Vaginal Natural Orifice Transluminal Endoscopic Surgery for Treating Gynecologic Malignancies

Abstract

Background: Vaginal natural orifice transluminal endoscopic surgery (vNOTES) is a hybrid approach utilizing laparoscopy through the vagina. This approach has the advantages of excellent visualization and instrumentation provided by laparoscopy with the cosmesis, short recovery time, and diminished pain associated with transvaginal surgery. The application of vNOTES continues to expand with increasing experience using this tool. Almost all gynecologic procedures performed minimally invasively have been performed using vNOTES. This includes oncologic procedures that have been performed for endometrial cancer, ovarian cancer, cervical cancer, adnexal surgery, and risk-reducing surgery. Randomized trials with vNOTES are few to date due to the very new development of these techniques. Methods: This review covers the literature on procedures performed for gynecologic cancer by vNOTES. Conclusions: As more surgeons become familiar with this approach, studies will become available to compare v NOTES outcomes versus abdominal laparoscopy/robotics in terms of oncology outcomes, patient-symptom outcomes, complication rates, recovery times, and financial considerations. As has been seen with the explosive application of minimally invasive surgery and gynecologic oncology, vNOTES has the potential to be utilized for all gynecologic oncology procedures. (J GYNECOL SURG 40:111)