Sexual quality of life after hysterectomy performed by conventional laparoscopy versus Vaginal Natural Orifice Transluminal Endoscopic Surgery (vNOTES) in benign gynecology - 2025
Sexual quality of life after hysterectomy performed by conventional laparoscopy versus Vaginal Natural Orifice Transluminal Endoscopic Surgery (vNOTES) in benign gynecology
adenomyosis; hysterectomy; laparoscopy; vNOTES; sexual quality of life
Abstract :
[en] Background
Hysterectomy is a common surgical procedure in gynecology, performed through abdominal, vaginal, and laparoscopic techniques. The vaginal route is typically preferred for benign conditions like fibroids, adenomyosis, and uterine prolapse due to shorter operative time, faster recovery, reduced pain, and fewer complications. In cases where the uterus is large or vaginal access is restricted, a laparoscopic approach may be necessary. A minimally invasive alternative, Vaginal Natural Orifice Transluminal Endoscopic Surgery (vNOTES), allows hysterectomy via vaginal access using a combination of endoscopic and laparoscopic techniques.
Objectives
To evaluate if sexual quality of life (sQoL) is impaired by using vNOTES for hysterectomy compared to conventional laparoscopy in benign gynecology.
Methods
A retrospective monocentric study. One hundred and twenty seven patients were included in the study. Of these, 91 underwent TLH and 36 vNOTES hysterectomies between September 2020 and October 2022 at Brugmann University Hospital.
Main Outcome Measures
This study compares SQoL after hysterectomy performed via conventional laparoscopy versus vNOTES for benign gynecological conditions.
Results
Regarding surgical characteristics, there were no differences between the two groups in terms of operative time, drop in blood hemoglobin levels and days of hospitalisation. Arousal and Orgasm scores are improved post-operatively in patients suffering from adenomyosis (4.47 vs. 3.91 <em>P</em> 0.04 for arousal and 5.07 vs. 4.26, <em>P</em> 0.016 for orgasm).
Conclusions
The vNOTES method shows shorter hospital stay and faster re-introduction to sexual life over conventional laparoscopy for total hysterectomy in patients with benign gynecology.
What is New
Our study shows that in patients suffering from adenomyosis, sQoL improved after hysterectomy using the vNOTES approach.
Disciplines :
Reproductive medicine (gynecology, andrology, obstetrics)
Nisolle, Michelle ; Université de Liège - ULiège > Département des sciences cliniques
Karampelas, Stavros
Language :
English
Title :
Sexual quality of life after hysterectomy performed by conventional laparoscopy versus Vaginal Natural Orifice Transluminal Endoscopic Surgery (vNOTES) in benign gynecology
Neis KJ, Zubke W, Fehr M, Römer T, Tamussino K, Nothacker M. Hysterectomy for benign uterine disease. Dtsch Arztebl Int. 2016;113:242-9.
Buderath P, Kimmig R, Dominowski L. Hysterectomy in benign conditions: a 20-year single-center retrospective on the development of surgical techniques. Arch Gynecol Obstet. 2023;307:807-12.
Aarts JW, Nieboer TE, Johnson N, Tavender E, Garry R, Mol BW, et al. Surgical approach to hysterectomy for benign gynaecological disease. Cochrane Gynaecology and Fertility Group, ed. Cochrane Database Syst Rev. 2015;2015:3677.
Baekelandt J, De Mulder PA, Le Roy I, Mathieu C, Laenen A, Enzlin P, et al. Postoperative outcomes and quality of life following hysterectomy by natural orifice transluminal endoscopic surgery (NOTES) compared to laparoscopy in women with a non-prolapsed uterus and benign gynaecological disease: a systematic review and meta-analysis. Eur J Obstet Gynecol Reprod Biol. 2017;208:6-15.
Lee SH, Oh SR, Cho YJ, Han M, Park JW, Kim SJ, et al. Comparison of vaginal hysterectomy and laparoscopic hysterectomy: a systematic review and meta-analysis. BMC Women’s Health. 2019;19:83.
Li CB, Hua KQ. Transvaginal Natural Orifice Transluminal Endoscopic Surgery (vNOTES) in gynecologic surgeries: a systematic review. Asian J Surg. 2020;43:44-51.
Zorrón R, Filgueiras M, Maggioni LC, Pombo L, Lopes Carvalho G, Lacerda Oliveira A. NOTES transvaginal cholecystectomy: report of the first case. Surg Innov. 2007;14:279-83.
Su H, Yen CF, Wu KY, Han CM, Lee CL. Hysterectomy via Transvaginal Natural Orifice Transluminal Endoscopic Surgery (NOTES): Feasibility of an innovative approach. Taiwan J Obstet Gynecol. 2012;51:217-21.
Baekelandt J, De Mulder PA, Le Roy I, Mathieu C, Laenen A, Enzlin P, et al. Hysterectomy by Transvaginal Natural Orifice Transluminal Endoscopic Surgery versus laparoscopy as a day‐care procedure: a randomised controlled trial. BJOG. 2019;126:105-13.
Yang CY, Shen TC, Lin CL, Chang YY, Huang CC, Lin WC. Surgical outcomes of hysterectomy by Transvaginal Natural Orifice Transluminal Endoscopic Surgery (vNOTES) compared with laparoscopic total hysterectomy (LTH) in women with non-prolapsed and benign uterine diseases. Taiwan J Obstet Gynecol. 2020;59:565-9.
Krentel H, De Wilde RL. Prevalence of adenomyosis in women undergoing hysterectomy for abnormal uterine bleeding, pelvic pain or uterine prolapse – a retrospective cohort study. Ann Med Surg (Lond). 2022;78:103809.
Filip G, Balzano A, Cagnacci A. Histological evaluation of the prevalence of adenomyosis, myomas and of their concomitance. Minerva Ginecol. 2019;71:177-81.
Rosen R, Brown C, Heiman J, Leiblum S, Meston C, Shabsigh R, et al. The Female Sexual Function Index (FSFI): a multidimensional self-report instrument for the assessment of female sexual function. J Sex Marital Ther. 2000;26:191-208.
Lauterbach R, Matanes E, Amit A, Wiener Z, Lowenstein L. Transvaginal Natural Orifice Transluminal Endoscopic (vNOTES) hysterectomy learning curve: feasibility in the hands of skilled gynecologists. Isr Med Assoc J. 2020;22:13-6.
Lamblin G, Mansoor A, Nectoux L, Provost M, Chabert P, Carriere M, et al. [How I do… a vaginal hysterectomy with V-NOTES technique]. Gynecol Obstet Fertil Senol. 2020;48:827-33.
Baron C, Netter A, Tourette C, Pivano A, Agostini A, Crochet P. Initial experience with vNOTES hysterectomy for benign conditions in a French university hospital. Facts Views Vis Obgyn. 2022;14:147-53.
Kaya C, Alay I, Cengiz H, Yıldız GO, Baghaki HS, Yasar L. Comparison of hysterectomy cases performed via conventional laparoscopy or vaginally assisted natural orifice transluminal endoscopic surgery: a paired sample cross-sectional study. J Obstet Gynaecol. 2021;41:434-8.
Meston CM, Freihart BK, Handy AB, Kilimnik CD, Rosen RC. Scoring and interpretation of the FSFI: what can be learned from 20 years of use? J Sex Med. 2020;17:17-25.
Bucher P, Ostermann S, Pugin F, Morel P. Female population perception of conventional laparoscopy, transumbilical LESS, and transvaginal NOTES for cholecystectomy. Surg Endosc. 2011;25:2308-15.
Dundar B, Dincgez Cakmak B, Aykanat Y, Macunluoglu AC. Laparoscopic versus vaginal cuff closure in laparoscopic hysterectomy: does it affect female sexuality? Ginekol Pol. 2019;90:365-70.
Uccella S, Capozzi VA, Ricco’ M, Perrone E, Zanello M, Ferrari S, et al. Sexual function following laparoscopic versus Transvaginal Closure of the Vaginal Vault after Laparoscopic Hysterectomy: secondary analysis of a randomized trial by the Italian Society of Gynecological Endoscopy Using a Validated Questionnaire. J Minim Invasive Gynecol. 2020;27:186-94.
Bastu E, Yasa C, Dural O, Ozgor BY, Yilmaz G, Gungor Ugurlucan F, et al. Comparison of 2 methods of vaginal cuff closure at laparoscopic hysterectomy and their effect on female sexual function and vaginal length: a randomized clinical study. J Minim Invasive Gynecol. 2016;23:986-93.
Alcalde AM, Martínez-Zamora MÁ, Gracia M, Ros C, Rius M, Carmona F. Assessment of quality of sexual life in women with adenomyosis. Women Health. 2021;61:520-6.
Andersson JK, Khan Z, Weaver AL, Vaughan LE, Gemzell-Danielsson K, Stewart EA. Vaginal bromocriptine improves pain, menstrual bleeding and quality of life in women with adenomyosis: a pilot study. Acta Obstet Gynecol Scand. 2019;98:1341-50.
Raquet J, Namèche L, Nisolle M, Closon F. The revival of vaginal surgery in the era of endoscopy: V-NOTES initial experience with a series of 32 patients. Facts Views Vis Obgyn. 2023;15:69-78.
