Transvaginal natural orifice endoscopic surgery for tubal ectopic pregnancy: A more suitable surgical approach for enhanced recovery after surgery

Ying Liu; Xin Li; Tianjiao Liu; Aijie Xie; Xian Wu; Yujian Jia; Xiaoyan Liao; Wei Cheng; Hui Wang; Fangyuan Zhong; Lijuan Xu; Juan Huang; Siqin Xiu; Zhongzhi Li; Yalan Li; Xue Xiao; Yonghong Lin; Xiaoqin Gan

doi:10.1016/j.heliyon.2024.e24945

Transvaginal natural orifice endoscopic surgery for tubal ectopic pregnancy: A more suitable surgical approach for enhanced recovery after surgery

Heliyon. 2024 Jan 20;10(2):e24945. doi: 10.1016/j.heliyon.2024.e24945. eCollection 2024 Jan 30.

Authors

Ying Liu¹, Xin Li¹, Tianjiao Liu¹, Aijie Xie¹, Xian Wu¹, Yujian Jia¹, Xiaoyan Liao¹, Wei Cheng¹, Hui Wang¹, Fangyuan Zhong¹, Lijuan Xu¹, Juan Huang¹, Siqin Xiu¹, Zhongzhi Li², Yalan Li³, Xue Xiao⁴, Yonghong Lin¹, Xiaoqin Gan¹

Affiliations

¹ Department of Gynecology and Obstetrics, Chengdu Women's and Children's Central Hospital, School of Medicine, University of Electronic Science and Technology of China, Chengdu, 611731, China.
² Department of Gynecology and Obstetrics, Chongqing University Fuling Hospital, Chongqing, 408099, China.
³ Psychiatry Department, Psychosomatic Medical Center, The Fourth People's Hospital of Chengdu, Chengdu, 610036, China.
⁴ Department of Gynecology and Obstetrics, West China Second University Hospital, Sichuan University, Chengdu, 610041, China.

Abstract

Objective: We aimed to determine the safety of Vaginal natural orifice transluminal endoscopic surgery (vNOTES) in terms of the Enhanced Recovery after Surgery (ERAS) concept for tubal pregnancy surgery and provide a detailed process of vNOTES for tubal pregnancy surgery, including experience and key points for surgeons performing this procedure.

Methods: The Longitudinal Vaginal Natural Orifice Transluminal Endoscopic Surgery Study (LovNOTESS), which was conducted in Chengdu, China. A total of 219 patients who underwent tubal ectopic pregnancy surgery between September 2021 and March 2022. The patients underwent salpingectomy or salpingostomy using transumbilical laparoendoscopic single-site surgery (LESS) or vNOTES, according to their preferences. This study prospectively collected perioperative and one-year follow-up data on tubal pregnancy outcomes after vNOTES and compared them with those after LESS.

Results: The vNOTES group showed a shorter surgical duration, hospitalization duration, and postoperative exhaust time and a lower analgesic medication usage rate, but it showed a higher surgical conversion rate. The vNOTES approach reduced the postoperative exhaust time by approximately 9 h (95% confidence interval [CI]: -11.93, -5.57 h, p < .001) and the risk of postoperative analgesic drug use by 77% (odds ratio, 0.23; 95% CI: 0.10, 0.61, p = .023).

Conclusion: vNOTES can shorten the exhaust time and duration of hospitalization, reduce postoperative pain, and avoid surface surgical scars in tubal pregnancy surgeries, consistent with the ERAS concept. However, more comprehensive preoperative evaluation of patients who choose vNOTES is required to reduce the occurrence of intraoperative conversion.Trial registration: ChiCTR2100053483.

Keywords: Enhanced recovery after surgery; Laparoendoscopic; Salpingectomy; Salpingostomy; Transvaginal natural orifice endoscopic surgery; Tubal pregnancy.