vNOTES Salpingectomy for Ectopic Pregnancy – the Future of Endoscopic Surgery? A Case Series of Nine Patients

 

Introduction and Objectives

Vaginal Natural Orifice Transluminal Endoscopic Surgery (vNOTES) is an emerging minimally invasive technique utilising endoscopic instruments to perform surgical procedures through a posterior colpotomy incision. This technique obviates the need for abdominal trocar insertions and is associated with reduced morbidity, improved cosmesis and decreased length of stay compared to conventional laparoscopic surgery. This case series set out to evaluate the the safety, patient acceptability and surgical outcomes of vNOTES in the management of both ruptured and un-ruptured ectopic pregnancies.

 

Design and Methodology

Observational case series of emergency adnexal surgery in nine patients with ectopic pregnancies by a surgeon from a single centre. Nine women aged 25 to 37 underwent vNOTES salpingectomy. Ectopic size, ectopic rupture status, estimated blood loss, operative duration and post-operative stay were recorded both retro- and prospectively into a database from patient records. Patient acceptability was assessed in the post-operative period via direct patient questioning.

 

Conclusion

vNOTES salpingectomy is an acceptable, safe and potentially time and cost effective approach to the management of ectopic pregnancy. This case series demonstrates the suitability for ectopics of varying size and rupture status. The improved recovery time and cosmesis make this route an attractive option to patients and increased training, expertise and research is needed to enable widespread practice and feasibility.