Evaluation of the mid-term surgical outcomes of vNOTES sacrocolpopexy and vNOTES high uterosacral ligament suspension in pelvic organ prolapse

Background: This multicenter retrospective study aimed to assess the surgical outcomes of vNOTES-HUSLS and sacrocolpopexy after vNOTES hysterectomy for apical pelvic organ prolapse (POP). Methods: A total of 101 patients were included. Pre and postoperative modified POP-Q scores, postoperative Visual Analog Scale (VAS) scores and complications were among the information gathered. POP-Q-C score of less than −1 cm was considered an apical recurrence. ‘Overall success’ was defined as the absence of each of the following factors: ≥ Stage 2 POP (in any compartment), retreatment for prolapse. Results: vNOTES-HUSLS (n = 78) achieved an overall success rate of 92.2%, accompanied by a low intraoperative complication rate of 2.6% (n = 2) at the 23-month median follow-up. vNOTES-sacrocolpopexy (n = 23) achieved an anatomical success rate of 78.3% and exhibited a low intraoperative complication rate of 4.3% (n = 1) at the 21-month median follow-up. The apical prolapse recurrence rate was 2.6% and 8.7% in the HUSLS and sacrocolpopexy groups, respectively (p = 0.185). Total duration of surgery and VAS scores were significantly lower in the vNOTES-HUSLS group than in the vNOTES-sacrocolpopexy group. Conclusions: In POP surgery, HUSLS and sacrocolpopexy may be performed using the vNOTES technique depending on the patient’s preference for natural tissue repair or mesh use.