Endoscopy 2008; 40(7): 576-580
DOI: 10.1055/s-2008-1077379
Original article

© Georg Thieme Verlag KG Stuttgart · New York

How do gynecologists feel about transvaginal NOTES surgery?

F.  Thele1 , M.  Zygmunt1 , A.  Glitsch2 , C.-D.  Heidecke2 , A.  Schreiber2
  • 1Department of Gynecology and Obstetrics, Greifswald University Hospital, Ernst-Moritz-Arndt University of Greifswald, Germany
  • 2Department of Surgery, Greifswald University Hospital, Ernst-Moritz-Arndt University of Greifswald, Germany
Further Information

Publication History

submitted 9 April 2008

accepted after revision 28 May 2008

Publication Date:
07 July 2008 (online)

Background: Natural-orifice transluminal endoscopic surgery (NOTES) is regarded as safer and less invasive than laparoscopic surgery. However, there has been no documentation of the opinions of surgically active, experienced gynecologists about the indications, contraindications, risks, and complications of transvaginal access.

Methods: A two-page questionnaire was distributed to the heads of the gynecological departments at 181 university and major teaching hospitals across Germany, Austria, and Switzerland. Fifty-two questionnaires (28.7 %) were returned and evaluated. The questionnaire contained ten questions, four of which were yes/no questions and another five of which allowed between four and seven answers. The questionnaire contained one additional open question.

Results: Of the respondents, 69.2 % classified transvaginal access for extrapelvic abdominal surgery as ethical; the remaining 30.8 % described it as experimental. Only 28.8 % would recommend NOTES to their patients if NOTES presented the same surgical risks as the laparoscopic approach. When asked about NOTES-associated complications, 73.1 % mentioned the risk of infection, 61.5 % visceral lesions, 44.2 % infertility, and 34.6 % adhesions. In terms of long-term problems, gynecologists are concerned about dyspareunia and infertility. Adopting their patients’ point of view, 17.3 % voted the lack of scarring compared to laparoscopy as important and 57.6 % as unimportant.

Conclusions: While transvaginal NOTES is argued to be a promising access for scarless surgery, gynecologists mention postoperative infection, visceral lesions, infertility, and adhesions as conceivable complications. Since long-term experience has not yet been achieved, potential problems such as dyspareunia, infertility, and the spread of pre-existing endometriosis remain definitely conceivable complications.

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C.-D. Heidecke, MD

Department of Surgery
Greifswald University Hospital
Ernst-Moritz-Arndt University of Greifswald

Friedrich-Loeffler-St. 23b
17475 Greifswald
Germany

Fax: +49-3834-866002

Email: heidecke@uni-greifswald.de