Comparative Analysis of Sacrospinous Ligament Fixation versus vNOTES-Assisted High Uterosacral Ligament Plication for Apical Prolapse during Vaginal Hysterectomy: A Retrospective Cohort Study

This study investigates the anatomical and functional outcomes of two surgical techniques for apical prolapse during vaginal hysterectomy: traditional Sacrospinous Ligament Fixation (SSF) and vNOTES-assisted High Uterosacral Ligament Plication (USLP). While both methods achieved similar anatomical success rates, the vNOTES approach demonstrated superior functional outcomes, including greater postoperative vaginal length and a lower incidence of de novo dyspareunia, despite a longer operative time. The authors suggest that vNOTES may offer advantages over SSF, although the results should be interpreted with caution due to the study's small sample size and retrospective nature.