vNOTES Versus Laparoscopic Lateral Suspension for Advanced Pelvic Organ Prolapse: A Single-Center, Single-Surgeon...

Background/Objectives: Vaginal natural orifice transluminal endoscopic surgery lateral suspension (vNOTES-LS) may reduce the perioperative burden of conventional laparoscopic lateral suspension (LLS), but comparative evidence remains limited. We compared perioperative, anatomical, safety, and patient-reported outcomes. Methods: This single-center retrospective cohort included 97 women with stage III-IV pelvic organ prolapse who underwent vNOTES-LS (n = 33) or LLS (n = 64) and completed 12-month follow-up. The primary outcome was anatomical success at 12 months. Results: Operating time was shorter with vNOTES-LS (78.0 ± 16.6 vs. 110.0 ± 14.2 min; p < 0.001), as were estimated blood loss, hospitalization, and 24-h pain scores. After adjustment, vNOTES-LS was associated with a 31.7-min shorter operating time (95% CI, -38.7 to -24.6; p < 0.001). Anatomical success was 87.9% versus 89.1% (p = 1.000; RR, 0.99; 95% CI, 0.85-1.15), with an absolute risk difference of -1.2 percentage points (95% CI, -14.7 to 12.3). Cumulative mesh exposure within 12 months was 9.1% and 9.4%, respectively. No statistically significant between-group differences were detected in recurrence, measured safety outcomes, or longitudinal changes in the Pelvic Floor Distress Inventory-20 (PFDI-20), Pelvic Floor Impact Questionnaire-7 (PFIQ-7), and 12-item Pelvic Organ Prolapse/Urinary Incontinence Sexual Questionnaire (PISQ-12). Conclusions: vNOTES-LS was associated with shorter operating time and favorable early perioperative outcomes. Observed 12-month anatomical success rates were not statistically significantly different; however, equivalence or non-inferiority cannot be concluded.