Hysterectomy and Shull Suspension Using the V-NOTES Technique Versus Traditional Vaginal Surgery: A Prospective Analysis of Short-Term Efficacy and Safety.

OBJECTIVES

The aim of this study is to describe a modified method for applying Shull's technique using the V-NOTES approach and to compare it with the traditional vaginal technique in terms of efficacy, safety, operative duration, recurrence, and patient-reported outcomes at median follow-up.

METHODS

The study included 40 women with Stage ≥ III uterine prolapse (POP-Q) undergoing conventional vaginal hysterectomy with Shull suspension (vaginal native tissue repair [VNTR] Group A) or V-NOTES hysterectomy with endoscopic Shull suspension (vaginal natural orifice transluminal endoscopic surgery [V-NOTES] Group B) between December 2024 and December 2025. The median follow-up was 6 months. Informed consent was obtained. Outcomes included perioperative parameters, complications, hospital stay, recurrence, and quality-of-life and sexual function.

RESULTS

The median follow-up was 6 months (5-9); 22 patients underwent VNTR (Group A) and 18 V-NOTES (Group B) during hysterectomy and prolapse repair. Both procedures achieved anatomical improvement, with no difference in recurrence (Group A 1 case [4.5%] vs. Group B 0 cases [0%], p = 0.12). Operative time was comparable (Group A 112 ± 25 min vs. Group B 102 ± 22 min, p = 0.06), while hospital stay was shorter with V-NOTES (Group A 2 days (2-3) vs. Group B 1 day (1-2), p = 0.03). Complications were low (Group A 13.6% vs. Group B 0%, p = 0.05), with two ureteral events only in Group A (4.5% each; p = 0.21 and p = 0.22). Sexual function improved (FSFI Group A 29.63 ± 1.97 vs. Group B 29.23 ± 2.01, p = 0.001), with greater satisfaction in V-NOTES (PGI-I "Very much better": 68.2% vs. 88.8%; p = 0.002).

CONCLUSIONS

V-NOTES Shull suspension is a safe and effective alternative with advantages in recovery and patient-reported outcomes.