Related Experiment Video
Updated: Jun 28, 2026
Development of a Uterosacral Ligament Suspension Rat Model
Published on: August 17, 2022
vNOTES Pelvic Reconstruction and Presacral-uterosacral Ligament Compound Suspension for Treatment of Multicompartment
Jing Peng1, Xiaojuan Wang1, Chengzhen Xiao1
1Obstetrics & Gynecology Hospital, Fudan University (all authors), Shanghai, China; Shanghai Key Lab of Reproduction and Development (all authors), Shanghai, China; Shanghai Key Lab of Female Reproductive Endocrine Related Diseases (all authors), Yangpu, Shanghai, China.
Objective:
To compare the effectiveness and safety of transvaginal natural orifice transluminal endoscopic surgery (vNOTES) pelvic reconstruction (PRC), vNOTES presacral-uterosacral ligament suspension (PULS), and sacrospinous ligament fixation (SSLF) during 3-year follow-up.
Design:
A single-center, open-label, 3-arm, prospective randomized controlled trial.
Setting:
A single-center specialized hospital (Obstetrics & Gynecology Hospital, Fudan University).
Patients:
Women aged 50 to 80 years undergoing initial surgery for severe multicompartment pelvic organ prolapse (POP), with stage II or higher prolapse in 2 or more compartments and no desire for uterine preservation.
Interventions:
Participants were randomly assigned in a 1:1:1 ratio to undergo either vNOTES-PRC (n = 50), vNOTES-PULS with colporrhaphy (n = 50), or SSLF with colporrhaphy (n = 50) following a vaginal hysterectomy.
Measurements And Main Results:
The primary outcome was composite surgical success, defined as absence of prolapse beyond the hymen, absence of bothersome bulge symptoms, and no retreatment (pessary or surgery) for POP in any compartment. Secondary outcomes included anatomic results, patient-reported outcomes, perioperative variables, and surgery-related complications. Among 150 enrolled patients, a total of 140 completed the 3-year follow-up. The composite surgical success rate was highest in the vNOTES-PRC group (95.7%), compared with 78.2% in the vNOTES-PULS group and 74.5% in the SSLF group. No significant difference was observed between vNOTES-PULS and SSLF. Perioperative outcomes and complication rates were similar across all groups.
Conclusions:
vNOTES-PRC was superior to vNOTES-PULS and SSLF in the treatment of severe multicompartment POP based on composite surgical success at 3 years.
