Gynecological natural orifice transluminal endoscopic surgeries from an anesthesiologist’s perspective: A retrospective cohort study

Abstract

Background/Aim: Natural orifice transluminal endoscopic surgical (NOTES) approach allows either transgastric or transvaginal access to the targeted organs by endoscopes without a skin incision. This study aimed to evaluate the intraoperative and postoperative outcomes of patients who underwent vaginally assisted NOTES (VaNOTES) for gynecological surgery. Methods: One hundred ten patients who underwent hysterectomy and/or bilateral salpingo-oophorectomy (BSO) under general anesthesia either with conventional laparoscopy (CL) or VaNOTES methods were examined. The data of the patients were obtained from the medical records retrospectively. Demographic data, perioperative hemodynamic data, Visual Analogue Scale (VAS) scores, and analgesic consumption at the 1st, 6th, and 24th postoperative hours were assessed. Results: Among all patients, the median duration of anesthesia, median operation time, and hospital stay were lower in the VaNOTES group compared to those in CL (P<0.001). The change in perioperative hemodynamic findings was similar in both patient groups. While the median VAS scores were lower in the VaNOTES group at the 6th and 24th postoperative hours in patients with BSO (P=0.024 and P=0.021), those of patients who underwent hysterectomy were lower at the 1st postoperative hour (P=0.002). However, the change in VAS scores was similar in both patient groups. In addition, no postoperative complications or mortality were observed in any of the groups. Conclusion: Application of NOTES technique in gynecological operations may contribute to the reduction of invasive procedures, shorten the duration of surgery and anesthesia, lower pain severity, and improve hospital stay postoperatively.