vNOTES for Diagnostic Peritoneal Exploration in Peritoneal Carcinomatosis of Unknown Primary: A Prospective Pilot Feasibility Study.

BackgroundPeritoneal carcinomatosis (PC) of unknown primary origin remains a diagnostic challenge, often requiring surgical exploration and tissue sampling. Vaginal natural orifice transluminal endoscopic surgery (vNOTES) has emerged as a minimally invasive access route; however, evidence regarding its feasibility for diagnostic peritoneal assessment in this setting is limited. This study aimed to evaluate the technical feasibility of vNOTES for peritoneal exploration, biopsy acquisition, and intraoperative estimation of the Peritoneal Cancer Index (PCI).MethodsThis prospective single-center pilot study included 11 female patients with radiologically suspected PC and unknown primary malignancy. All patients underwent peritoneal exploration and biopsy via vNOTES. Intraoperative PCI was recorded and descriptively compared with preoperative radiological PCI. Perioperative outcomes and early postoperative complications were assessed.ResultsvNOTES access, peritoneal exploration, and biopsy acquisition were successfully completed in all patients without conversion. Adequate tissue samples were obtained in all cases. The mean surgical PCI was 28.9 ± 4.0, indicating advanced disease. Radiological and surgical PCI assessments showed apparent high concordance, likely influenced by the uniformly advanced disease burden. No intraoperative or major postoperative complications occurred, and all patients had an uncomplicated postoperative course.ConclusionsvNOTES appears to be a technically feasible minimally invasive approach for diagnostic peritoneal exploration and biopsy in selected patients with PC of unknown primary origin. These preliminary findings require validation in larger comparative studies to determine safety and clinical utility.