Transvaginal natural orifice transluminal endoscopic surgery for early-stage ovarian cancer and borderline ovarian tumors: a case series

Introduction Surgery is the cornerstone of ovarian cancer treatment. Transvaginal natural orifice transluminal endoscopic surgery (vNOTES) is a novel, minimally invasive technique that is gaining interest in gynecological oncology. However, its use in ovarian cancer is still limited, with only a few cases reported. This study aimed to evaluate the feasibility of vNOTES for the surgical staging of borderline and early-stage ovarian cancer.Methods We retrospectively reviewed all cases of borderline ovarian tumors (BOTs) and early-stage ovarian cancer surgically staged by vNOTES at our institution between October 2021 and August 2024.Results Eleven patients were included, seven with early-stage ovarian or tubal cancer and 4 with BOTs. The median age was 47 (27-81) years, and the median body mass index was 28.1 (22.4-39.2) kg/m2. Complete vNOTES staging was achieved in all cases, including peritoneal washing, unilateral/bilateral salpingo-oophorectomy, abdominal cavity inspection, peritoneal biopsies, infracolic omentectomy, and total hysterectomy when required. The median operating time was 70 (35-138) min, with a median blood loss of 50 (10-100) ml. No intraoperative complications occurred except for one case of minor ovarian spillage. No conversions to conventional laparoscopy or laparotomy were needed. Postoperative complications included one surgical site infection (9.1%) and 2 cases of postoperative cystitis (18.2%). No severe complications graded >= 3 on the Clavien-Dindo classification were observed.Conclusion vNOTES appears to be a feasible approach for the surgical staging of highly selected patients with early-stage adnexal malignancies. Further studies are needed to validate its long-term safety and oncological outcomes.