When Performing vNOTES Salpingectomy, Are We Damaging the Ovarian Reserve? Results From a Randomized, Controlled Trial.

STUDY

OBJECTIVE

To compare the effects of transvaginal natural orifice transluminal endoscopic surgery (vNOTES) and conventional laparoscopy (CL) on ovarian reserve in women undergoing opportunistic bilateral salpingectomy (BS) for permanent sterilization.

DESIGN

Prospective randomized controlled trial.

SETTING

Tertiary care university hospital.

PATIENTS: Eighty-one women seeking permanent surgical sterilization were included; 35 underwent vNOTES salpingectomy and 46 underwent laparoscopic salpingectomy.

INTERVENTIONS: All participants underwent BS using either the vNOTES approach or conventional laparoscopy.

MEASUREMENTS AND MAIN

RESULTS

Ovarian reserve was assessed using serum anti-Müllerian hormone (AMH) levels and antral follicle count (AFC) measured preoperatively and at 3 months postoperatively. The 2 groups were comparable in terms of demographic characteristics. No statistically significant differences were observed between the vNOTES and CL groups regarding preoperative or postoperative 3-month AMH levels (p > .05), and repeated-measures ANOVA revealed no significant time × group interaction (p = .222). AFC values were also comparable between groups. Postoperative pain scores at 6 hours were significantly lower in the vNOTES group compared with the CL group (p < .001).

CONCLUSION

vNOTES salpingectomy did not adversely affect ovarian reserve at 3 months compared with conventional laparoscopy, as assessed by AMH and AFC. Early postoperative pain scores were lower in the vNOTES group; however, pain was a secondary outcome. Larger studies with longer follow-up are warranted.

CLINICALTRIALS: GOV: NCT07177144, Date: 15/06/2025.