Abstract / Summary
Transvaginal natural orifice transluminal endoscopic surgery (vNOTES) is a minimally invasive gynecological technique with well-documented short-term safety. Data on pregnancy and delivery outcomes, particularly the feasibility of vaginal delivery after repeated vNOTES procedures, remain limited. This descriptive case series included 19 reproductive-aged women who underwent a second fertility-preserving vNOTES procedure for benign conditions between April 2022 and December 2024. Reproductive follow-up was summarized for all 19 patients, with detailed perioperative and obstetric outcomes reported for the seven who delivered. Among the 19 patients, 7 patients delivered, 7 had no current intention to conceive, and 5 wished to conceive but had not achieved delivery during follow-up. Among the seven who delivered, four conceived naturally and three underwent IVF, primarily for underlying tubal disease or prior tubal surgery. Two delivered vaginally and five by cesarean section. Five had pregnancy complications, including gestational diabetes, gestational hypertension, cervical insufficiency, placenta accreta, and asymptomatic Group B Streptococcus vaginal colonization. Neonatal outcomes were favorable, with a median gestational age of 274 days, no cases of neonatal asphyxia, and birth weights ranging from 2650 to 3540 g. Pregnancy and delivery after a second vNOTES procedure appear to be feasible. However, future studies with larger sample size are needed to establish the safety of pregnancy and childbirth after repeated vNOTES. Trial registration Chinese Clinical Trial Registry: ChiCTR2200059282 (registered on April 28th, 2022).