Transvaginal natural-orifice transluminal endoscopic surgery: a new approach to myomectomy

Background: Myomectomy, the surgical removal of uterine fibroids, has traditionally been performed through abdominal or laparoscopic approaches, each with its own set of advantages and limitations. The reasons for pursuing a myomectomy include alleviating symptoms like pelvic pain, heavy menstrual bleeding, and fertility issues. Various approaches exist for myomectomy, and one innovative technique is vNOTES. Aim of study: This study aimed to assess the efficacy of transvaginal natural-orifice transluminal endoscopic surgery (vNOTES) as a potential substitute for laparoscopic myomectomy. Subjects and methods: This prospective interventional study conducted at obstetrics & gynecology department of Minia University Hospital. Result: the mean Procedure time of studied patients was 62.27±6.02 min,mean bleeding volume was 68.7±11.6 ml, 5.7% of patients required a surgical conversion and there were no surgical injuries. there was significant association between procedure time,Myoma size (cm) and Surgical conversion while there was no significant association between procedure time Age,BMI and History of pelvic surgery. there was significant association between operative bleeding, Myoma size (cm), Surgical conversion and Operative time while there was no significant association between operative bleeding, Age, BMI and History of pelvic surgery. Conclusion: The present study provides valuable insights into the clinical and perioperative outcomes of patients undergoing vNOTES myomectomy. The findings indicate that the procedure is associated with favorable surgical and postoperative outcomes. The average patient age was 36.54 years with a mean BMI of 22.39 kg/m²,and the mean maximum diameter of the myoma was 5.1cm. A notable portion of patients (37.1%) had a history of pelvic surgery.