Vaginal natural orifice transluminal endoscopic surgery versus laparoscopy for salpingo-oophorectomy and adnexectomy: A systematic review and meta-analysis
- 1Department of Obstetrics and Gynecology, King Abdulaziz University, Jeddah, Saudi Arabia
Abstract
Vaginal natural orifice transluminal endoscopic surgery (vNOTES) and laparoscopic surgeries have widely been utilized in gynecologic surgeries including adnexectomy and hysterectomy. The aim of conducting this comprehensive meta-analysis is to evaluate the peri- and post-operative safety and clinical efficacy of vNOTES versus laparoscopic surgeries for the indications of unilateral or bilateral salpingectomy, unilateral or bilateral salpingo-oophorectomy, oophorectomy, and adnexectomy with or without hysterectomies for gynecological pathologies. Five electronic databases (PubMed, ScienceDirect, Google Scholar, ERIC, and Cochrane CENTRAL) were searched for studies published from their inception till 28th March 2024, following the PRISMA guidelines. Mendeley Desktop 1.19.8 was used to evaluate and remove the duplicates. Inclusion criteria comprised of: (a) female patients; (b) vNOTES for salpingectomy/salpingo-oophorectomy/adnexectomy; (c) control group of laparoscopy; (d) outcomes like mean operation time, post-operative 24-h visual analogue scale (VAS) score, intra- and post-operative complications, estimated blood loss, length of stay (LOS) in hospital, hemoglobin level changes, conversion, and total post-operative analgesic usage; (d) randomized controlled trials (RCTs) and observational studies. The Newcastle-Ottawa Scale and Cochrane risk of bias tool 2.0 (ROB 2.0) were used to assess the quality of cohorts and RCTs respectively. Review Manager (Version 5.3) was utilized to perform statistical analysis. Mantel-Haenszel statistical tests were applied for dichotomous data keeping risk ratio (RR) as effect measure while inverse variance statistical method was selected and weighted mean difference (WMD) was used as the effect measure for continuous data. P < 0.05 was considered statistically significant. Forest plots were constructed to evaluate the pooled results. Confidence interval (CI) value was chosen at 95%. Higgins I2 statistics were applied to assess the heterogeneity among the studies. The included eight studies comprised of a total of 1203 patients (vNOTES: 542 patients; laparoscopy: 630 patients. Mean change in hemoglobin before and after the procedure was slightly higher in vNOTES (WMD: 0.10; 95% CI = 0.02, 0.17; P = 0.01). LOS was relatively shorter in vNOTES patients (WMD: −0.75; 95% CI = −1.09, −0.41; P < 0.0001). Mean operation time was 22 min shorter in vNOTES (WMD: −22.08; 95% CI = −33.64, −10.52; P = 0.0002). VAS pain scores were lesser in intense in vNOTES (WMD: −1.57; 95% CI = −2.92, −0.22; P = 0.02). No significant differences were observed between the two groups in terms of total post-operative analgesia (WMD: −3.57; 95% CI = −7.15, 0.00; P = 0.05), estimated blood loss (WMD: −18.00; 95% CI = −44.70, 8.70; P = 0.19), intra-operative complications (RR: 1.13; 95% CI = 0.17, 7.47; P = 0.90), post-operative complications (RR: 0.69; 95% CI = 0.32, 1.51; P = 0.35), and conversion to alternate surgeries (RR: 2.56; 95% CI = 0.41, 15.87; P = 0.31). In conclusion, vNOTES proved to be relatively superior than laparoscopic surgery in terms of efficacy. However, the two groups did not differ in terms of safety. Considering this, we declare vNOTES to be a superior alternative to currently available minimally invasive techniques.
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BibTeX
@article{khayat2026vaginal,
title = {{Vaginal natural orifice transluminal endoscopic surgery versus laparoscopy for salpingo-oophorectomy and adnexectomy: A systematic review and meta-analysis}},
author = {Suhaib Khayat and Mohammad Khojah},
journal = {Journal of family medicine and primary care},
year = {2026},
month = jul,
doi = {10.4103/jfmpc.jfmpc_2170_25},
url = {https://europepmc.org/article/PMC/PMC13722247},
note = {CC BY-NC-ND},
}
RIS
TY - JOUR
TI - Vaginal natural orifice transluminal endoscopic surgery versus laparoscopy for salpingo-oophorectomy and adnexectomy: A systematic review and meta-analysis
AU - Suhaib Khayat
AU - Mohammad Khojah
PY - 2026
DA - 2026/07/01
JO - Journal of family medicine and primary care
DO - 10.4103/jfmpc.jfmpc_2170_25
UR - https://europepmc.org/article/PMC/PMC13722247
AB - Vaginal natural orifice transluminal endoscopic surgery (vNOTES) and laparoscopic surgeries have widely been utilized in gynecologic surgeries including adnexectomy and hysterectomy. The aim of conducting this comprehensive meta-analysis is to evaluate the peri- and post-operative safety and clinical efficacy of vNOTES versus laparoscopic surgeries for the indications of unilateral or bilateral salpingectomy, unilateral or bilateral salpingo-oophorectomy, oophorectomy, and adnexectomy with or without hysterectomies for gynecological pathologies. Five electronic databases (PubMed, ScienceDirect, Google Scholar, ERIC, and Cochrane CENTRAL) were searched for studies published from their inception till 28th March 2024, following the PRISMA guidelines. Mendeley Desktop 1.19.8 was used to evaluate and remove the duplicates. Inclusion criteria comprised of: (a) female patients; (b) vNOTES for salpingectomy/salpingo-oophorectomy/adnexectomy; (c) control group of laparoscopy; (d) outcomes like mean operation time, post-operative 24-h visual analogue scale (VAS) score, intra- and post-operative complications, estimated blood loss, length of stay (LOS) in hospital, hemoglobin level changes, conversion, and total post-operative analgesic usage; (d) randomized controlled trials (RCTs) and observational studies. The Newcastle-Ottawa Scale and Cochrane risk of bias tool 2.0 (ROB 2.0) were used to assess the quality of cohorts and RCTs respectively. Review Manager (Version 5.3) was utilized to perform statistical analysis. Mantel-Haenszel statistical tests were applied for dichotomous data keeping risk ratio (RR) as effect measure while inverse variance statistical method was selected and weighted mean difference (WMD) was used as the effect measure for continuous data. P < 0.05 was considered statistically significant. Forest plots were constructed to evaluate the pooled results. Confidence interval (CI) value was chosen at 95%. Higgins I2 statistics were applied to assess the heterogeneity among the studies. The included eight studies comprised of a total of 1203 patients (vNOTES: 542 patients; laparoscopy: 630 patients. Mean change in hemoglobin before and after the procedure was slightly higher in vNOTES (WMD: 0.10; 95% CI = 0.02, 0.17; P = 0.01). LOS was relatively shorter in vNOTES patients (WMD: −0.75; 95% CI = −1.09, −0.41; P < 0.0001). Mean operation time was 22 min shorter in vNOTES (WMD: −22.08; 95% CI = −33.64, −10.52; P = 0.0002). VAS pain scores were lesser in intense in vNOTES (WMD: −1.57; 95% CI = −2.92, −0.22; P = 0.02). No significant differences were observed between the two groups in terms of total post-operative analgesia (WMD: −3.57; 95% CI = −7.15, 0.00; P = 0.05), estimated blood loss (WMD: −18.00; 95% CI = −44.70, 8.70; P = 0.19), intra-operative complications (RR: 1.13; 95% CI = 0.17, 7.47; P = 0.90), post-operative complications (RR: 0.69; 95% CI = 0.32, 1.51; P = 0.35), and conversion to alternate surgeries (RR: 2.56; 95% CI = 0.41, 15.87; P = 0.31). In conclusion, vNOTES proved to be relatively superior than laparoscopic surgery in terms of efficacy. However, the two groups did not differ in terms of safety. Considering this, we declare vNOTES to be a superior alternative to currently available minimally invasive techniques.
SN - 2249-4863
SN - 2278-7135
ER -