Minimally invasive surgery has become the preferred approach for benign ovarian cysts, with conventional laparoscopic ovarian cystectomy long considered the standard of care. Vaginal natural orifice transluminal endoscopic surgery (vNOTES) is a developing technique that uses a transvaginal access route to permit endoscopic procedures without abdominal incisions, potentially offering scarless access, reduced postoperative discomfort, and improved cosmetic outcomes. Prior literature has described vNOTES for adnexal disease and other gynecologic procedures, but direct comparative data focused on early postoperative pain and patient satisfaction for ovarian cystectomy remain limited.
The investigators aimed to evaluate and compare postoperative pain scores, patient satisfaction, and selected surgical outcomes between vNOTES and conventional laparoscopy for ovarian cystectomy. This was framed as a prospective quasi-randomized pilot study to assess feasibility and generate data to inform larger trials.
This prospective quasi-randomized pilot study was conducted at the Minimal Access surgery unit of Ain Shams University Maternity hospitals. The trial enrolled 20 premenopausal women scheduled for ovarian cystectomy for benign pathology.
Participants were equally allocated into two groups: vNOTES (n = 10) and conventional laparoscopy (n = 10). The report focuses on feasibility metrics (procedure completion and conversions), operative time, early postoperative pain measured by visual analogue scale (VAS) at set time points, and patient satisfaction. Specific inclusion and exclusion criteria, randomization method details, perioperative analgesic protocols, and longer-term outcomes were not reported in the abstract.
Completion and conversion rates: vNOTES was completed successfully in 80% of attempted cases. One vNOTES procedure required conversion because of adhesions. The laparoscopic approach had a 90% completion rate.
Operative time: Mean operative time in the vNOTES group was 85.6 ± 38.4 minutes versus 103.7 ± 31.6 minutes in the laparoscopy group. The observed difference in operative time did not reach statistical significance (p = 0.26), as reported by the authors.
Postoperative pain: Early postoperative pain measured by VAS at 6 hours and 24 hours was lower in the vNOTES group. Reported median or mean VAS values in the abstract were 6.0 at 6 hours and 3.0 at 24 hours for vNOTES, compared with 6.7 at 6 hours and 3.7 at 24 hours for laparoscopy.
Patient satisfaction: Patient satisfaction scores were reported as significantly higher in the vNOTES group compared with conventional laparoscopy. The abstract does not provide the exact satisfaction scoring instrument or numerical values.
Safety and adverse events: The abstract identifies a conversion in the vNOTES arm due to adhesions but does not list other intraoperative or postoperative complications, estimated blood loss, length of hospital stay, or readmissions.
In this small pilot series, vNOTES ovarian cystectomy demonstrated feasibility with an 80% completion rate and one conversion attributable to adhesions. The shorter mean operative time observed with vNOTES did not achieve statistical significance, and variability in times was notable given the reported standard deviations.
Early postoperative pain appeared lower after vNOTES at both measured time points (6 and 24 hours), and patient-reported satisfaction was higher in the vNOTES group. These findings suggest potential patient-centered advantages for vNOTES, particularly in the immediate postoperative period. However, the abstract lacks granular details about analgesic regimens, blinding, the pain assessment method beyond VAS values, and whether differences in pain were clinically meaningful as opposed to statistically different.
The pilot nature and small sample size (n = 20) limit generalizability and statistical power. Reporting did not include comprehensive perioperative outcome measures such as complications, blood loss, conversion reasons beyond the single adhesive case, length of stay, cosmesis assessment, or long-term follow-up.
The authors conclude that vNOTES ovarian cystectomy is a safe and feasible technique in this pilot cohort and is associated with reduced early postoperative pain and improved patient satisfaction compared with conventional laparoscopy. They recommend further evaluation of vNOTES in larger, adequately powered trials to confirm these early findings and to more fully characterize safety, reproducibility, and longer-term outcomes.
Clinicians and surgical teams considering vNOTES should weigh these preliminary patient-centered advantages against the limited sample size and the need for procedural expertise and patient selection criteria. The abstracted data support continued investigation but do not yet establish vNOTES as a definitive replacement for conventional laparoscopic ovarian cystectomy.
(Study indexed: Clin Ter. 2026 Sep-Oct;177(5):1001-1008. PMID: 42664117. DOI: 10.7417/CT.20262097.)