The Effect of Posterior Colpotomy on Type of Delivery After Natural Orifice Specimen Extraction: A Systematic Review.

Abstract

<h4>Objective</h4>The purpose of this study is to evaluate the reproductive outcomes, including pregnancy rates and modes of delivery, in women of reproductive age who previously underwent vaginal natural orifice transluminal endoscopic surgery (vNOTES).<h4>Data sources</h4>A literature search was conducted using PubMed, Scopus, Web of Science, and EBSCO databases. The review used topic-specific keywords and MeSH terms such as ("transvaginal tissue removal" OR "Natural Orifice Transluminal Endoscopic Surgery" OR "transvaginal tissue extraction" OR "transvaginal specimen extraction" OR NOTES OR vNOTES) AND (delivery OR childbirth OR birth).<h4>Method study selection</h4>All English-language articles focusing on vNOTES in women of reproductive age (18-45), with a uterus, and desiring to conceive were included. Studies were excluded if they involved bowel or gynecological malignancies, prior total hysterectomy, nonuse of posterior colpotomy for tissue removal, animal studies, or were not in English.<h4>Tabulation, integration, and results</h4>The quality of included studies was assessed using the Nonrandomized Studies of Interventions (ROBINS-I) tool. Five studies out of 66 159 were included-four retrospective and one case series-encompassing 903 patients who underwent vNOTES for various procedures. These included laparoscopic and minimally invasive surgeries, such as cholecystectomy, appendectomy, gastric sleeve, intestinal operations, and gynecological procedures. Of these, 180 became pregnant: 12 had miscarriages, 47 had vaginal births, and 32 had C-sections (15 elective, five due to prior C-section). Fifty-eight used Assisted Reproductive Treatment (ART). No cases of sexual dysfunction, vaginal pain, laceration, or shortening were reported.<h4>Conclusion</h4>The findings suggest that vNOTES is a safe surgical approach for women wishing to conceive, as it does not negatively impact fertility or childbirth. Mode of delivery is influenced more by obstetric indications than by a history of vNOTES.<h4>Trial registration</h4>Registered in PROSPERO (CRD420250644811).