A Case Control Study of vNOTES Versus Conventional Laparoscopic Salpingectomy for Ectopic Pregnancy

Study Objective: While the laparoscopic approach is the surgical treatment of choice for ectopic pregnancy, vaginal Natural Orifice Transluminal Endoscopic Surgery (vNOTES) is emerging as an alternative route with its good optical visibility and avoidance of abdominal incisions. The authors compare demographics and outcome data of vNOTES vs conventional laparoscopic (CL) salpingectomy for the surgical management of ectopic pregnancy. Design: Case-control study. Setting: A London University hospital. Patients: Women with ectopic pregnancy unsuitable for medical management who underwent surgical management. Intervention: Twenty-five cases of vNOTES vs 25 CL salpingectomy. Measurements and Main Results: The mean patient age (29.7 +/- 53 vs 31.4 +/- 6.7 days), parity (1.2 +/- 1.1 vs 1.6 +/- 2.1), body mass index (26.7 +/- 5.3 vs 27.2 +/- 5.4 kg/m(3)), gestation age (8.44 +/- 2.1 vs 7.3 +/- 1.7 weeks) and beta human chorionic gonadotrophin (beta hCG) levels (3725.4 +/- 3674.8 vs 4376.5 +/- 6493.4 IU/liter) were comparable (p >.05, t test) between patients having vNOTES vs CL salpingectomy. While estimated blood loss was similar (218.2 +/- 491.7 vs 173.5 +/- 138.7 mL) (p >.001), vNOTES patients had a statistically shorter duration of surgery (35.8 +/- 14.4 vs 75.8 +/- 19.7 mins) (p <.001, t test) and length of stay (median: 11.5 vs 19.7 hours) (U = 72, p <.05, Mann-Whitney U test). Less patients in the vNOTES group required postoperative opioids (9% vs 25%), and the median visual analog score (/10) for pain at 24 hours was significantly lower (2.0 vs 4.0) (U = 75, p <.05, Mann-Whitney U test). Patients from the vNOTES group were able to return to normal daily activity 11.3 days quicker (5.8 +/- 4.3 vs 17.1 +/- 8.2 days) (p <.05, t test). vNOTES cases cost approximately USD150 more due to the price of the commercial kits but this is offset by reduced intraoperative time, length of stay and need for postprocedure analgesia. Conclusion: Patients undergoing vNOTES have shorter intraoperative times and length of stays, less postoperative pain, and more rapid recovery, which help mitigate higher costs incurred by commercial kits. While the vNOTES approach for ectopic pregnancy appears safe and efficacious, more robust data from larger randomized studies are needed.