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Published on: August 17, 2022
Anatomic and Functional Outcomes After Vaginal Hysterectomy With Mesh-Based V-NOTES Lateral Suspension Versus
Havva Betul Bacak1, Suleyman Salman1, Enes Serhat Coskun1
1Department of Obstetrics and Gynecology, University of Health Sciences Gaziosmanpasa Training and Research Hospital (Drs Bacak, Salman, Coskun, Kumbasar, Gencer, Timur, Bilici, Atar, Guven, and Hazır), Istanbul, Türkiye.
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.
