Functional Outcomes After Vaginal Natural Orifice Transluminal Endoscopic Surgery Hysterectomy: A Systematic Review of Sexual Function and Pelvic Floor Integrity.
Charlotte M Wignall, Jane E McDonnell, Batool Nadim
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In 30 seconds
This systematic review evaluated sexual function and pelvic floor outcomes after vaginal Natural Orifice Transluminal Endoscopic Surgery (vNOTES) hysterectomy compared to minimally invasive techniques. Analyzing five studies with 526 patients, the review found that sexual function was similar between vNOTES and laparoscopic methods at 3-6 months, with one study reporting higher FSFI scores (p = 0.003) beyond 6 months.
Key findings
- Sexual function was equivalent between vNOTES and laparoscopic approaches at 3-6 months.
- One study reported higher FSFI scores for vNOTES beyond 6 months (p = 0.003).
- Dyspareunia rates were comparable between the two surgical methods.
- Pelvic floor outcomes suggested improved anterior compartment support (POP-Q Aa; p < 0.003).
Why it matters
Understanding the functional outcomes of vNOTES hysterectomy is crucial for clinicians to provide informed counseling to patients considering this surgical option, especially as uptake declines despite its advantages.
What to keep in mind
The review included small sample sizes and observational studies, which limited the overall certainty of the evidence.