Comparative Analysis of Spinal Anesthesia Versus General Anesthesia for vNOTES

Inclusion Criteria:

* Age ≥21years old keeping in line with regulations posed by federally funded insurance programs
* cis-female or gender non-conforming person with female reproductive organs
* request for permanent sterilization
* no prior hysterectomy or trachelectomy
* undergoing tubal sterilization only or salpingo-oophorectomy only for cancer risk reduction due to genetic pre-disposition
* non-emergent/scheduled outpatient procedure
* non-pregnant, ≥6 weeks postpartum
* American Society of Anesthesia (ASA) physical status classification I or II
* All subjects must be determined to be appropriate candidates for VNOTES by the surgeon based on the review of medical and surgical history
* Those undergoing additional procedures such as insertion or removal of a long-acting reversible contraceptive (Intrauterine device or subdermal implant) may be included.

Exclusion Criteria:

* Ectopic pregnancy, ovarian torsion, or adnexal mass requiring urgent or emergent treatment;
* Trans-masculine person considering surgical masculinization due to additional surgeries involved;
* Undergoing adnexal surgery for suspected or confirmed malignancy;
* History of endometriosis, or other inflammatory diseases that have been determined to add to the complexity and increase the risk of injury with vaginal surgery;
* prior genital surgery or congenital abnormality that would prevent vaginal access;
* prior spinal surgery or severe scoliosis that would hinder placement and effective functioning of neuraxial anesthetics;
* uncorrected thrombocytopenia or coagulopathy;
* ASA physical status classification ≥III.