title: Evaluation of transvaginal peritoneal surgery in young female patients.
abstract: BACKGROUND
  The transvaginal approach is being used for natural orifice transluminal endoscopic surgery (NOTES), and reports of the clinical use of transvaginal NOTES have increased rapidly. However, hasty use of a transvaginal route may cause unexpected complications. Infertility or dyspareunia after transvaginal NOTES in young women is one of the most important issues to be resolved. The purpose of this study was to assess long-term complications, including infertility and dyspareunia, after transvaginal peritoneal surgery.
  
  
  METHODS
  An anonymous questionnaire was sent to 73 young patients who had undergone ovarian cystectomy using a transvaginal approach from 2003 to 2011. The questionnaire contained 15 questions; 6 dealt with fertility, and 8 dealt with discomfort after surgery. A 5-point scale was used to evaluate patients' overall satisfaction with surgery.
  
  
  RESULTS
  Forty-four (60 %) questionnaires were returned. The patients' mean age was 33.0 years, and the mean postoperative follow-up period was 16.5 months. Of responders younger than age 40 years, 24 did not use contraception, and 9 (38 %) conceived. The pregnancy rate among women younger than age 30 years was 60 %. Two (5 %) women reported temporary dyspareunia 1 month after surgery, but none developed permanent dyspareunia. The average patient satisfaction score was 4.12.
  
  
  CONCLUSIONS
  There was no evidence to suggest that transvaginal peritoneal surgery causes infertility or dyspareunia. The majority of patients gave a high evaluation to vaginal ovarian cystectomy, suggesting the usability of a transvaginal approach for intraperitoneal surgery in young premenopausal women.
authors: Department of Obstetrics and Gynecology, School of Medicine, Kanazawa University, 13-1, Takaramachi, Kanazawa, Ishikawa 920-8641, Japan. masaaki@med.kanazawa-u.ac.jp
authors: Masaaki
authors: M
authors: Tanaka
authors: Tetsuya
authors: T
authors: Sagawa
authors: Rena
authors: R
authors: Yamazaki
authors: Subaru
authors: S
authors: Myojo
authors: Satoshi
authors: S
authors: Dohi
authors: Masaki
authors: M
authors: Inoue
mesh_terms: D000328:Adult; D004414:Dyspareunia / Q000209:etiology; D005260:Female; D006801:Humans; D010535:Laparoscopy; D057605:Natural Orifice Endoscopic Surgery / Q000009:adverse effects / Q000379:methods*; D010048:Ovarian Cysts / Q000601:surgery*; D017060:Patient Satisfaction; D011247:Pregnancy; D018873:Pregnancy Rate; D011795:Surveys and Questionnaires; D014621:Vagina
references: J Minim Invasive Gynecol. 2008 May-Jun;15(3):350-4
references: 18439510
references: Fertil Steril. 2010 Dec;94(7):2497-502
references: 20850716
references: Endoscopy. 2009 May;41(5):472-4
references: 19418403
references: Surg Innov. 2010 Jun;17(2):142-58
references: 20504792
references: Surg Endosc. 2009 Apr;23(4):680-7
references: 19118425
references: Endoscopy. 2007 Nov;39(11):1013-7
references: 17926236
references: Ann Surg. 2008 Apr;247(4):583-602
references: 18362621
references: Surg Innov. 2012 Mar;19(1):37-44
references: 21742657
references: J Minim Invasive Gynecol. 2008 Jul-Aug;15(4):505-7
references: 18602053
references: Semin Reprod Med. 2000;18(4):433-40
references: 11355802
references: Ann Surg. 2010 Aug;252(2):263-70
references: 20585238
references: BJOG. 2004 Sep;111(9):950-9
references: 15327610
references: Ultrasound Obstet Gynecol. 2008 Mar;31(3):342-5
references: 18307175
references: Surg Endosc. 2011 Jul;25(7):2308-15
references: 21301884
references: Surg Innov. 2011 Jun;18(2):114-8
references: 21307011
references: Science. 1986 Sep 26;233(4771):1389-94
references: 3755843
references: Endoscopy. 2008 Jul;40(7):576-80
references: 18609451