Anatomic and Functional Outcomes After Vaginal Hysterectomy With Mesh-Based V-NOTES Lateral Suspension Versus Sacrospinous Ligament Fixation: A Randomized Controlled Trial

Abstract

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, Gaziosmanpa & scedil;a Training and Research Hospital, Istanbul, T & uuml;rkiye. 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. (c) 2025 AAGL. All rights are reserved, including those for text and data mining, AI training, and similar technologies.