Transvaginal Natural Orifice Transluminal Endoscopic Ovarian Cystectomy versus Laparoscopic Ovarian Cystectomy. A prospective quasi-randomized pilot study.

BACKGROUND: Minimally invasive approaches have revolutionized the management of benign ovarian cysts, with laparoscopy long regarded as the gold standard. Vaginal natural orifice transluminal endoscopic surgery (vNOTES) is an emerging alternative offering the potential for scarless access and reduced postoperative discomfort. However, comparative data on pain outcomes between vNOTES and conventional laparoscopy for ovarian cystectomy remain lacking in the literature. OBJECTIVE: To evaluate and compare postoperative pain scores, patient satisfaction, and surgical outcomes between vNOTES and conventional laparoscopic ovarian cystectomy. METHODS: This prospective quasi-randomized pilot study included 20 premenopausal women undergoing ovarian cystectomy for benign pathology at a tertiary care center at Ain Shams University Maternity hospitals, Minimal Access surgery unit. Patients were equally divided into two groups: vNOTES (n = 10) and conventional laparoscopy (n = 10). RESULTS: vNOTES was successfully completed in 80% of cases, with one conversion due to adhesions; laparoscopic completion rate was 90%. Operative time was shorter in the vNOTES group (85.6 ± 38.4 min) versus the laparoscopy group (103.7 ± 31.6 min), though not statistically significant (p = 0.26). Pain scores at 6 and 24 hours were lower in the vNOTES group (VAS: 6.0 and 3.0) compared to laparoscopy (VAS: 6.7 and 3.7), and patient satisfaction was significantly higher with vNOTES. CONCLUSIONS: vNOTES ovarian cystectomy is a safe, feasible technique associated with reduced early postoperative pain and improved patient satisfaction compared to conventional laparoscopy. These findings support the potential of vNOTES as a patient-centered surgical alternative and warrant further investigation in larger trials.