Unilateral versus Bilateral High Uterosacral Ligament Suspension Following vNOTES Hysterectomy for Apical Pelvic Organ Prolapse: A Observational Study.

STUDY

OBJECTIVE

To compare the anatomical and functional outcomes of unilateral versus bilateral high uterosacral ligament suspension performed following vNOTES hysterectomy for apical pelvic organ prolapse.

DESIGN

Prospective observational cohort study.

SETTING

Department of Obstetrics and Gynecology, Gazi Yaşargil Training and Research Hospital, Diyarbakır, Türkiye.

PATIENTS: A total of 160 women aged ≥40 years with symptomatic uterine prolapse undergoing hysterectomy followed by uterosacral ligament suspension.

INTERVENTIONS: Patients were divided according to surgical technique into unilateral (n = 70) and bilateral (n=90) high uterosacral ligament suspension performed after vNOTES hysterectomy.

MEASUREMENTS AND MAIN

RESULTS

The primary outcome was short-term objective anatomical success at 12 months, defined as apical support with point C ≤-1 cm according to the POP-Q system. Both techniques resulted in significant improvement in POP-Q parameters. Apical support improved markedly in both groups with no significant difference between unilateral and bilateral suspension (p = .88). Perioperative outcomes, including operative time, hemoglobin decrease, hospital stay, and postoperative pain, were comparable. Patient-reported outcomes (POPDI-6, CRADI-8, UDI-6, and PISQ-12) also improved substantially in both groups. Postoperative complications were uncommon (7.1% vs 8.9%).

CONCLUSION

Both unilateral and bilateral uterosacral ligament suspension following vNOTES hysterectomy provide effective anatomical and functional improvement in apical pelvic organ prolapse. Unilateral suspension yields outcomes comparable to bilateral suspension and may simplify the surgical procedure. At 12 months, unilateral suspension showed outcomes comparable to bilateral suspension; however, longer follow-up is needed before drawing firm conclusions about its role as an alternative approach.