Short-term sexual function after vNOTES vs. transumbilical single-port laparoscopic hysterectomy for benign...

Sexual function is an important patient-reported outcome after hysterectomy but remains underreported in direct comparisons of scar-minimizing surgical approaches. This study compared short-term sexual function, perioperative outcomes, and postoperative pain between transumbilical single-port laparoscopic hysterectomy and vaginal natural orifice transluminal endoscopic surgery (vNOTES) for benign gynecologic indications.

This retrospective cohort study included 90 consecutive eligible patients treated between January 2023 and January 2025: 49 underwent transumbilical single-port laparoscopic hysterectomy and 41 underwent vNOTES hysterectomy. Surgical route was selected according to patient preference after preoperative counseling. The primary outcome was the change in total Female Sexual Function Index (FSFI) score from baseline to 3 months postoperatively (ΔFSFI). Secondary outcomes included postoperative pain, additional analgesic requirement, operative time, length of hospital stay, hematocrit change, and intraoperative complications. An adjusted analysis of postoperative FSFI accounted for baseline FSFI, age, BMI, and menopausal status.

Baseline age, BMI, parity, menopausal status, previous cesarean delivery, and uterine weight were comparable between groups. Median operative time was shorter with vNOTES than with single-port laparoscopy [58 (IQR, 55-65) vs. 79 (IQR, 75-87) min; p < 0.001], as was hospital stay [2 (IQR, 1-2) vs. 3 (IQR, 3-3) days; p < 0.001]. VAS scores were lower after vNOTES at 24 and 48 h (both p < 0.001), and additional analgesia was required less frequently (19.5% vs. 36.7%; p = 0.048). Preoperative and 3-month FSFI total scores were comparable between groups. FSFI decreased modestly within both groups at 3 months, but ΔFSFI did not differ between single-port and vNOTES groups (-2.17 ± 0.63 vs. -2.03 ± 0.54; p = 0.297). Surgical approach was not independently associated with postoperative FSFI after adjustment (β =0.156; 95% CI, -0.090 to 0.402; p = 0.214). Intraoperative complication rates did not differ significantly (6.1% vs. 0%; p = 0.248).

vNOTES hysterectomy was associated with shorter operative time, shorter hospital stay, lower postoperative pain, and less frequent additional analgesic requirement than transumbilical single-port laparoscopy, while short-term sexual-function outcomes were comparable between techniques. These findings support vNOTES as a feasible scar-minimizing alternative for appropriately selected patients undergoing hysterectomy for benign gynecologic disease.