ABSTRACT Aim To compare outcomes, efficacy, and safety of vNOTES versus conventional laparoscopy and laparoendoscopic single‐site surgery salpingectomy for ectopic pregnancy. Methods Electronic databases including PubMed, Medline, Cochrane Library, and Embase were systematically searched. Articles were evaluated according to specified inclusion criteria. Data were extracted and reviewed, with reported duration of procedure and length of patient stay as primary outcomes. Due to heterogeneity of data, analysis was further stratified depending on whether the control groups underwent conventional laparoscopy or laparoendoscopic single‐site surgery. Secondary outcomes include success rates, estimated blood loss, Visual Analogue Scores (VAS) for postoperative pain and complications. A formal risk of bias assessment accompanied the included studies. Results Twenty‐one studies were included within the review with a cumulative total of 405 cases of vNOTES salpingectomy. Studies included randomized control trials ( n = 2), cohort control studies ( n = 6), case series ( n = 12), and case report ( n = 1). Meta‐analyses of duration of procedure and length of stay were performed across seven papers (stratified according to control groups). This revealed a significant reduction in length of stay but similar duration of surgery under fixed and random effects models ( p < 0.05) for vNOTES versus conventional laparoscopic salpingectomy. Patients undergoing vNOTES salpingectomy versus laparoendoscopic single‐site surgery had similar duration of surgery and length of stay. Women who had vNOTES demonstrated lower VAS pain scores and reduced analgesia requirements. Up to 4% of cases may need conversion to laparoscopy (these were cases associated with pelvic adhesions or torrential hemorrhage), and documented complications included hemorrhage, post‐operative pyrexia, and need for blood transfusion. Conclusions vNOTES salpingectomy for ectopic pregnancy appears to be a safe and feasible procedure, with high levels of patient satisfaction and low pain scores. The heterogeneity of data of the control groups is acknowledged and patients undergoing vNOTES versus conventional laparoscopic salpingectomy had reductions in length of stay but similar duration of surgery, while vNOTES salpingectomy versus laparoendoscopic single‐site surgery incurred similar duration of surgery and length of stay. Procedural standardization and larger randomized clinical trials to assess long‐term outcomes are crucial if vNOTES salpingectomy should become widely used for surgical treatment of ectopic pregnancy.
Hartshorn et al. (Sun,) studied this question.
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