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 functionin…