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Transvaginal natural orifice transluminal endoscopic surgery for presacral–uterosacral ligament compound suspension in apical compartment prolapse

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Abstract

Introduction and hypothesis

We aimed to describe a novel mesh-free pelvic repair surgery for apical prolapse and to evaluate the effect of this technique and early outcomes.

Methods

We demonstrate the key techniques in a video: exposing the anterior longitudinal ligament (ALL) of the presacral space; securing a non-absorbable suture to the ALL by horoscope stitch; shortening the right uterosacral ligament (USL); placing a non-absorbable suture around the intermediate portion of the left USL for three stitches; placing the non-absorbable suture in the transverse portion of the pubocervical and rectovaginal fascia; locking sutures in place to approximate anterior to posterior connective tissue. Fifteen patients were enrolled to undergo this procedure between December 2020 and April 2021.

Results

The mean age of the patients was 60.67 (range 46–69) years, the mean body mass index was 24.25 kg/m2 (range 19.61–30.08). The mean operation time was 103.6 min (range 65–166), and the mean blood loss was 82 ml (range 50–200). No intraoperative complications occurred. All patients gained a significant improvement in anatomical and objective outcomes during a mean 9.93-month follow-up, and there was no recurrence.

Conclusions

Our experience showed that this mesh-free repair surgery was a feasible and safe technique for apical prolapse.

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Fig. 1

References

  1. Maher CF, Baessler KK, Barber MD, Cheon C, Consten ECJ, Cooper KG, et al. Summary: 2017 International Consultation on Incontinence Evidence-Based Surgical Pathway for Pelvic Organ Prolapse. Female Pelvic Med Reconstr Surg. 2020;26(1):30–6.

    Article  Google Scholar 

  2. Barber MD, Brubaker L, Burgio KL, Richter HE, Nygaard I, Weidner AC, et al. Comparison of 2 transvaginal surgical approaches and perioperative behavioral therapy for apical vaginal prolapse: the OPTIMAL randomized trial. JAMA. 2014;311(10):1023–34.

    Article  CAS  Google Scholar 

  3. Margulies RU, Rogers MA, Morgan DM. Outcomes of transvaginal uterosacral ligament suspension: systematic review and metaanalysis. Am J Obstet Gynecol. 2010;202(2):124–34.

    Article  Google Scholar 

  4. Baekelandt JF, De Mulder PA, Le Roy I, Mathieu C, Laenen A, Enzlin P, et al. Hysterectomy by transvaginal natural orifice transluminal endoscopic surgery versus laparoscopy as a day-care procedure: a randomised controlled trial. BJOG. 2019;126(1):105–13.

    Article  CAS  Google Scholar 

  5. Aharoni S, Matanes E, Lauterbach R, Mor O, Weiner Z, Lowenstein L. Transvaginal natural orifice transluminal endoscopic versus conventional vaginal hysterectomy with uterosacral ligament suspension for apical compartment prolapse. Eur J Obstet Gynecol Reprod Biol. 2021;260:203–7.

    Article  Google Scholar 

  6. Li J, Hu C, Wang X, Hua K, Chen Y. Transvaginal single-port laparoscopic pelvic reconstruction with Y-shaped mesh: experiences of 93 cases. Int Urogynecol J. 2021;32(6):905–11.

    Article  Google Scholar 

  7. Lu Z, Chen Y, Wang X, Li J, Hua K, Hu C. Transvaginal natural orifice transluminal endoscopic surgery for uterosacral ligament suspension: pilot study of 35 cases of severe pelvic organ prolapse. BMC Surg. 2021;21(1):286.

    Article  Google Scholar 

  8. Lowenstein L, Baekelandt J, Paz Y, Lauterbach R, Matanes E. Transvaginal natural orifice transluminal endoscopic hysterectomy and apical suspension of the vaginal cuff to the uterosacral ligament. J Minim Invasive Gynecol. 2019;26(6):1015.

    Article  Google Scholar 

  9. Liu J, Lin Q, Zhou X, Wu C, Guan Z, Guan X. Techniques for apical prolapse management in transvaginal natural orifice transluminal endoscopic surgery high uterosacral ligament suspension. J Minim Invasive Gynecol. 2021;28(6):1144–5.

    Article  Google Scholar 

  10. Pelvic Organ Prolapse. ACOG Practice Bulletin, Number 214. Obstet Gynecol. 2019;134(5):e126–42.

    Article  Google Scholar 

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Funding

This study was supported by Science and Technology Innovation Plan Of Shanghai Science and Technology Commission (Grant No. 21Y11906700, 20Y11907300).

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Authors and Affiliations

  1. Department of Gynecology, Obstetrics and Gynecology Hospital of Fudan University, 128 Shenyang Road, Shanghai, 200050, People’s Republic of China

    Xiaojuan Wang, Junwei Li, Keqin Hua & Yisong Chen

  2. Shanghai Key Laboratory of Female Reproductive Endocrine Related Diseases, 413 ZhaoZhou Road, Shanghai, 200011, People’s Republic of China

    Xiaojuan Wang, Junwei Li, Keqin Hua & Yisong Chen

  3. Shanghai Medical College, Fudan University, 138 Yixueyuan Road, Shanghai, 200032, People’s Republic of China

    Kinji Arikawa

Authors
  1. Xiaojuan Wang
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  2. Kinji Arikawa
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  3. Junwei Li
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  4. Keqin Hua
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  5. Yisong Chen
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Contributions

Xiaojuan Wang: manuscript writing and data collection; Kinji Arikawa: recording and data collection; Junwei Li: assistant of surgery; Keqin Hua: protocol development and surgery performed; Yisong Chen: protocol development and surgery performed.

Corresponding authors

Correspondence to Keqin Hua or Yisong Chen.

Ethics declarations

Details of ethics approval

Investigational review board approval (2019-32, 26 March 2019) was obtained from Obstetrics and Gynecology Hospital of Fudan University.

Consent

Written informed consent was obtained from the patient for publication of this video article and any accompanying images.

Conflicts of interest

None.

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Wang, X., Arikawa, K., Li, J. et al. Transvaginal natural orifice transluminal endoscopic surgery for presacral–uterosacral ligament compound suspension in apical compartment prolapse. Int Urogynecol J 34, 301–304 (2023). https://doi.org/10.1007/s00192-022-05292-5

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  • DOI: https://doi.org/10.1007/s00192-022-05292-5

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