Evaluating the efficacy and benefits of vNOTES for ovarian cystectomy: a systematic review and meta-analysis

Objective: This meta-analysis aims to evaluate the effectiveness and overall outcomes of vNOTES in ovarian cystectomy compared to conventional laparoscopy (CL). Study design: A systematic review and meta-analysis were conducted by searching PubMed/MEDLINE, EBSCO, Cochrane, and Embase databases for studies comparing vNOTES and laparoscopy for ovarian cystectomy. A comprehensive literature search was performed to identify relevant publications up to June 21, 2024. The search strategy utilized a combination of Medical Subject Headings (MeSH) terms and relevant keywords. Eligible studies included randomized controlled trials, cohort studies, and case-control studies, while case reports and studies lacking a direct comparison were excluded. Two independent reviewers assessed study eligibility and performed Risk of Bias evaluation. Quantitative synthesis was performed using meta-analysis techniques. The protocol was registered in the PROSPERO database (CRD42024560612). Results: Six studies reported operative times, with vNOTES showing a significantly shorter duration compared to CL (mean difference [MD]: −13.05 min, 95 % confidence interval [CI]: −19.04 to −7.07, I² = 67 %). Five studies demonstrated that vNOTES was associated with shorter hospital stays (MD: −0.43 days, 95 % CI: −0.74 to −0.12, I² = 90 %). Pain scores were also significantly lower in vNOTES patients (3 studies, MD: −1.25, 95 % CI: −1.49 to −1.01, I² = 43 %). However, no significant differences were observed between the groups regarding hemoglobin drop, blood loss, or conversion rates. Conclusion: This systematic review and meta-analysis highlight the advantages of vNOTES ovarian cystectomy, including reduced operative times, faster recovery, lower postoperative pain, and shorter hospital stays. These findings support the wider adoption of vNOTES as an effective alternative to conventional laparoscopy for ovarian cystectomy, offering potential benefits for both patients and surgical efficiency.