Consensus on safe implementation of vaginal natural orifice transluminal endoscopic surgery (vNOTES)

Transvaginal Natural Orifice Transluminal Endoscopic Surgery for Surgical Staging of Early-Stage Ovarian Cancers: A Report of Two Cases

“…To further reduce the morbidity and scarring related to transabdominal surgeries, ovarian cancer staging by vNOTES was recently introduced at our institution. Despite the limited number of comparative studies, the main advantages of vNOTES over conventional laparoscopy appear to be reduced blood loss, less postoperative pain, lower rate of wound site infection, absence of visible scars, and shorter hospitalization length ( 14 , 27 ). The transvaginal approach reduces surgical risks associated with (blind) transabdominal peritoneal cavity access, which is mostly important in multioperated patients (see Case 1).…”

“…In Case 2, a hybrid vNOTES approach allowed safe peritoneal cavity access and secure salpingo-oophorectomy, avoiding the risk of eventual tumor cell spilling. Since vNOTES can be realized with a low-pressure pneumoperitoneum and a steeper Trendelenburg position is rarely needed ( 18 , 27 , 28 ), a reduced impact on cardiovascular and respiratory functions during surgery is observed, making this technique suitable for elderly, obese, and other fragile patients. The main limitations of vNOTES are reduced instrument triangulation, restricted space for manipulations, and limited accessibility of some anatomical regions.…”

Is transvaginal natural orifice transluminal endoscopic surgery (vNOTES) indicated in patients with previous extensive pelvic surgeries? A case report

“…However, patients with previous extensive pelvic surgeries may also present an increased risk of complications associated with transvaginal access. Specific conditions seem to contraindicate the use of vNOTES, such as rectovaginal endometriosis or pelvic radiotherapy [ 2 ], whereas it appears feasible in cases involving previous hysterectomy [ 4 ]. However, evidence is lacking on the feasibility of vNOTES in patients with previous extensive pelvic surgeries.…”

“…In recent years, vNOTES has been increasingly applied to perform a large number of gynecologic procedures, and knowledge concerning this surgical approach has improved considerably [ 1 ]. Compared with conventional laparoscopy, vNOTES appears to be associated with reduced blood loss, less postoperative pain, shorter hospitalization time, improved cosmetic results, and decreased postoperative morbidity [ [1] , [2] , [3] ]. Another interesting feature it offers is the ease and safety of access to the abdominal cavity, avoiding passage through the abdominal wall.…”

“…A consensus exists regarding some contraindications to vNOTES interventions, such as known rectovaginal endometriosis and a history of pelvic radiotherapy [ 2 ]. A history of pelvic surgery does not seem to represent a contraindication to vNOTES [ 4 ], but little is known about whether vNOTES is feasible in patients with previous highly adhesiogenic interventions such as extensive surgeries for gynecological cancers.…”