Feasibility and Clinical Application of Vaginal Natural Orifice Transluminal Endoscopic Surgery (VNOTES) in Early-Stage Ovarian Cancer: A Narrative Literature Review

Background: Vaginal Natural Orifice Transluminal Endoscopic Surgery (vNOTES) represents a novel evolution in minimally invasive gynecologic surgery, combining endoscopic visualization with a transvaginal access route. Although its safety and efficacy in benign conditions and endometrial cancer have been well established, evidence regarding its role in ovarian malignancies remains limited. Objective is to evaluate the feasibility, perioperative safety, and oncologic adequacy of vNOTES for the surgical management and staging of apparent early-stage ovarian cancer.Methods: A narrative literature review was performed following a PICO-driven framework. Databases including PubMed, Scopus, Cochrane CENTRAL, ClinicalTrials.gov, and Google Scholar were searched up to September 2025. Eligible studies included case reports, series, and comparative analyses reporting outcomes of vNOTES in early-stage ovarian cancer or borderline ovarian tumors. Data on feasibility, intra- and postoperative complications, tumor spillage, conversion rates, and oncologic outcomes were synthesized descriptively.Results: The current evidence base comprises several case reports and small series (totaling approximately 50 reported patients). Across studies, vNOTES enabled completion of standard staging steps—oophorectomy, hysterectomy, omentectomy, peritoneal biopsies, and selective lymphadenectomy—entirely via the transvaginal route in nearly all cases, with conversion rates approaching zero. Estimated blood loss was minimal (≤150 mL), median operative times ranged from 45–90 minutes, and hospital stay was typically ≤2 days. Complication rates were low, and intraoperative tumor spillage was rare (<5%). Short- to medium-term follow-up (≤3 years) revealed recurrence rates consistent with expected outcomes for early-stage disease and no disease-related deaths.Conclusions: Early evidence indicates that vNOTES is a technically feasible and safe approach for carefully selected patients with apparent early-stage ovarian cancer, achieving oncologically sound procedures with reduced postoperative pain, minimal morbidity, and excellent cosmetic outcomes. Nevertheless, its use should currently be limited to specialized centers with vNOTES expertise, pending confirmation of long-term oncologic equivalence through multicenter prospective studies.