2025 Volume 21 Issue 1 Pages 1-5
Background: Natural Orifice Transluminal Endoscopic Surgery (NOTES) utilizes natural orifices for endoscopic procedures. In gynecology, vaginal NOTES (vNOTES) has been applied to total hysterectomy and to POP surgery. This study evaluates the outcomes of vNOTES for vaginal apex suspension in uterine prolapse.
Methods: We reviewed 6 cases of women with POP-Q Stage 3 or greater uterine prolapse, with or without mild cystocele, who underwent vNOTES vaginal apex suspension using GelPOINTⓇV-Path. All patients had a follow-up period of one year. The surgical technique involved the hysterectomy followed by suspension of the vaginal apex using delayed absorbable sutures at six sites: bilateral uterosacral ligaments and three sites on the Douglas pouch peritoneum.
Results: The mean age of patients was 69.7 years. The average operative time was 134.8 minutes with minimal blood loss. At one-year follow-up, there were no cases of vaginal apex recurrence. However, there was one case each of rectocele recurrence and ectopic cystocele recurrence.
Conclusion: vNOTES for vaginal apex suspension demonstrated favorable outcomes at one year. Although there was an incidence of ectopic recurrence, vNOTES remains a viable minimally invasive technique for managing uterine prolapse. Continued vigilance for recurrence is advised.
