Abstract
Background
Laparoscopic and minimally invasive surgery has changed the surgical landscape irrevocably. Natural orifice translumenal endoscopic surgery (NOTES) offers the possibility of surgery without visible scars. Transvaginal entry offers potential benefits because it gains access to the peritoneal cavity without the need to open an abdominal viscus. Much of the discussion pertaining to NOTES focuses on technical and training issues, with little attention to date paid to the opinions of women. The perceptions of female health care workers and patients were sought in relation to their views on transvaginal NOTES.
Methods
This study surveyed 300 women using a 12-point questionnaire devised by a multidisciplinary group of surgeons interested in minimally invasive surgery. The questionnaire was designed to establish the opinions of women with respect to NOTES surgery versus standard laparoscopic procedures. Responses were de-identified.
Results
Three-fourths of the women surveyed were neutral or unhappy about the prospect of a NOTES procedure, and this remained constant even when it was stipulated that laparoscopic cholecystectomy and NOTES had equivalent safety and efficacy. Younger nulliparous women were most concerned about the potential negative effect of NOTES on sexual function. A minority were concerned about the cosmetic effect of surgery, although surgical scars were perceived as more important to younger respondents.
Conclusions
Potentially, NOTES surgery offers women a scarless operation with the possibility of less pain than experienced in standard laparoscopic surgery. Few women, however, were troubled about the cosmetic effect of surgery. The effect of NOTES on sexual function was expressed as a particular concern by younger women. In all groups and across all ages, peritoneal access using the transvaginal route was met by significant scepticism. In Australia, women remain to be convinced about the potential advantages of the emerging NOTES technology.
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Acknowledgments
The authors thank Jacqueline Stephens and Sheona Page for their help in questionnaire design as well as data collection and collation.
Disclosures
Andrew D. Strickland, Michael G. A. Norwood, Fariba Behnia-Willison, Santosh A. Olakkengil, and Peter J. Hewett have no conflicts of interest or financial ties to disclose.
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Appendices
Appendix 1: Healthcare Professionals Questionnaire
Appendix 2: Gynecology Outpatient Group
Appendix 3: Laparoscopic Cholecystectomy Group
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Strickland, A.D., Norwood, M.G.A., Behnia-Willison, F. et al. Transvaginal natural orifice translumenal endoscopic surgery (NOTES): a survey of women’s views on a new technique. Surg Endosc 24, 2424–2431 (2010). https://doi.org/10.1007/s00464-010-0968-3
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DOI: https://doi.org/10.1007/s00464-010-0968-3