The Pure Extraperitoneal Approach for Sacrocolpopexy in Transvaginal Natural-Orifice Transluminal Endoscopic Surgery

Area of Science:

• Minimally Invasive Gynecologic Surgery
• Pelvic Reconstructive Surgery
• Surgical Innovation

Background:

• Pelvic organ prolapse (POP) significantly impacts women's quality of life.
• Traditional surgical approaches for central pelvic defects can be invasive.
• There is a need for minimally invasive techniques offering favorable outcomes.

Purpose of the Study:

• To evaluate the feasibility, safety, and short-term clinical outcomes of pure extraperitoneal sacrocolpopexy utilizing transvaginal natural orifice transluminal endoscopic surgery (V-NOTES).
• To assess the efficacy of this novel technique in treating central pelvic defects.

Main Methods:

• A retrospective analysis of 9 patients with central pelvic prolapse who underwent extraperitoneal sacrocolpopexy with V-NOTES.
• Surgical steps included establishing an extraperitoneal approach via V-NOTES, dissecting to the sacral promontory, and securing mesh to the anterior longitudinal ligament and vaginal cuff.

Main Results:

• All 9 procedures were successful, with a median operative time of 145 minutes and median blood loss of 150 mL.
• Significant improvement in Pelvic Organ Prolapse-Quantification (POP-Q) scores was observed (preoperative C:+4 to 3-month postoperative C:-6).
• No mesh-related complications (erosion, exposure, infection) or prolapse recurrences were reported during 3-11 months of follow-up.

Conclusions:

• Extraperitoneal sacrocolpopexy with V-NOTES represents a safe and feasible surgical option for central pelvic defects.
• This minimally invasive technique demonstrates promising short-term clinical outcomes for pelvic organ prolapse treatment.