Bilateral Salpingectomy for Sterilization: A Prospective Comparison of Laparoscopy and vNOTES.

OBJECTIVE: Prospective data comparing vaginal natural orifice transluminal endoscopic surgery (vNOTES) with laparoscopy, and general with spinal anesthesia, in bilateral salpingectomy performed for elective sterilization remain limited. This study compared these surgical approaches and anesthesia modalities with respect to early postoperative pain and perioperative outcomes. METHODS: In this single-center prospective comparative cohort study, 375 women aged 30 to 45 years who underwent bilateral salpingectomy for elective sterilization between January 1, 2025, and January 1, 2026, were evaluated. Patients were grouped by surgical approach as laparoscopy (n = 180) or vNOTES (n = 195), and by anesthesia type as general (n = 187) or spinal anesthesia (n = 188). The primary endpoint was the 12-hour postoperative visual analog scale (VAS) pain score. Secondary endpoints included 24-hour VAS score, shoulder pain, decrease in hemoglobin, additional analgesic requirements, nausea and vomiting, complications, conversion to laparotomy, and 6-month Female Sexual Function Index (FSFI) scores. RESULTS: The 12-hour VAS score was lower with vNOTES than laparoscopy (2.82 ± 0.66 vs 3.62±1.08; P < .001). vNOTES was also associated with lower 24-hour pain, less shoulder pain, and reduced additional analgesic use. Body mass index (BMI) was similar between surgical groups. Spinal anesthesia was associated with a lower 12-hour VAS scores compared to general anesthesia (2.83 ± 0.67 vs 3.58 ± 1.08; P < .001), although shoulder pain was higher with spinal anesthesia (P < .001). No conversion to laparotomy occurred. CONCLUSION: For elective sterilization, vNOTES bilateral salpingectomy was associated with lower early pain and reduced analgesic requirement compared with laparoscopy. Spinal anesthesia may reduce early pain but may influence shoulder pain patterns.