Postoperative vaginal anatomy and dyspareunia after vNOTES hysterectomy without apical suspension: a comparative study
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Published on: October 25, 2024
Seyhmus Tunc1, Kevser Arkan2, Huseyin Kayaalp3
1Department of Obstetrics and Gynecology, Diyarbakir Gazi Yasargil Research and Training Hospital, Diyarbakir, Türkiye.
Objective:
This study compared postoperative vaginal length, apical support, dyspareunia, and sexual function outcomes among vNOTES, laparoscopic, and abdominal hysterectomy in patients who did not undergo concomitant apical suspension.
Methods:
This retrospective comparative study included 140 women aged 40-55 years who underwent hysterectomy for benign indications between June 2018 and June 2024. Patients were allocated to three groups according to the surgical approach: vNOTES (n = 60), total laparoscopic hysterectomy (TLH; n = 40), and total abdominal hysterectomy (TAH; n = 40). None of the included patients had undergone concomitant apical suspension at the time of hysterectomy. The primary anatomical outcomes were vaginal length (VL) and apical support, assessed using the Pelvic Organ Prolapse Quantification (POP-Q) C-point, at 6 months postoperatively. Sexual function was assessed using the Female Sexual Function Index (FSFI), and dyspareunia severity was evaluated using a 10-cm visual analog scale (VAS).
Results:
Postoperative vaginal length was shortest in the vNOTES group (7.2 ± 0.6 cm), compared with the TLH (7.9 ± 0.7 cm) and TAH (8.4 ± 0.8 cm) groups (p < 0.001). Similarly, the C-point was located more caudally in the vNOTES group (-4.5 ± 1.0 cm) than in the TLH (-6.1 ± 0.9 cm) and TAH (-6.8 ± 1.0 cm) groups (p < 0.001). Significant differences in FSFI and dyspareunia scores were observed at 6 months, with lower FSFI and higher dyspareunia scores in the vNOTES group (p < 0.001).
Conclusion:
The surgical approach was associated with differences in postoperative vaginal anatomy and dyspareunia. Compared with TLH and TAH, vNOTES without apical suspension was associated with shorter vaginal length, a more caudal apical position, and higher dyspareunia scores. Because apical suspension was not directly evaluated, whether concomitant apical support would modify these outcomes remains unknown and warrants prospective investigation.