Minimally invasive lateral suspension for pelvic organ prolapse: which route, laparoscopy or vNOTES?

To compare laparoscopic lateral suspension (LLS) and transvaginal natural orifice transluminal endoscopic surgery lateral suspension (vNOTES-LS) in the surgical treatment of pelvic organ prolapse (POP), focusing on anatomical outcomes and complication rates.

Single-center retrospective cohort study.

A total of 111 women with stage ≥ 2 apical POP who underwent LLS (n = 63) or vNOTES-LS (n = 48) between August 2020 and March 2024. Subgroup analyses were performed based on uterine preservation status.

The overall surgical success rate was 82.5% in the LLS group and 95.8% in the vNOTES-LS group. vNOTES-LS was associated with significantly greater improvement in POP-Q points (Aa, Ap, Ba,Bp, C; p < 0.05 for all). Reoperation rates were significantly lower in the vNOTES uterine-preserving subgroup compared to the corresponding LLS subgroup (4.2% vs. 17.5%, p = 0.035). Estimated blood loss was higher in the vNOTES group (p = 0.0001). Intraoperative and postoperative complication rates were comparable between the groups (p > 0.05 for all). All late mesh removals due to pelvic pain occurred in the LLS group.

Both LLS and vNOTES-LS are effective and safe techniques for POP repair. vNOTES-LS appears to provide superior anatomical outcomes and lower reoperation rates, particularly uterine-preserving cases, supporting its broader adoption in minimally invasive pelvic reconstructive surgery.