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

Abstract

<h4>Study objective</h4>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.<h4>Design</h4>Prospective, randomized, controlled clinical trial.<h4>Setting</h4>Department of Obstetrics and Gynecology, Gaziosmanpaşa Training and Research Hospital, Istanbul, Türkiye.<h4>Patients</h4>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).<h4>Interventions</h4>Patients underwent vaginal hysterectomy combined with either V-NOTES lateral suspension or sacrospinous ligament fixation.<h4>Measurements and main results</h4>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.<h4>Conclusion</h4>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.