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Surg Innov. 2016 Apr;23(2):201-11. doi: 10.1177/1553350615598621. Epub 2015 Aug 2.

Women's Perception of Transvaginal Natural Orifice Transluminal Endoscopic Surgery (NOTES): Results of a Survey of Female Medical Staff and Literature Review.

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Burjeel Hospital, Abu Dhabi, United Arab Emirates.
University Medical Center Hamburg-Eppendorf, Hamburg, Germany.
The New European Surgical Academy (NESA), Berlin, Germany.
Burjeel Hospital, Abu Dhabi, United Arab Emirates The New European Surgical Academy (NESA), Berlin, Germany



Over the past 8 years, natural orifice transluminal endoscopic surgery (NOTES) has developed from preclinical to routine clinical practice. However, there are still concerns regarding the transvaginal approach. In our survey, we were interested in females with a professional medical background, thus having at least a basic medical understanding, which might discriminate between objective and subjective concerns.


A questionnaire with 14 items was distributed among 1895 female physicians and nursing and administration staff of the University Medical Center Hamburg-Eppendorf. In addition, a qualitative literature review was performed. Data analysis was carried out using statistical package R version 2.15.0.


The questionnaire was answered anonymously by 553 employees (29%). Fifty-seven percent were nurses, 18.6% belonged to administration, and 17% were physicians. A total of 63.1% of our respondents would choose the transvaginal NOTES technique for an assumed ovariectomy, while only 30.4% would choose this access for cholecystectomy. Doubts regarding transvaginal NOTES were related to sexual dysfunction (44.8%), its experimental nature (43.8%), future pregnancies (36.8%), and ethical reasons (30.3%). The literature review showed that women's perception of the transvaginal access is documented very heterogeneously and therefore difficult to compare.


Despite the good reported results of NOTES and the medical background of the surveyed female employees, our study and the literature review clearly shows that there are fears regarding the transvaginal access, which might be a result of limited information. More accurate explanation of the available methods by the attending surgeon can lead to a better choice of the patient's preferred method.


females; natural orifice transluminal endoscopic surgery (NOTES); perception; survey; transvaginal

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