Repeat Vaginal Natural Orifice Transluminal Endoscopic Surgery: A First Feasibility Study

<b><i>Objectives:</i></b> Vaginal natural orifice transluminal endoscopic surgery (vNOTES) is an emerging minimally invasive technique in benign gynaecologic whereby surgical access to the peritoneal cavity achieved through orifices, namely a vaginal colpotomy. Experience repeat vNOTES cases limited and so far, have not been described literature. The purpose of this study was demonstrate feasibility hysterectomy women with history previous adnexal surgery. <b><i>Design:</i></b> We performed retrospective cohort first 11 our centre. All procedures, primary as well hysterectomy, were by one surgeon (J.B.). <b><i>Materials, Setting, Methods:</i></b> Between March 2016 May 2020, patients underwent after prior adnexectomy or cystectomy Imelda Hospital, Bonheiden, Belgium. Relevant patient characteristics outcome data collected written informed consent. <b><i>Results:</i></b> Median age 49 years (range 44–65) at moment procedure. Two had more caesarean sections history, 2 nulliparous. interval between procedure 15 months 0.8–37 months). vaginally assisted NOTES (VANH) Performing colpotomy entering technically feasible all cases. VANHs successfully performed. There 3 minor complications vNOTES, which anaesthesia-related. associated both cystitis. In these patients, there high post-void residues, easily managed bladder training. no conversions laparoscopy laparotomy, neither serious nor life-threatening complications. No ureteric, bladder, intestinal injuries occurred. <b><i>Limitations:</i></b> design small sample size are main limitations study. Moreover, follow-up period most recently operated too short draw conclusions on long-term outcomes, including sexual function. <b><i>Conclusions:</i></b> case series, Large-scale prospective trials needed evaluate safety multiple consecutive procedures 1 patient.