Patient-centered outcomes after vNOTES and laparoscopic gynecological surgery: a comparative analysis of sexual...

This study aimed to investigate and compare the postoperative effects of vaginal natural orifice transluminal endoscopic surgery (vNOTES) and conventional laparoscopy on patients' sexual function, quality of life, and self-esteem for benign indications.

Data from patients who underwent hysterectomies and tubal surgeries using either vNOTES or conventional laparoscopy between January 2022 and August 2023 were analyzed and compared. The primary outcomes were sexual function, quality of life, and self-esteem, assessed both preoperatively and at 3 months post-surgery. Other outcomes of interest, such as surgical success, duration of surgery, complication rates, and postoperative pain, were also included.

Among the women included in the study, 105 (34.8%) underwent total laparoscopic hysterectomy (TLH), 63 (20.9%) underwent vNOTES hysterectomy (VH), 53 (17.5%) underwent laparoscopic tubal surgery (LTS), and 81 (26.8%) underwent vNOTES tubal surgery (VTS). Postoperative Short Form-12 (SF-12) Physical Component Summary (PCS) scores improved significantly in the hysterectomy groups (TLH: 41.16 ± 4.85; VH: 39.68 ± 4.73; p = 0.001). Similarly, Mental Component Summary (MCS) scores also improved postoperatively (TLH: 42.54 ± 5.05; VH: 39.68 ± 4.26; p = 0.001). In the tubal surgery groups, postoperative PCS scores were 42.87 ± 3.38 for LTS and 41.6 ± 3.25 for VTS, with significant improvements observed in both LTS (p = 0.033) and VTS (p = 0.002). However, postoperative MCS changes were not statistically significant for either LTS (p = 0.808) or VTS (p = 0.072). Postoperative Female Sexual Function Index (FSFI) scores increased significantly in both hysterectomy groups (TLH: 20.73 ± 6.26; VH: 21.52 ± 5.23; p = 0.001). Preoperative FSFI scores were similar between the LTS (23.67 ± 6.88) and VTS (23.75 ± 3.26) groups (p = 0.741). Postoperatively, mean FSFI scores increased to 26.98 ± 5.35 in the LTS group and 29.95 ± 4.31 in the VTS group, demonstrating significant improvement (p = 0.001). On the Rosenberg Self-Esteem Scale, only the VH group showed a significant postoperative improvement (p = 0.001).

The vNOTES procedures yielded results comparable to those of the control group while demonstrating notable improvements in patient-centered outcomes, including sexual function, quality of life, and self-esteem, alongside favorable perioperative surgical outcomes.