Vaginal Natural Orifice Transluminal Endoscopic Surgery Versus Laparoscopic Tubal Ligation for Interval Sterilization: A Retrospective Cohort Study

BACKGROUND: To compare the transvaginal natural orifice transluminal endoscopic surgery (vNOTES) approach versus conventional laparoscopy in bilateral tubal ligation for interval sterilization regarding perioperative outcomes, postoperative pain, and sexual function. METHODS: This retrospective cohort study at a tertiary center included 88 women who underwent elective tubal ligation between February 2024 and October 2025 (vNOTES: n = 39; laparoscopy: n = 49). Women aged 18-45 years seeking permanent contraception with American Society of Anesthesiologists (ASA) physical status classification ≤ 3 were included. Primary outcomes included operative time and estimated blood loss (assessed by hemoglobin/hematocrit changes). Secondary outcomes included length of hospital stay, postoperative pain assessed using a visual analog scale (VAS) at 6 and 24 h postoperatively, total amount of analgesic requirements and sexual function evaluated using the Female Sexual Function Index (FSFI) preoperatively and at 1 and 6 months postoperatively. Statistical analysis used t-test/Mann-Whitney U test and chi-square/Fisher's exact test (α = 0.05). RESULTS: Baseline characteristics were comparable between groups (vNOTES: n = 39; laparoscopy: n = 49). No significant differences were found in hemoglobin changes or operative time. vNOTES demonstrated significantly shorter hospital stay (14.90 ± 7.27 vs. 20.10 ± 3.96 h, p < 0.001), lower postoperative total amount of analgesic requirements (1.72 ± 0.76 vs. 4.88 ± 1.63 doses, p < 0.001), and reduced VAS pain scores at 6 and 24 h. No intraoperative conversions occurred. Complication rates were similar between groups (p > 0.999). FSFI scores showed no significant differences at baseline, 1, or 6 months postoperatively. CONCLUSION: vNOTES for tubal ligation offers significant advantages in postoperative pain reduction, decreased analgesic requirements, and shorter hospital stay while maintaining comparable operative times, safety, and sexual function outcomes.