Anatomic and Functional Outcomes After Vaginal Hysterectomy With Mesh-Based V-NOTES Lateral Suspension Versus Sacrospinous Ligament Fixation: A Randomized Controlled Trial.

STUDY

OBJECTIVE

To compare the short-term anatomical and functional outcomes of V-NOTES lateral suspension and sacrospinous ligament fixation (SSLF) following vaginal hysterectomy for apical pelvic organ prolapse.

DESIGN

Prospective, randomized, controlled clinical trial.

SETTING

Department of Obstetrics and Gynecology, Gaziosmanpaşa Training and Research Hospital, Istanbul, Türkiye.

PATIENTS: Ninety women with clinically relevant pelvic organ prolapse, defined as POP-Q point Ba ≥ -1 and/or C ≥ -1, were included and randomized into 2 groups: V-NOTES-LS (n = 48) and SSLF (n = 42).

INTERVENTIONS: Patients underwent vaginal hysterectomy combined with either V-NOTES lateral suspension or sacrospinous ligament fixation.

MEASUREMENTS AND MAIN

RESULTS

POP-Q points and Pelvic Organ Prolapse/Urinary Incontinence Sexual Questionnaire-12 (PISQ-12) scores were evaluated preoperatively and at 12 months. Both groups showed significant anatomical improvement (p < .001). The V-NOTES-LS group demonstrated a small but statistically significant improvement in Aa, Ba, C, and TVL points (p < .05) and in total PISQ-12 scores compared with SSLF (p = .039). Operative time, blood loss, and hospital stay were comparable. No major complications were observed.

CONCLUSION

Both techniques are safe and effective for apical prolapse repair after vaginal hysterectomy. However, V-NOTES lateral suspension provided better anatomical restoration, improved sexual function, and greater preservation of vaginal length. Longer-term multicenter studies are warranted to confirm these outcomes.