Vaginal natural orifice transluminal endoscopic surgery versus conventional laparoscopy for salpingectomy: a comparative analysis of sexual function, dyspareunia, and perioperative outcomes.

BACKGROUND

This study evaluates the clinical feasibility and perioperative outcomes of vaginal natural orifice transluminal endoscopic surgery (vNOTES) for adnexal procedures, with particular emphasis on postoperative sexual function and dyspareunia.

METHODS

A retrospective cohort study was conducted at İzmir City Hospital between October 2023 and June 2025, including reproductive-aged patients without future fertility desire, an intact uterus, and indications for bilateral salpingectomy for gynecologic cancer prophylaxis. Patients underwent either vNOTES or conventional laparoscopic salpingectomy. Perioperative outcomes-including operative time, blood loss, complications, analgesic use, hospital stay, conversion to laparotomy, hemoglobin change, and pain scores at six and 24 hours-were compared. Postoperative sexual function was assessed using the Female Sexual Function Index (FSFI) and Couple Satisfaction Index-16 (CSI-16) at three and six months. Dyspareunia was evaluated using a standardized surgeon-designed questionnaire.

RESULTS

A total of 467 patients were analyzed (vNOTES: 233; laparoscopy: 234). vNOTES was associated with significantly shorter operative time, reduced intraoperative blood loss, lower postoperative pain scores, and decreased analgesic requirements. No conversions to laparotomy occurred in either group. FSFI and CSI-16 scores showed no significant differences between groups at six months, and dyspareunia rates were comparable.

CONCLUSION

vNOTES salpingectomy demonstrates perioperative advantages over laparoscopy without adversely affecting sexual function. It represents a safe and effective alternative for appropriately selected patients.