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Surgical outcomes and postoperative sexual function after vNOTES versus TU-LESS ovarian cystectomy: a randomized
Jiaxin Chen1, Dan Feng1, Tianjiao Liu1
1Department of Gynecology, Chengdu Women's and Children's Central Hospital, School of Medicine, University of Electronic Science and Technology of China, No. 1617, Riyue Avenue, Chengdu, 610091, Sichuan, People's Republic of China.
Objective:
To compare surgical outcomes and sexual function after Transvaginal natural orifice transluminal endoscopic surgery (vNOTES) versus transumbilical laparoendoscopic single-site surgery (TU-LESS) ovarian cystectomy.
Design:
Randomized controlled trial.
Setting:
A university-affiliated tertiary women's and children's hospital.
Population:
160 women with benign ovarian cysts randomized 1:1 to vNOTES or TU-LESS.
Methods:
After written informed consent, candidates underwent two-step eligibility assessment before and after anesthesia to confirm suitability for both approaches. Participants were then randomly assigned to vNOTES or TU-LESS ovarian cystectomy. Perioperative outcomes were prospectively collected. Pain was assessed using a visual analogue scale at 12, 24, and 48 h. Cosmetic satisfaction was evaluated at 1 month, and sexual function was assessed preoperatively and at 3-6 months using the Female Sexual Function Index.
Main Outcome Measures:
Conversion, operative outcomes, complications, recovery, pain, cosmetic satisfaction, and sexual function.
Results:
No conversion occurred. Intraoperative complications, operative time, blood loss, postoperative complications (5.0% vs 3.8%), rescue analgesic use, wound events, incisional hernia, and postoperative FSFI scores between 3rd and 6th postoperative months were comparable between vNOTES and TU-LESS groups. vNOTES yielded lower pain scores at 12, 24, and 48 h, shorter total and postoperative hospital stay, and higher cosmetic satisfaction (all p < 0.001).
Conclusion:
vNOTES ovarian cystectomy demonstrated perioperative safety and postoperative sex function comparable to TU-LESS, while offering superior early postoperative pain control, shorter hospitalization, and better cosmetic satisfaction.
Trial Registration:
ChiCTR2100053483, registered on 22 November 2021 ( https://www.chictr.org.cn/showprojEN.html?proj=136407 ).
