Transvaginal Natural Orifice Transluminal Endoscopic Surgery (vNOTES) in Urogynecological Surgery: A Systematic Review

Overview

Journal J Clin Med

Specialty General Medicine

Date 2024 Oct 16

PMID 39407766

Authors

Lorenzo Vacca

Eleonora Rosato

Riccardo Lombardo

Paolo Geretto

Simone Albisinni

Riccardo Campi

Sabrina De Cillis

Laura Pelizzari

Maria Lucia Gallo

Gianluca Sampogna

Andrea Lombisani

Giuseppe Campagna

Alessandro Giammo

Vincenzo Li Marzi

Cosimo De Nunzio

Young Research Group Of The Italian Society Of Urodynamics

Affiliations

Soon will be listed here.

Abstract

Minimally invasive surgery could improve cosmetic outcomes and reduce the risks of surgical injury with less postoperative pain and a quicker patient's discharge. Recently, transvaginal natural orifice transluminal endoscopic surgery (vNOTES) has been introduced in urogynecology with exciting results. After PROSPERO registration (n°CRD42023406815), we performed a comprehensive literature search on Pubmed, Embase, and Cochrane CENTRAL, including peer-reviewed studies evaluating transvaginal natural orifice transluminal endoscopic surgery. No limits on time or type of study were applied. Overall, 12 manuscripts were included in the analysis. Seven studies evaluated uterosacral ligament suspension, four studies evaluated sacral colpopexy, three evaluated sacrospinous ligament suspension, and one study evaluated lateral suspension. Overall success rates were high (>90%); however, definitions of success were heterogeneous. In terms of complication, most of the studies reported low-grade complications (Clavien-Dindo I and II); only two patients needed mesh removal because of mesh exposure. The risk of bias of the trials was rated in the medium to high-risk category. The present review highlights important initial results for vNOTES. Future randomized clinical trials are needed to better define its role in the management of urogynecological procedures.

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