Extraperitoneal versus transperitoneal approach in vNOTES sacrocolpopexy: a comparative pilot study

Area of Science:

• Minimally Invasive Gynecologic Surgery
• Pelvic Floor Reconstruction
• Surgical Innovation

Background:

• Pelvic organ prolapse (POP) significantly impacts women's quality of life.
• Sacrocolpopexy is a key surgical intervention for advanced POP.
• Vaginal NOTES (natural orifice transluminal endoscopic surgery) offers a minimally invasive alternative.

Purpose of the Study:

• To evaluate the feasibility and safety of extraperitoneal vNOTES sacrocolpopexy.
• To compare short-term outcomes of extraperitoneal versus transperitoneal vNOTES sacrocolpopexy.
• To assess anatomical success and patient recovery metrics.

Main Methods:

• Retrospective analysis of 36 patients with POP-Q stage III or higher undergoing vNOTES hysterectomy, BSO, and sacrocolpopexy.
• Patients divided into extraperitoneal (n=14) and transperitoneal (n=22) groups.
• Outcomes assessed using POP-Q, P-QOL, ICIQ-UI SF, QoR-15, and MESH-R scales at six months.

Main Results:

• Similar six-month anatomical success rates: 90.8% (extraperitoneal) vs. 91.6% (transperitoneal).
• Extraperitoneal approach required significantly lower Trendelenburg angles (10°-15° vs. 25°-30°).
• Trends favored extraperitoneal approach for operative time and time to first stool, though not statistically significant. No major complications reported.

Conclusions:

• Extraperitoneal vNOTES sacrocolpopexy is a feasible and safe surgical option.
• Achieves comparable anatomical outcomes to the transperitoneal approach at six months.
• Reduced Trendelenburg positioning may benefit high-BMI patients; larger trials needed to confirm benefits.