Uterine-Sparing vNOTES vs. laparoscopic lateral suspension for pelvic organ prolapse repair: a prospective comparative study of feasibility and early outcomes

Background Vaginal natural orifice transluminal endoscopic surgery (vNOTES) represents a minimally invasive uterus-preserving technique for apical prolapse repair. Comparative data with laparoscopic lateral suspension are scarce. This study aimed to evaluate perioperative performance, anatomical correction, and functional outcomes of both approaches. Methods In this prospective cohort, 100 women with symptomatic anterior–apical pelvic organ prolapse (POP-Q ≥ II) underwent either vNOTES lateral suspension ( n = 50) or LLS ( n = 50). Perioperative metrics, POP-Q parameters, and validated functional questionnaires (POPDI-6, UDI-6, CRADI-8) were recorded preoperatively and at 3 and 6 months. Complications and recurrence were assessed. Radar visualization was used to illustrate POP-Q approximation relative to expected anatomical contours. Results Both techniques provided successful anterior–apical correction. Operative time (60.4 ± 11.2 vs. 90.7 ± 8.4 min; p < 0.001) and length of hospital stay (1.32 ± 0.59 vs. 1.98 ± 0.65 days; p < 0.001) were significantly shorter with vNOTES. POP-Q measurements favored vNOTES at 6 months for Ba and Bp ( p < 0.001), whereas point C and total vaginal length were comparable. Functional outcomes demonstrated lower POPDI-6 and UDI-6 scores in the vNOTES cohort at both follow-ups ( p < 0.05). No mesh exposures occurred. Complication rates were low and did not differ significantly. Radar visualization demonstrated more uniform postoperative approximation in the vNOTES group. Conclusion Both vNOTES and laparoscopic lateral suspension achieved effective uterus-preserving prolapse repair with favorable short-term anatomical and functional results. vNOTES provided faster perioperative recovery and greater functional symptom improvement without compromising safety. Extended follow-up will clarify durability.