Abstract
Background
Trans-vaginal natural orifice transluminal endoscopic surgery (vNOTES) is a recently popularised minimally invasive surgical procedure, aimed at minimising abdominal wall scars and improving pain and patient recovery times. Although vNOTES has been studied in the context of post-operative pain and cosmesis, women’s acceptance of the technique has only been cursorily examined. In this survey-based observational study, we assessed the acceptability of this technique among a cohort of Middle Eastern women.
Materials and methods
A cohort of 175 Middle Eastern women were surveyed using a 13-item questionnaire at a single gynaecology centre. The survey used was a translated version of a questionnaire from a previous study (1) and comprised open-response, five-point Likert Scale and agree-disagree items.
Results
Among 175 Middle Eastern women participated in this study most of them holding neutral view on abdominal and gynaecological procedures via vagina. 47% of participants were unsure regarding the effect of surgery via vagina on their sexual function. Although 61% of the participants showed no preference towards vNOTES over laparoscopic cholecystectomy, more than half of them indicated preference if vNOTES shown to be as effective and safe as laparoscopic cholecystectomy. The gender of the surgeon was shown to have no influence on the perspectives of the majority of participants to undergo vNOTES.
Conclusions
vNOTES may hold value for women who have conservative upbringing and/or value cosmesis. This study provides information regarding Middle Eastern women’s perspectives on vNOTES, which may be of considerable clinical use as the popularity of this surgical technique continues to increase.
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Acknowledgements
The authors would like to sincerely thank Mahin Jourabchi, Amirreza Jourabchi and Mehrnoush Sarmadi.
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Appendices
Appendix 1 Patient Questionnaire
Background
Key hole (laparoscopic) surgery using small incisions, is a well-established technique. However, there is now a new concept in surgery known as ‘N.O.T.E.S.’ (Natural Orifice Transluminal Endoscopic Surgery). This utilises a natural orifice (e.g. the vagina) to allow entry into the abdominal cavity so that operations such as a cholecystectomy (removal of the gallbladder) can be performed with the use of specialised equipment. In the case of cholecystectomy, the gallbladder would be removed from the body via the vagina, leaving no visible scars. It may also be potentially less painful. In a few specialist centres, this procedure is now being performed although there are no clinical trials to support its use. As a woman, we would be interested to hear your views regarding the utilisation of the vagina as a way of performing this type of surgery.
1. Age: __________years.
2. Have you had children? Y/N.
3. Are you known to have gall stones? Y/N.
4. Have you had a cholecystectomy (removal of gall bladder)? Y/N.
5. Have you had an abdominal operation before? Y/N.
6. Would you mind abdominal scars as part of an abdominal operation? Y/N.
7a. Would you find it preferable if you could have the operation (laparoscopic cholecystectomy), using an alternative method resulting in no scars? Y/N.
7b. If yes, is this because of:
a) Cosmetic reasons.
b) Potential for less pain.
c) Both.
d) Other (please state).
8. How do you feel about using the vagina as an entry site for an operation? (Please circle)
a) Very happy, b) Happy, c) Not sure, d) Unhappy, e) Very unhappy.
9. Would you be concerned that surgery through the vagina (NOTES) may have a negative impact on your sexual function?
a) Yes b) No c) Not sure.
10. Would you prefer to have a laparoscopic (key hole) cholecystectomy or a NOTES cholecystectomy?
a) Laparoscopic cholecystectomy b) NOTES cholecystectomy.
11. If NOTES cholecystectomy was shown to be as effective and as safe as laparoscopic cholecystectomy which would you prefer?
a) Laparoscopic cholecystectomy b) NOTES cholecystectomy.
12. If you required a gynaecological procedure such as a sterilisation, how would you feel about this being performed vaginally (NOTES sterilisation), rather than with standard key hole surgery
a) Very happy, b) Happy, c) Not sure, d) Unhappy, e) Very unhappy.
13. Finally, would the sex of the surgeon influence your decision as to whether to undergo a NOTES procedure?
Yes/No/Unsure.
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Behnia-Willison, F., Nguyen, T., Rezaeimotlagh, A. et al. Middle Eastern women’s attitudes and expectations towards vaginal natural orifice transluminal endoscopic surgery (vNOTES): a survey-based observational study. Surg Endosc 35, 6865–6872 (2021). https://doi.org/10.1007/s00464-020-08193-0
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DOI: https://doi.org/10.1007/s00464-020-08193-0