Repeated transvaginal natural orifice transluminal endoscopic surgery: An initial Chinese experience

Aims: To investigate the perioperative outcomes and sexual function of patients undergoing repeated transvaginal natural orifice transluminal endoscopic surgery (vNOTES). Methods: We retrieved the records of patients who underwent vNOTES twice at our institute between April 2019 and December 2022 and analyzed their baseline information and perioperative complications, and compared the pre- and postoperative sexual function of both vNOTES. Results: Patients' mean age and body mass index were 29.00 +/- 3.59 and 30.4 +/- 4.00 years and 21.89 +/- 3.69 and 22.76 +/- 3.88 kg/m(2), respectively, when receiving the first and second vNOTES. Ectopic pregnancy was the most frequent indication for vNOTES, with 7 cases in the first vNOTES and 11 cases in repeated vNOTES. The interval between the two vNOTESs ranged from 9 days to 38 months. The operation duration (63.33 +/- 13.71 vs. 67.33 +/- 22.51 min, p = 0.723), intraoperative estimated blood loss (32.00 +/- 20.42 vs. 30.00 +/- 9.26 mL, p = 0.429), and duration of postoperative hospital stay (2.20 +/- 0.56 vs. 2.40 +/- 0.51 days, p = 0.082) of both vNOTESs were comparable. No significant differences were found in any of the domains in the comparison of pre-first and post-first vNOTES, pre-second and post-second vNOTES, and pre-first and post-second vNOTES female sexual function index. None of the patients delivered after the second vNOTES. Conclusion: Repeated vNOTES is safe and feasible. No significant change in the patients' sexual function was found in our cohort after the first and second vNOTES.