vNOTES vs Laparoscopy: Respiratory Mechanics and Hemodynamics

This study aims to compare vNOTES (Vaginal Natural Orifice Transluminal Endoscopic Surgery) and laparoscopic gynecological surgery in terms of intraoperative respiratory mechanics and hemodynamics in patients scheduled for elective gynecological surgery.

The findings of this study will contribute to more effective planning of ventilation and hemodynamic management by anesthesiologists in vNOTES cases, the development of lung-protective ventilation protocols, and the improvement of perioperative anesthesia quality.

This study is designed as a prospective, observational, single-center, parallel-group cohort study. Patients scheduled for elective gynecological surgery will be divided into two groups according to the surgical technique: Group 1 (vNOTES, n=15) and Group 2 (Laparoscopic surgery, n=15). No randomization will be performed; the surgical technique, insufflation pressure, and Trendelenburg angle will be left to the clinician's discretion.

Measurements will be performed at four time points: T0 (10th minute after intubation, before insufflation), T1 (15th minute after pneumoperitoneum and Trendelenburg positioning), T2 (45th minute after pneumoperitoneum; or the last 5 minutes before desufflation in cases where the 45th minute is not reached), and T3 (15th minute after desufflation). At each time point, respiratory mechanics parameters (Ppeak, Pplateau, DP, MPtot, MPdyn, Crs), hemodynamic parameters (MAP, HR, vasopressor requirement), and intraoperative opioid consumption will be recorded. Insufflation pressure, Trendelenburg angle, and surgical duration will be recorded as confounding variables.

Inclusion criteria

• Female patients aged 18 to 75 years
• Patients scheduled for elective gynecological surgery
• Patients undergoing mechanical ventilation under general anesthesia
• ASA physical status I-III
• Patients providing written informed consent

Exclusion criteria

• Severe or uncontrolled chronic obstructive pulmonary disease, asthma, or other chronic pulmonary diseases
• Cardiac arrhythmia
• ASA physical status IV or above
• Patients developing intraoperative hemodynamic instability
• Patients receiving spinal or epidural anesthesia
• Cases requiring conversion to laparoscopy or laparotomy
• Patients refusing to participate