Sexual quality of life after hysterectomy performed by conventional laparoscopy versus Vaginal Natural Orifice Transluminal Endoscopic Surgery (vNOTES) in benign gynaecology.

Background: Hysterectomy is a common surgical procedure in gynaecology, 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 gynaecology. 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 haemoglobin levels and days of hospitalisation. Arousal and Orgasm scores are improved post-operatively in patients suffering from adenomyosis (4.47 vs. 3.91 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 gynaecology. What is New: Our study shows that in patients suffering from adenomyosis, sQoL improved after hysterectomy using the vNOTES approach.