Natural orifice transluminal endoscopic surgery (NOTES) is a challenging minimally invasive procedure where ‘scarless’ abdominal surgeries are performed through an endoscope inserted through a natural orifice (mouth, anus, vagina, and urethra) and is considered as a less invasive approach to laparoscopic surgeries.
NOTES is considered a logical next step in the evolution of minimal invasive surgery, and the first NOTES procedure in humans is often considered to be a transgastric appendectomy performed in India in 2006 which was presented but not reported in manuscript form.
vNOTES is a natural orifice surgery performed through the vaginal route. A look into history reveals that gynecologists have been performing colpotomies for years, adding their valuable experience towards NOTES surgeries and subsequent closure.
A recently published paper in July issue of Fertility and Sterility have demonstrated a new technique of performing tubal reanastomosis via the vaginal route. The step-by-step procedure is explained in the accompanying video, using the surgical case of a 42-year-old female G2P2 with a history of tubal ligation 11 years before, who requested a tubal reanastomosis.
A three-dimensional sonohystogram at 8 weeks postop showed bilateral patency of both the fallopian tubes.
The current method of performing tubal reanastomosis involves a minimal invasive surgery with end-to-end anastomosis with a 60% to 90% success rate of post-operative intrauterine pregnancy.
A recent systematic review comparing laparotomy vs laparoscopy vs robotic mode of surgery showed that laparotomy had the worst outlook.
NOTES have the advantage of a fast recovery, no abdominal incision, and an extremely cosmetic outcome. With prophylactic antibiotic, the current rate of pelvic infection with NOTES is a 0%–3.1%.
In the hands of a skilled minimally invasive surgeon, vNOTES offers an alternate route for tubal surgery.
Here is a video showing the stepwise surgical procedure
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