Scarless Sterilization? A Comparative Study of Vaginal Notes and Laparoscopic Tubal Ligation.

BACKGROUND

Tubal ligation is a common permanent contraception method. Vaginal natural orifice transluminal endoscopic surgery (vNOTES) offers a scarless alternative to laparoscopy, but comparative evidence for interval tubal ligation is limited.

OBJECTIVE

To compare surgical outcomes and recovery between vNOTES and conventional laparoscopic tubal ligation.

METHODS

Retrospective cohort at a tertiary center (August 2024-May 2025). Women aged 30-50 seeking permanent contraception with ASA ≤ 3 were included.

EXCLUSIONS: prior pelvic surgery or known pelvic pathology, salpingectomy or non-contraceptive indications (e.g., hydrosalpinx), concomitant procedures, incomplete records. Patients were grouped by technique: vNOTES (n = 20) or laparoscopy (n = 27).

OUTCOMES: operative time, hospital stay, time to mobilization, analgesia use, Δhemoglobin/Δhematocrit, complications.

TESTS: t-test/Mann-Whitney, Chi-square/Fisher; effect sizes (Cohen's d) and 95% CIs reported (α = 0.05).

RESULTS

Baseline demographics were comparable. Operative time did not differ (mean difference -3.77 min, 95% CI -9.70 to 2.15; p = 0.199; d = -0.32). vNOTES was associated with shorter hospitalization (-3.40 h, 95% CI -6.51 to -0.29; p = 0.033; d = 0.47), earlier mobilization (-0.80 h, 95% CI -1.27 to -0.33; p < 0.001; d = 0.94), and lower postoperative analgesia use (-1.05 doses, 95% CI -1.48 to -0.63; p < 0.001; d = 1.55). Changes in hemoglobin and hematocrit were similar (both p > 0.40). One vNOTES case required conversion to laparoscopy due to adhesions; no conversions occurred in the laparoscopy group.

CONCLUSIONS

vNOTES and laparoscopy are both safe for interval tubal ligation. vNOTES confers clinically meaningful recovery advantages-shorter hospitalization, faster mobilization, and reduced analgesic need-while maintaining comparable operative time and blood loss surrogates. These findings support vNOTES as a promising, patient-centered alternative.