postoperative Pain, Sexual Functions, and Surgical Outcomes.","authors":"Mehmet Genco, Merve Genco, Feyza Azmak Çinaz, Semih Çinaz","doi":"10.4293/JSLS.2025.00062","DOIUrl":null,"url":null,"abstract":"<p><strong>Introduction: </strong>Vaginal natural orifice transluminal endoscopic surgery (vNOTES) is a novel minimally invasive technique that eliminates the need for abdominal incisions. Compared to conventional laparoscopy (CL), vNOTES may offer reduced postoperative pain and faster recovery. While laparoscopy is the standard method for bilateral tubal ligation (BTL), limited comparative data exist regarding vNOTES for this indication.</p><p><strong>Aim: </strong>To compare postoperative outcomes, pain levels, and sexual function following BTL performed via vNOTES versus CL.</p><p><strong>Material and methods: </strong>This retrospective comparative study included 43 women who underwent elective BTL between September 2023 and December 2024 (vNOTES: n = 23; CL: n = 20). Pain was assessed using a visual analog scale (VAS) at 1, 6, and 24 hours postoperatively. Shoulder pain incidence, intra-abdominal pressure, need for intraoperative opioids, and 6-item Female Sexual Function Index (FSFI-6) scores were also evaluated. Operative time, blood loss, and length of hospital stay were recorded.</p><p><strong>Results: </strong>All procedures were completed without major complications. VAS pain scores at all measured time points were significantly lower in the vNOTES group (<i>P</i> < .05). Shoulder pain occurred in 15% of vNOTES cases versus 85% in the CL group (<i>P</i> < .001). Intra-abdominal pressure and intraoperative opioid requirements were significantly lower in the vNOTES group (<i>P</i> < .05). No significant differences were observed between groups in sexual function scores, operative time, blood loss, or hospital stay (<i>P</i> > .05).</p><p><strong>Conclusions: </strong>vNOTES is a safe and effective alternative to CL for female sterilization. It offers significant benefits in terms of reduced early postoperative and shoulder pain, without negatively affecting sexual function or surgical safety. These findings highlight the potential advantages of vNOTES as a minimally invasive technique in gynecologic surgery.</p>","PeriodicalId":17679,"journal":{"name":"JSLS : Journal of the Society of Laparoendoscopic Surgeons","volume":"29 3","pages":""},"PeriodicalIF":1.8000,"publicationDate":"2025-07-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC12479056/pdf/","citationCount":"0","resultStr":null,"platform":"Semanticscholar","paperid":null,"PeriodicalName":"JSLS : Journal of the Society of Laparoendoscopic Surgeons","FirstCategoryId":"3","ListUrlMain":"https://doi.org/10.4293/JSLS.2025.00062","RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":null,"EPubDate":"2025/9/24 0:00:00","PubModel":"Epub","JCR":"Q3","JCRName":"SURGERY","Score":null,"Total":0}
引用次数: 0
Abstract
Introduction: Vaginal natural orifice transluminal endoscopic surgery (vNOTES) is a novel minimally invasive technique that eliminates the need for abdominal incisions. Compared to conventional laparoscopy (CL), vNOTES may offer reduced postoperative pain and faster recovery. While laparoscopy is the standard method for bilateral tubal ligation (BTL), limited comparative data exist regarding vNOTES for this indication.
Aim: To compare postoperative outcomes, pain levels, and sexual function following BTL performed via vNOTES versus CL.
Material and methods: This retrospective comparative study included 43 women who underwent elective BTL between September 2023 and December 2024 (vNOTES: n = 23; CL: n = 20). Pain was assessed using a visual analog scale (VAS) at 1, 6, and 24 hours postoperatively. Shoulder pain incidence, intra-abdominal pressure, need for intraoperative opioids, and 6-item Female Sexual Function Index (FSFI-6) scores were also evaluated. Operative time, blood loss, and length of hospital stay were recorded.
Results: All procedures were completed without major complications. VAS pain scores at all measured time points were significantly lower in the vNOTES group (P < .05). Shoulder pain occurred in 15% of vNOTES cases versus 85% in the CL group (P < .001). Intra-abdominal pressure and intraoperative opioid requirements were significantly lower in the vNOTES group (P < .05). No significant differences were observed between groups in sexual function scores, operative time, blood loss, or hospital stay (P > .05).
Conclusions: vNOTES is a safe and effective alternative to CL for female sterilization. It offers significant benefits in terms of reduced early postoperative and shoulder pain, without negatively affecting sexual function or surgical safety. These findings highlight the potential advantages of vNOTES as a minimally invasive technique in gynecologic surgery.
阴道自然孔腔内窥镜手术（vNOTES）是一种新的微创技术，消除了对腹部切口的需要。与传统腹腔镜（CL）相比，vNOTES可以减少术后疼痛和更快的恢复。虽然腹腔镜是双侧输卵管结扎（BTL）的标准方法，但关于该指征的vNOTES的比较数据有限。目的：比较通过vNOTES和CL进行BTL的术后结果、疼痛水平和性功能。材料和方法：本回顾性比较研究包括43名在2023年9月至2024年12月期间接受选择性BTL治疗的女性（vNOTES: n = 23; CL: n = 20）。术后1、6、24小时采用视觉模拟评分（VAS）评估疼痛。同时评估肩痛发生率、腹内压、术中阿片类药物需求和6项女性性功能指数（FSFI-6）评分。记录手术时间、出血量和住院时间。结果：所有手术均顺利完成，无重大并发症。vNOTES组各测量时间点VAS疼痛评分均显著低于对照组（P < 0.05）。结论：vNOTES是一种安全、有效的替代CL的女性绝育方法。它在减少术后早期和肩部疼痛方面提供了显著的好处，而不会对性功能或手术安全性产生负面影响。这些发现突出了vNOTES作为妇科手术微创技术的潜在优势。
期刊介绍：
JSLS, Journal of the Society of Laparoscopic & Robotic Surgeons publishes original scientific articles on basic science and technical topics in all the fields involved with laparoscopic, robotic, and minimally invasive surgery. CRSLS, MIS Case Reports from SLS is dedicated to the publication of Case Reports in the field of minimally invasive surgery. The journals seek to advance our understandings and practice of minimally invasive, image-guided surgery by providing a forum for all relevant disciplines and by promoting the exchange of information and ideas across specialties.
求助内容：
应助结果提醒方式：
京公网安备 11010802042870号
