Advancing apical POP treatment: a comparative analysis of vNOTES lateral suspension and laparoscopic lateral suspension.

BACKGROUND

Apical pelvic organ prolapse (POP) significantly impacts quality of life. The vaginal natural orifice transluminal endoscopic surgery lateral suspension (vNOTES LS) combines the benefits of vNOTES and mesh-based suspension. This study compares clinical outcomes of vNOTES LS and laparoscopic lateral suspension (LLS) in patients with ≥ Stage 3 apical POP.

METHODS

In this retrospective cohort study, 80 patients with ≥ Stage 3 apical and/or anterior wall defects underwent hysterectomy with vNOTES LS (n = 40) or LLS (n = 40) between January 2022 and January 2024. Perioperative parameters, postoperative outcomes, and POP-Q measurements (Ba and C) were analyzed.

RESULTS

Preoperative characteristics, including BMI and prolapse stage, were comparable. Postoperative POP-Q measurements (Ba and C) significantly improved in the vNOTES LS group at day 1, month 6, and year 1 (p < 0.05). Operative time and hematocrit changes were similar (p > 0.05). Hospital stay was shorter with vNOTES LS (1.05 ± 0.22 vs. 2.2 ± 0.75 days, p < 0.05), and fewer complications were noted. No urinary injury, mesh erosion, or recurrence occurred in the vNOTES LS group.

CONCLUSIONS

vNOTES LS demonstrated comparable success to LLS with shorter hospital stays and fewer complications. Its minimally invasive nature highlights its potential as a promising alternative for selected patients.