A case of transvaginal natural orifice transluminal endoscopic hysterectomy and uterosacral ligament suspension for apical support of the vaginal cuff

Abstract

NOTES (Natural Orifice Transluminal Endoscopic Surgery) is an endoscopic technique that uses natural orifices to access the cavities of the human body to perform surgical interventions. In Japan, GelPOINT^® V-Path for vaginal NOTES (vNOTES) has been available since January 2020. We report a case of pelvic organ prolapse who underwent a native tissue repair with vNOTES. A 66-year-old woman (gravida2, para2) with POP-Q stage Ⅲ symptomatic uterine prolapse was referred to our hospital. We performed a total hysterectomy and uterosacral ligament colpopexy using GelPOINT^® V-Path. No perioperative complications were observed. The vNOTES technique is a fusion of conventional vaginal surgery and laparoscopic surgery—and is less invasive than abdominal surgery. It allows for safe colpopexy by visualizing anatomical structures of the ureter and the uterosacral ligament, however, long-term follow up and technical improvements are required.