Transvaginal natural orifice endoscopic surgery for ovarian cystectomy: a more suitable surgical approach for the day-care procedure

Aijie Xie; Xin Li; Juan Huang; Hui Wang; Ying Liu; Lulu Wang; Jianmei Liao; Jie Yu; Ziru Yan; Jiajia Zhang; Liqiong Huang; Tianjiao Liu; Yalan Li; Yonghong Lin; Yujian Jia; Xiaoqin Gan

doi:10.3389/fmed.2023.1164970

Transvaginal natural orifice endoscopic surgery for ovarian cystectomy: a more suitable surgical approach for the day-care procedure

Front Med (Lausanne). 2023 May 18:10:1164970. doi: 10.3389/fmed.2023.1164970. eCollection 2023.

Authors

Aijie Xie^#^{1

2}, Xin Li^#¹, Juan Huang^#¹, Hui Wang¹, Ying Liu¹, Lulu Wang¹, Jianmei Liao¹, Jie Yu¹, Ziru Yan¹, Jiajia Zhang¹, Liqiong Huang³, Tianjiao Liu¹, Yalan Li^#⁴, Yonghong Lin¹, Yujian Jia¹, Xiaoqin Gan^{1

2}

Affiliations

¹ Chengdu Women's and Children's Central Hospital, School of Medicine, University of Electronic Science and Technology of China, Chengdu, China.
² School of Medicine, University of Electronic Science and Technology of China, Chengdu, China.
³ Department of Gynaecology and Obstetrics, Shanghai Tongren Hospital, Shanghai Jiaotong University School of Medicine, Shanghai, China.
⁴ Psychosomatic Medical Center, The Fourth People's Hospital of Chengdu, Chengdu, China.

^# Contributed equally.

Abstract

Introduction: Although previous studies have shown that vaginal natural orifice transluminal endoscopic surgery (vNOTES) has the advantages of causing less pain, faster recovery, and better concealment of surgical incisions, which aligns with the concept of the day-care procedure, this approach poses a greater risk of damaging adjacent organs (i. e., rectum and bladder) due to its anatomical specificity. Moreover, the day-care procedure may lead to relatively less preoperative evaluation and postoperative care. Hence, it is necessary to explore the safety and effectiveness of vNOTES for ovarian cystectomy in the day-care procedure, to provide a theoretical basis for the wider development of vNOTES surgery.

Materials and methods: This retrospective study included 131 patients at our hospital who underwent ovarian cystectomy from September 2021 to October 2022. Based on the surgical approach, patients were classified into transumbilical laparoendoscopic single-site surgery (LESS) and vNOTES groups. The patients' demographic characteristics and follow-up data were collected during the perioperative period and 1-month postoperatively.

Results: Vaginal natural orifice transluminal endoscopic surgery has less postoperative exhaust time, a lower postoperative 6-hour pain score, and a lower incidence of analgesic drug use, with higher surgical conversion incidence. Multiple linear regression analysis showed that the surgical conversion, chocolate cyst, bilateral cyst, and pelvic adhesion increased the operation duration by ~43 (95% CI: 10.309, 68.152, p < 0.001), 15 (95% CI: 6.342, 45.961, p = 0.036), 10 (95% CI: 3.07, 40.166, p = 0.019), and 8 (95% CI: 4.555, 26.779, p = 0.035) min, respectively. Interestingly, vNOTES decreased the operation duration by ~8.5 min (95% CI: -18.313, -2.699, p = 0.033).

Conclusion: Vaginal natural orifice transluminal endoscopic surgery was equally safe and effective for ovarian cystectomy compared to LESS. vNOTES aligned with the concept of the day-care procedure due to its reduced postoperative pain, shorter exhaust time, and absence of scarring. However, surgeons should conduct a comprehensive preoperative evaluation and exclude patients suspected to have severe pelvic adhesions.

Keywords: day-care procedure; ovarian cyst; ovarian cystectomy; transumbilical laparoendoscopic single-site surgery; transvaginal natural orifice endoscopic surgery.

Grants and funding

Financial support for this study was provided by Chengdu Science and Technology Bureau (Nos: 2021-YF0500530-SN and 2021-YF0500868-SN) and Chengdu Municipal Health Commission (No: 2021074). The funding agencies did not have any role in the design of the study, collection, analysis, and interpretation of data, and in writing the manuscript.