Early experience with the gasless vNOTES technique for adnexal surgery.

Abstract

Introduction: This study evaluates the feasibility, safety, and outcomes of gasless vNOTES (vaginal Natural Orifice Transluminal Endoscopic Surgery) for benign adnexal surgeries.

Materials and methods: This was an observational, retrospective study performed in two centers with over 3 years of experience in vNOTES: the University Hospital Center of Nice (France) and Kantys Private Hospital Center (Nice, France). Gasless vNOTES adnexal surgery was performed without the use of pneumoperitoneum or abdominal parietal material. Procedures followed a standardized technique using a posterior colpotomy, the placement of a mesh to push the bowels, and a transvaginal access platform.

Results: Fifty patients underwent gasless vNOTES adnexal surgery between December 18, 2023, and April 17, 2024. The median age of patients was 40.4 ± 9.7 years, with a median body mass index (BMI) of 22.4 (range 17.6-42.0). Thirteen patients (26.0%) had a history of abdominal or pelvic surgery. The most common procedure was bilateral salpingectomy (60.0%). The median and mean durations for all procedures were 21 min (range 15-60) and 27.4 min (SD ± 10.8), respectively. No postoperative bleeding complications were noted, but one patient developed an abscess requiring surgical intervention. Pain scores were low, with only one patient reporting pain (10/100 on the visual analog scale) 6 h post-surgery. Ninety percent of patients were managed in an ambulatory setting, with a median time to first stand-up of 4 h and 7 min.

Conclusion: Gasless vNOTES adnexal surgery is a feasible and safe technique for surgeons experienced in vNOTES. It offers the potential for reduced postoperative pain and analgesic requirements without increasing operating time or complication rates, making it a viable alternative to conventional pneumoperitoneum-assisted vNOTES. Further prospective studies are needed to confirm these findings and evaluate long-term outcomes.