Genco Mehmet, Genco Merve, Azmak Çinaz Feyza, Çinaz Semih
Department of Obstetrics and Gynecology, Kayseri City Hospital, Kayseri, Türkiye. (Dr. Genco).
Department of Obstetrics and Gynecology, Kayseri State Hospital, Kayseri, Türkiye. (Dr. Genco).
JSLS. 2025 Jul-Sep;29(3). doi: 10.4293/JSLS.2025.00062. Epub 2025 Sep 24.
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.
To compare postoperative outcomes, pain levels, and sexual function following BTL performed via vNOTES versus CL.
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.
All procedures were completed without major complications. VAS pain scores at all measured time points were significantly lower in the vNOTES group ( < .05). Shoulder pain occurred in 15% of vNOTES cases versus 85% in the CL group ( < .001). Intra-abdominal pressure and intraoperative opioid requirements were significantly lower in the vNOTES group ( < .05). No significant differences were observed between groups in sexual function scores, operative time, blood loss, or hospital stay ( > .05).
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.
经阴道自然腔道内镜手术（vNOTES）是一种新型的微创技术，无需腹部切口。与传统腹腔镜手术（CL）相比，vNOTES可能会减轻术后疼痛并加快恢复速度。虽然腹腔镜手术是双侧输卵管结扎（BTL）的标准方法，但关于vNOTES用于该适应症的比较数据有限。
比较经vNOTES与CL进行BTL后的术后结果、疼痛程度和性功能。
这项回顾性比较研究纳入了2023年9月至2024年12月期间接受择期BTL的43名女性（vNOTES组：n = 23；CL组：n = 20）。术后1小时、6小时和24小时使用视觉模拟量表（VAS）评估疼痛。还评估了肩部疼痛发生率、腹内压、术中使用阿片类药物的需求以及6项女性性功能指数（FSFI-6）评分。记录手术时间、失血量和住院时间。
所有手术均顺利完成，无重大并发症。vNOTES组在所有测量时间点的VAS疼痛评分均显著更低（P <.05）。vNOTES组15%的病例出现肩部疼痛，而CL组为85%（P <.001）。vNOTES组的腹内压和术中阿片类药物需求量显著更低（P <.05）。两组在性功能评分、手术时间、失血量或住院时间方面未观察到显著差异（P >.05）。
vNOTES是CL用于女性绝育的一种安全有效的替代方法。它在减轻术后早期疼痛和肩部疼痛方面具有显著优势，且不负面影响性功能或手术安全性。这些发现凸显了vNOTES作为妇科手术微创技术的潜在优势。
