vNOTES vs Minimally Invasive Colpopexy: National Study and Literature Review

OBJECTIVES: (1) Compare perioperative complications of vNOTES to other minimally invasive AS, (2) review prior comparative literature, and (3) describe the rates of different minimally invasive AS routes in the United States. STUDY DESIGN: A retrospective cohort study was performed with data on female patients with benign diagnoses undergoing vNOTES, robotic, laparoscopic, and vaginal AS in 2022 from the NSQIP database. PubMed and ClinicalKey were used to conduct a comprehensive literature search. RESULTS: Of the 7374 AS cases included, 21.3% were vaginal, 4.9% vNOTES, 37.1% robotic, and 36.7% laparoscopic. After adjustment, there were no significant differences in the odds of perioperative composite complications with vNOTES when compared to the other routes of surgery, with rates between 4.28 and 6.21%. Operative time for vaginal AS was shorter at 125 [87-173] minutes, followed by vNOTES at 134 [84-191], laparoscopic at 146 [103-199], and robotic at 172 [129-231]. Median hospital length of stay (LOS) was significantly shorter with vNOTES (n = 0) than with other routes (n = 1). In the seven studies included in the literature review (639 patients total), there were no significant differences in blood transfusion rates, postoperative complications, wound complications, urinary tract infections, reoperation, or surgical cost. CONCLUSION: vNOTES demonstrated similar complication rates to more commonly used routes of AS, supporting findings noted in our literature review.