Women’s Perceptions of Trans-Vaginal NOTES Surgery

Two decades ago, Minimally Invasive Surgery (MIS) was introduced and led to a revolution in modern surgery; currently MIS procedures are the standard of care for many surgical interventions and patients often seek out surgeons with special training in MIS. Today, Natural Orifice Translumenal Endoscopic Surgery (NOTES) appears to be on the threshold of another such revolution. Its advantages are similar to other MIS procedures, but there are no associated abdominal wall complications as there are no abdominal incisions. Trans-vaginal procedures mandate an incision in the vaginal wall (1). To date, there is no data evaluating women’s perceptions of such a procedure and their willingness to consent for this type of surgical approach. Based upon previously presented unpublished data by E.T. Volkmann MD (2007) regarding the positive perceptions of other NOTES procedures, we hypothesized that women would be interested in trans-vaginal surgery for its advantages over current MIS procedures. 100 women aged 18 to 79 years of age were given a written description of MIS and NOTES surgery along with a 10-question survey exploring their concerns and opinions regarding trans-vaginal surgery. The majority of women (68%) indicated that they would want a trans-vaginal procedure in the future. Of the women polled, nulliparous women and those under age 45 were most concerned with how trans-vaginal surgery may affect a healthy sexual life and fertility issues. The majority of women respondents indicated that they were interested in trans-vaginal surgery because of a decreased risk of hernia and decreased operative pain (90% and 93% respectively), while only 39% were concerned with the improved cosmesis of NOTES surgery. Interestingly, of the women who indicated that they would consider a trans-vaginal procedure for themselves, 35% would not recommend the procedure to family members (2). This likely reflects the lack of long-term outcomes data for the procedure. Our study shows that there is considerable public interest in NOTES surgery and an assessment of the long-term outcomes of such procedures as well as the impact of potential complications is warranted.

1. Sauer M, Paulson R. Human oocyte and pre-embryo donation: an evolving method for the treatment of infertility. Am J Obstet Gynecol. 1990; 163:1421-1424.
2. Statistical support provided by grant MO1-RR00827 for the UCSD General Clinical Research Center from the NCRR of the NIH.

Session: Podium Presentation

Program Number: P195

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