Scarless Sterilization? A Comparative Study of Vaginal Notes and Laparoscopic Tubal Ligation

BACKGROUND: Tubal ligation is a common permanent contraception method. Vaginal natural orifice transluminal endoscopic surgery (vNOTES) offers a scarless alternative to laparoscopy, but comparative evidence for interval tubal ligation is limited. OBJECTIVE: To compare surgical outcomes and recovery between vNOTES and conventional laparoscopic tubal ligation. METHODS: Retrospective cohort at a tertiary center (August 2024-May 2025). Women aged 30-50 seeking permanent contraception with ASA ≤ 3 were included. EXCLUSIONS: prior pelvic surgery or known pelvic pathology, salpingectomy or non-contraceptive indications (e.g., hydrosalpinx), concomitant procedures, incomplete records. Patients were grouped by technique: vNOTES (n = 20) or laparoscopy (n = 27). OUTCOMES: operative time, hospital stay, time to mobilization, analgesia use, Δhemoglobin/Δhematocrit, complications. TESTS: t-test/Mann-Whitney, Chi-square/Fisher; effect sizes (Cohen's d) and 95% CIs reported (α = 0.05). RESULTS: Baseline demographics were comparable. Operative time did not differ (mean difference -3.77 min, 95% CI -9.70 to 2.15; p = 0.199; d = -0.32). vNOTES was associated with shorter hospitalization (-3.40 h, 95% CI -6.51 to -0.29; p = 0.033; d = 0.47), earlier mobilization (-0.80 h, 95% CI -1.27 to -0.33; p < 0.001; d = 0.94), and lower postoperative analgesia use (-1.05 doses, 95% CI -1.48 to -0.63; p < 0.001; d = 1.55). Changes in hemoglobin and hematocrit were similar (both p > 0.40). One vNOTES case required conversion to laparoscopy due to adhesions; no conversions occurred in the laparoscopy group. CONCLUSIONS: vNOTES and laparoscopy are both safe for interval tubal ligation. vNOTES confers clinically meaningful recovery advantages-shorter hospitalization, faster mobilization, and reduced analgesic need-while maintaining comparable operative time and blood loss surrogates. These findings support vNOTES as a promising, patient-centered alternative.