Vaginal natural orifice transluminal endoscopic surgery versus laparoscopic salpingectomy in the surgical management of tubal ectopic pregnancy: A systematic review and meta-analysis.
Ozan Karadeniz, Emre Kar, Mahjouba Soltani et al.
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In 30 seconds
This systematic review and meta-analysis compared vaginal natural orifice transluminal endoscopic surgery (vNOTES) with conventional or single-site laparoscopy for tubal ectopic pregnancy. Five studies included 550 women: 224 treated with vNOTES and 326 with laparoscopy. vNOTES was associated with lower postoperative analgesic requirements (OR 0.27; 95% CI 0.13-0.58; p < .001) and shorter hospital stay, although the reported p value for length of stay was .08. Conversion to laparoscopy was more frequent with vNOTES; other reported outcomes, including blood loss and postoperative pain scores, did not differ significantly.
Key findings
- Postoperative analgesic requirements were lower with vNOTES (OR 0.27; 95% CI 0.13-0.58; p < .001).
- Conversion was more frequent with vNOTES (OR 6.72; 95% CI 1.11-40.78; p = .04); 2.9 % of vNOTES cases converted to laparoscopy.
- Operative time showed a nonsignificant trend favoring vNOTES (MD, -10.08 min; 95 % CI, -22.03 to 1.86; p = .10).
- Estimated blood loss and postoperative VAS pain scores did not differ significantly between approaches.
Why it matters
The findings suggest vNOTES may offer some postoperative benefits while retaining a greater likelihood of conversion to laparoscopy. This balance is relevant when considering a transvaginal approach for tubal ectopic pregnancy. The evidence remains preliminary, and the review highlights the importance of surgical expertise and further research on patient selection and longer-term reproductive outcomes.
What to keep in mind
Only five studies were included. The review describes the evidence as preliminary and calls for high-quality prospective studies; long-term reproductive outcomes and training requirements remain unclear.