Transvaginal natural orifice transluminal endoscopic surgery for uterosacral ligament suspension: pilot study of 35 cases of severe pelvic organ prolapse

Background To describe the short-term outcomes of transvaginal natural orifice transluminal endoscopic surgery (vNOTES) for uterosacral ligament suspension (USLS) in patients with severe prolapse. Methods This was a retrospective study of patients with severe prolapse (>= stage 3) who underwent vNOTES for USLS between May 2019 and July 2020. The Pelvic Organ Prolapse Quantification (POP-Q) score, Pelvic Organ Prolapse/Urinary Incontinence Sexual Questionnaire short form (PISQ-12) and Pelvic Floor Inventory-20 (PFDI-20) were used to evaluate physical prolapse and quality of life before and after vNOTES for USLS. Results A total of 35 patients were included. The mean operative duration was 111.7 +/- 39.4 min. The mean blood loss was 67.9 +/- 35.8 ml. Statistically significant differences were observed between before and after vNOTES USLS in Aa (+ 0.6 +/- 1.7 versus - 2.9 +/- 0.2), Ba (+ 1.9 +/- 2.2 versus - 2.9 +/- 0.3), C (+ 1.5 +/- 2.2 versus - 6.9 +/- 0.9), Ap (- 1.4 +/- 1.0 versus - 3.0 +/- 0.1) and Bp (- 1.1 +/- 1.4 versus - 2.9 +/- 0.1) (P < 0.05 for all). The mean pre- and postoperative PFDI-20 score was 19.9 +/- 6.7 and 3.2 +/- 5.4, respectively, and the mean pre- and postoperative PISQ-12 score was 24.8 +/- 2.3 and 38.3 +/- 4.1, respectively (P < 0.05 for both). During 1-13 months of follow-up, there were no cases of severe complications or recurrence. Conclusions vNOTES for USLS may be a feasible technique to manage severe prolapse, with promising short-term efficacy and safety. Larger studies with more patients and longer follow-up periods should be performed to evaluate the long-term efficacy and safety profile of vNOTES for USLS.