Ozan Karadeniz: Can vNOTES Challenge Laparoscopy in Emergency Gynecology?
Ozan Karadeniz, Obstetrics and Gynecology Specialist at Başakşehir Çam ve Sakura Şehir Hastanesi, shared a post on LinkedIn:
“vNOTES in Emergency Gynecology: Are We Ready to Challenge the Gold Standard?
Ectopic pregnancy remains one of the most critical emergencies in gynecologic surgery, where timely intervention and surgical expertise directly impact outcomes.
In our recent work, we explored a rapidly evolving and increasingly discussed technique: vaginal Natural Orifice Transluminal Endoscopic Surgery (vNOTES) and compared it with the conventional gold standard—laparoscopy—in the emergency management of ectopic pregnancy.
- What does the current literature tell us?
- Most studies were performed by highly experienced surgeons, highlighting the impact of expertise on outcomes.
- perative time: Trend toward shorter procedures with vNOTES (−10 min), though not statistically significant.
- Blood loss and pain scores: No significant differences.
- Analgesic requirements: Significantly reduced with vNOTES (OR 0.27).
- Hospital stay: Slightly shorter for vNOTES patients.
- Conversion rate: Higher with vNOTES (2.9% of cases), all converted to laparoscopy.
- Complications: Comparable, limited to Clavien–Dindo I–II events.
So what is the real challenge?
In emergency settings, the discussion is not only about technique, but about the surgeon.
- Experience
- Case selection
- Learning curve
These factors remain the true determinants of success.
While vNOTES is promising, current evidence is still largely based on retrospective and single-center experiences, with limited sample sizes.
Take-home message:
While vNOTES shows promising recovery benefits and minimal complications, most procedures were performed by highly experienced surgeons, and conversion risk still exists. This underscores the importance of surgeon expertise and structured training, especially in emergency scenarios.
Next steps for the field:
Randomized controlled trials to strengthen evidence
Inclusion of vNOTES in surgical training and fellowship programs
Standardization of emergency protocols to ensure safety and reproducibility
Innovation is exciting—but in emergency gynecology, it must always be safe, teachable, and evidence-based.”
Title: Vaginal natural orifice transluminal endoscopic surgery versus laparoscopic salpingectomy in the surgical management of tubal ectopic pregnancy: A systematic review and meta-analysis
Authors: Ozan Karadeniz, Emre Kar, Mahjouba Soltani, Zainab Hussein, Murat Yassa, Cihan Kaya
Read the full article.
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