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

Abstract

<h4>Background</h4>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.<h4>Methods</h4>In this retrospective cohort study, 80 patients with ≥ Stage 3 apical and/or anterior wall defects underwent hysterectomy with vNOTES LS (<i>n</i> = 40) or LLS (<i>n</i> = 40) between January 2022 and January 2024. Perioperative parameters, postoperative outcomes, and POP-Q measurements (Ba and C) were analyzed.<h4>Results</h4>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 (<i>p</i> < 0.05). Operative time and hematocrit changes were similar (<i>p</i> > 0.05). Hospital stay was shorter with vNOTES LS (1.05 ± 0.22 vs. 2.2 ± 0.75 days, <i>p</i> < 0.05), and fewer complications were noted. No urinary injury, mesh erosion, or recurrence occurred in the vNOTES LS group.<h4>Conclusions</h4>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.