Abstract
BackgroundTo describe the short-term outcomes of transvaginal natural orifice transluminal endoscopic surgery (vNOTES) for uterosacral ligament suspension (USLS) in patients with severe prolapse.MethodsThis was a retrospective study of patients with severe prolapse (≥ stage 3) who underwent vNOTES for USLS between May 2019 and July 2020. The Pelvic Organ Prolapse Quantification (POP-Q) score, Pelvic Organ Prolapse/Urinary Incontinence Sexual Questionnaire short form (PISQ-12) and Pelvic Floor Inventory-20 (PFDI-20) were used to evaluate physical prolapse and quality of life before and after vNOTES for USLS.ResultsA total of 35 patients were included. The mean operative duration was 111.7 ± 39.4 min. The mean blood loss was 67.9 ± 35.8 ml. Statistically significant differences were observed between before and after vNOTES USLS in Aa (+ 0.6 ± 1.7 versus − 2.9 ± 0.2), Ba (+ 1.9 ± 2.2 versus − 2.9 ± 0.3), C (+ 1.5 ± 2.2 versus − 6.9 ± 0.9), Ap (− 1.4 ± 1.0 versus − 3.0 ± 0.1) and Bp (− 1.1 ± 1.4 versus − 2.9 ± 0.1) (P < 0.05 for all). The mean pre- and postoperative PFDI-20 score was 19.9 ± 6.7 and 3.2 ± 5.4, respectively, and the mean pre- and postoperative PISQ-12 score was 24.8 ± 2.3 and 38.3 ± 4.1, respectively (P < 0.05 for both). During 1–13 months of follow-up, there were no cases of severe complications or recurrence.ConclusionsvNOTES for USLS may be a feasible technique to manage severe prolapse, with promising short-term efficacy and safety. Larger studies with more patients and longer follow-up periods should be performed to evaluate the long-term efficacy and safety profile of vNOTES for USLS.
Highlights
To describe the short-term outcomes of transvaginal natural orifice transluminal endoscopic surgery for uterosacral ligament suspension (USLS) in patients with severe prolapse
The Pelvic Organ Prolapse/ Urinary Incontinence Sexual Questionnaire short form (PISQ-12) and Pelvic Floor Inventory-20 (PFDI-20), were completed before and at least 3 months after Transvaginal natural orifice transluminal endoscopic surgery (vNOTES) for USLS to assess the impact on quality of life
In total, 35 patients underwent vNOTES for USLS; in one patient, vNOTES sacrocolpopexy was planned, but the patient was converted to vNOTES for USLS because of a suspected malignant lesion on the surface of the colon
Summary
To describe the short-term outcomes of transvaginal natural orifice transluminal endoscopic surgery (vNOTES) for uterosacral ligament suspension (USLS) in patients with severe prolapse. Lu et al BMC Surg (2021) 21:286 ligament suspension (USLS) is a commonly performed procedure to support the vaginal apex [5]. Many procedures, such as laparoscopic procedures via an abdominal approach and transvaginal procedures, have been described for USLS. Unger et al performed the largest retrospective series examining transvaginal USLS and found a 4.5% risk of intraoperative ureteral kinking [8]. Houlihan et al compared uterosacral vault suspension at the time of hysterectomy via a laparoscopic versus vaginal approach.
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