vNOTES high uterosacral ligament suspension versus laparoscopic lateral suspension in the management of vaginal vault prolapse: initial experience in a single tertiary center.

Background/aim: The optimal technique for vaginal vault prolapse correction has yet to be identified. This study aimed to evaluate the anatomic and functional outcomes of women who underwent vaginal natural orifice transluminal endoscopic high uterosacral ligament suspension (vNOTES HUSLS) or laparoscopic lateral suspension (LLS). Materials and methods: This retrospective study included symptomatic women with stage ≥2 vault prolapse who underwent vNOTES HUSLS or LLS between January 2019 and June 2022 at a tertiary center. The surgical efficacy, postoperative outcomes, complication rates, and recurrence frequencies of these procedures were compared. The primary outcomes of the study included anatomical success, patient-reported (subjective) success, and recurrence rates. Results: The study included 64 women, 32 of whom underwent vNOTES HUSLS and 32 of whom underwent LLS. Demographic characteristics and preoperative Pelvic Organ Prolapse Quantification (POP-Q) values were comparable (p > 0.05). The mean Patient Global Impression of Improvement (PGI-I) score did not differ significantly between the groups (1.6 ± 0.8 vs. 1.7 ± 0.7, p = 0.344). Improvements in terms of sexual function scores (p < 0.001) were observed postoperatively in both groups. No difference was observed in postoperative sexual questionnaires scores (p > 0.05). Vault suspension by vNOTES produced better results only for point Ba (most distal portion of the remaining upper anterior side of the vaginal wall) of the POP-Q score (p = 0.03). The incidence rates and types of postoperative complications and recurrences were similar between the groups. Conclusion: Both vNOTES HUSLS and LLS safely support the vault and restore the normal vaginal anatomy with similar effectiveness. Functional results were also similar and satisfactory between the groups.