NOTES sacrocolpopexy versus sacrospinous ligament fixation for apical pelvic organ prolapse: a pilot, hypothesis-generating, single-centre retrospective comparative cohort study

<p>To compare anatomical, functional, and safety outcomes of vaginal natural orifice transluminal endoscopic surgery (vNOTES) sacrocolpopexy (SCP) and vNOTES sacrospinous ligament fixation (SSLF) for apical pelvic organ prolapse (POP).</p> <p>Single-centre, single-surgeon, retrospective comparative cohort study conducted in accordance with the STROBE statement. Allocation to vNOTES SSLF (<i>n</i> = 24) or vNOTES SCP with a lightweight polypropylene Y-mesh (<i>n</i> = 32) was based on prespecified intra-operative feasibility criteria rather than randomisation.

The primary outcome was composite apical anatomical success at 12 months (point C ≤ −5 cm and absence of apical POP-Q stage ≥ II). Secondary outcomes included perioperative parameters, visual analogue scale (VAS) pain scores, Quality-of-Recovery-40 (QoR-40), Prolapse Quality-of-Life (P-QOL), ICIQ-UI SF (International Consultation on Incontinence Questionnaire–Urinary Incontinence Short Form) and PGI-I scores, and complications classified with the Clavien–Dindo and IUGA/ICS Category–Time–Site systems.</p> <p>Baseline characteristics were balanced.