Transvaginal natural orifice transluminal endoscopic surgery (vNOTES) in gynecologic surgeries: A systematic review.

Natural orifice transluminal endoscopic surgery (NOTES) is a significant innovation in the field of minimally invasive surgery. Transvaginal NOTES has gained the most popularity than other transluminal natural orifices such as mouth, rectum, urinary tract or vagina. Since vNOTES is introduced, many surgeons have developed the technique in various gynecologic surgeries. The aim is to collect the growing evidences of vNOTES in gynecological surgeries and highlight vNOTES with an acceptable safety profile. In the present literature review, the search was carried out using the PubMed database with the following keywords: "natural orifice transluminal endoscopic surgery", "NOTES", "natural orifice" and "gynecologic surgery". The current status of vNOTES in gynecologic surgeries was investigated. A total of 33 studies with 628 cases were included in the review. Our outcomes showed that vNOTES had been performed successfully in a series of surgical procedures including salpingectomy, ovarian cystectomy, myomectomy, hysterectomy, lymphadenectomy and sacrocolpopexy. Advances in technology have improved the feasibility of vNOTES as a treatment option for gynecologic surgeries. When the technical limitations are overcome, wide application of vNOTES is expected to increase. Further prospective and comparative studies are needed to clarify the application of the techniques in gynecologic surgeries.