Anatomical and Sexual Quality of Life Outcome after vNOTES vs Conventional Surgery for Pelvic Organ Prolapse: A Meta-analysis
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Background: Pelvic organ prolapse (POP) is a common condition associated with urinary, bowel, and sexual dysfunction, adversely affecting quality of life. Vaginal natural orifice transluminal endoscopic surgery (vNOTES) has been introduced as a minimally invasive alternative to conventional approaches, but comparative evidence remains limited.
Objectives: To compare anatomical success, complications, operative time, and sexual quality of life following vNOTES versus conventional surgical techniques for POP repair.
Methods: We conducted a systematic review and meta-analysis in accordance with PRISMA guidelines. PubMed, ScienceDirect, and Semantic Scholar were searched for studies published between 2015 and 2025. Studies were selected based on predefined PICO criteria. Fourteen studies met the inclusion criteria from 248 identified records.
Results: vNOTES was associated with higher odds of anatomical success compared with conventional surgery (OR 2.38, 95% CI 1.26–4.52; p=0.008; I²=0%). There was no statistically significant difference in complication rates (RR 0.68, 95% CI 0.38–1.22; p=0.20; I²=0%). Operative time was shorter with vNOTES (MD −15.32 minutes, 95% CI −19.85 to −10.79; p<0.001; I²=70%). Sexual quality of life favored vNOTES (SMD 0.46, 95% CI 0.20–0.72; p=0.0006; I²=65%). Heterogeneity was moderate to high for some outcomes.
Conclusion: vNOTES may be associated with improved anatomical outcomes and shorter operative time, with similar complication rates and modest improvements in sexual quality of life. However, the findings should be interpreted with caution given heterogeneity and potential study-level limitations. Further high-quality, adequately powered randomized trials are warranted.
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