Vaginal natural orifice transluminal endoscopic surgery and native tissue repair for a patient with pelvic organ prolapse and an ovarian tumor: A case report

Abstract

Pelvic organ prolapse (POP) is generally treated with vaginal surgery, although concurrent removal of the uterine adnexa is difficult. Recently, vaginal natural orifice transluminal endoscopic surgery (vNOTES) has become widespread in Japan, which allows convenient concurrent removal of the adnexa. However, performing total hysterectomy alone in cases of POP carries the risk of postoperative vault prolapse and is often combined with native tissue repair (NTR) or mesh surgery. Herein, we report a case of an ovarian tumor associated with POP treated with vNOTES and NTR. A 70-year-old woman with a history of three pregnancies presented with symptoms of organ prolapse, dysuria, and a suspected ovarian tumor. Elevated squamous cell carcinoma antigen and cancer antigen 19-9 levels were observed. Imaging revealed a 9 cm mature cystic teratoma in the left ovary and stage III cystocele with uterine prolapse. The patient underwent total vaginal hysterectomy and bilateral adnexectomy via vNOTES, followed by total colpocleisis and posterior colporrhaphy. Postoperative pathology showed no malignancy, the tumor markers normalized, and dysuria improved. This case demonstrates the potential efficacy of combining vNOTES with NTR for the surgical management of POP associated with uterine and adnexal tumors.