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

KETENCİ GENCER F., Salman S., Kumbasar S., Bacak H. B., Coskun E. S., Bilici S. R., ...Daha Fazla

European Journal of Obstetrics and Gynecology and Reproductive Biology, cilt.321, 2026 (SCI-Expanded, Scopus)

Özet

Objective: 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.Study DesignSingle-center retrospective cohort study.MethodA 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.ResultsThe 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.ConclusionBoth 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.