Emergency Surgical Management of Ectopic Pregnancy Using Transvaginal NOTES (vNOTES) versus Laparoscopy: A Comparative Single-Surgeon Cohort Study

Background: Ectopic pregnancy remains a significant cause of maternal morbidity, and timely surgical intervention is critical, particularly in emergency settings. Objective: To compare perioperative and early postoperative outcomes of transvaginal natural orifice transluminal endoscopic surgery (vNOTES) and laparoscopy in the emergency surgical management of ectopic pregnancy. Materials and Methods: This retrospective cohort study included 63 patients who underwent emergency surgery for ectopic pregnancy, of whom 28 were treated with vNOTES and 35 with laparoscopy. Demographic characteristics, operative time, total intraoperative blood loss, procedure-related blood loss, hemoglobin change, β-hCG levels, and length of hospital stay were analyzed. ANCOVA was performed to adjust for the effect of total intraoperative blood loss. A subgroup analysis was conducted in 13 patients who underwent salpingostomy. Results: Baseline characteristics, including age and BMI, were comparable between groups. Operative time was significantly shorter in the vNOTES group (47.57 ± 14.48 vs. 88.43 ± 26.00 minutes, p = 0.001). Although total intraoperative blood loss was higher in the vNOTES group, procedure-related blood loss was significantly lower (48.57 ± 16.04 vs. 85.71 ± 34.41 mL, p = 0.001). Hemoglobin decrease, postoperative β-hCG levels, and length of hospital stay were similar between groups. After adjustment, vNOTES remained independently associated with shorter operative time, lower procedure-related blood loss, and reduced hemoglobin decrease. In the salpingostomy subgroup, all cases involved tubal ectopic pregnancies. Conclusion: In selected patients, vNOTES appears to be a feasible and safe minimally invasive approach in selected patients; however, these findings should be interpreted with caution due to the retrospective design and limited sample size. Keywords: vNOTES, laparoscopy, ectopic pregnancy, emergency surgery, minimally invasive gynecology