title: Transvaginal surgery: do women want it?
abstract: BACKGROUND
  Past studies comparing attitudes toward transvaginal natural orifice translumenal endoscopic surgery (NOTES(®); American Society for Gastrointestinal Endoscopy [Oak Brook, IL] and Society of American Gastrointestinal and Endoscopic Surgeons [Los Angeles, CA]) to laparoscopic surgery have produced a wide variety of conflicting results, with some studies showing a preference for NOTES, a preference for transgastric NOTES only, or a rejection of NOTES. Given the disparity in results, our study aimed to identify demographic data as well as clinical factors, such as risk of infection, need for postsurgical abstinence from sexual activity, and risk of infertility, that significantly affect women's opinions.
  
  
  METHODS
  At outpatient general surgery clinics, 142 women completed a survey regarding their opinions about transvaginal NOTES and their main concerns regarding surgery. Women rated their concerns using a 5-point Likert scale. De-identified demographic, social, and medical history data were also collected. Fisher's exact test and multiple logistic regression analysis were used to test associations between women's concerns and their choice for transvaginal NOTES over standard laparoscopic surgery.
  
  
  RESULTS
  Age was statistically significant in determining a woman's choice, and the interaction variable of age × cosmesis showed a trend toward significance. Thirty-five percent of women <36 years of age would choose transvaginal NOTES, whereas 63% and 61% of women 36-55 and >55 years of age, respectively, would choose the transvaginal technique (P=.024). Women who felt that cosmesis was a concern were much more likely to choose NOTES, especially if they were in the 36-55- or ≥ 56-year-old age groups. The comprehensive model showed that age ≥ 36 years, concern for adhesions, and concern for cosmesis made a woman more likely to choose NOTES. Similarly, concerns for hernia risk and abstinence made a woman less likely to choose NOTES.
  
  
  CONCLUSIONS
  Women generally have a positive perception of NOTES. However, because NOTES procedures are not yet widespread, further studies need to be done to investigate and to elucidate why this technique is not yet widely utilized despite these opinions and its potential benefits.
authors.affiliation: 1 Center for Minimally Invasive Surgery, The Ohio State University Wexner Medical Center , Columbus, Ohio.
authors.forename: Yueyang F
authors.initials: YF
authors.lastname: Fei
authors.forename: Lin
authors.initials: L
authors.lastname: Fei
authors.forename: Mario
authors.initials: M
authors.lastname: Salazar
authors.forename: David B
authors.initials: DB
authors.lastname: Renton
authors.forename: Jeffrey W
authors.initials: JW
authors.lastname: Hazey
mesh_terms: D000328:Adult; D000367:Age Factors; D000368:Aged; D003625:Data Collection; D004724:Endoscopy / Q000379:methods; D016099:Endoscopy, Gastrointestinal; D004954:Esthetics; D005260:Female; D006801:Humans; D007239:Infections / Q000209:etiology; D010535:Laparoscopy / Q000523:psychology*; D008875:Middle Aged; D057605:Natural Orifice Endoscopic Surgery / Q000009:adverse effects / Q000523:psychology*; D057240:Patient Preference; D012725:Sexual Behavior; D014621:Vagina; D055815:Young Adult