vNOTES retroperitoneal uterosacropexy using the semitendinosus tendon

The objective of this report is to demonstrate the feasibility of combining the harvested semitendinosus tendon technique (HoTT) technique, originally described laparoscopically, with a retroperitoneal vaginal natural orifice transluminal endoscopic surgery (vNOTES) approach for central compartment prolapse repair.

A 55-year-old woman with stage III uterine prolapse underwent native tissue sacropexy using an autologous semitendinosus tendon via the retroperitoneal vNOTES approach. Via a pararectal entry, the longitudinal ligament was identified, and the uterus was fixed to the longitudinal ligament of the sacrum using the semitendinosus tendon. The procedure combined native tissue repair with minimally invasive access through the vaginal route.

The result was an anatomically successful prolapse correction without any intraoperative or postoperative complications. The patient recovered well and was discharged after 48 hours.

In conclusion, this is the first case to combine vNOTES with the HoTT technique, enabling a minimally invasive, mesh-free, and anatomically precise prolapse repair. vNOTES offers precise dissection and sacral fixation using a vaginal approach. This should lead to fast recovery and reduced postoperative pain. A retroperitoneal approach allows faster operation times and prevents intraperitoneal adhesions. This technique is promising for patients desiring a mesh-free approach. This innovative approach may serve as a promising alternative to conventional techniques in selected patients.