Four cases of transvaginal natural orifice transluminal endoscopic hysterectomy and uterosacral ligament suspension

Abstract

Interest in native tissue repair (NTR) as a surgical option for the surgery of pelvic organ prolapse (POP) has undergone a recent resurgence, including the use of NOTES (Natural orifice transluminal endoscope). We used NOTES to perform 4 cases of vaginally associated NOTES hysterectomy (VANH) and uterosacral ligament suspension. We selected this surgical technique primarily for patients with uterine prolapse or ovarian tumors. For patients who also had bladder or rectum prolapse (other than uterine prolapse), we also performed anterior or posterior colporrhaphy. The median surgery and pneumoperitoneum time was 81 [71-111] minutes and 35.5 [24-55] minutes, respectively. Median total blood loss was 15 [0-49] ml. All were discharged on postoperative day 2 without any complications. We are still investigating the long-term prognosis for each of these cases. VANH and uterosacral ligament suspension does not create external scars and results in shorter hospital stays compared to laparoscopic hysterectomy (LH) with uterosacral ligament suspension and laparoscopic/robot-assisted sacrocolpopexy (LSC/RSC). vNOTES also makes it easier to obtain surgical space to recognize ureters and approach the adnexa of the uterus safer compared to conventional vaginal surgery. Therefore, VANH and uterosacral ligament suspension is an NTR technique which may be convenient in the appropriate situation.