Akademik Veri Yönetim Sistemi
IUGA/EUGA Joint Meeting 2025, IUGA 50th Annual Meeting, Barcelona, İspanya, 18 Haziran 2025, ss.249, (Özet Bildiri)
Introduction:
Pelvic organ prolapse (POP) is a common and distressing condition
among postmenopausal women. Stage 2 apical prolapse, characterized
by descent of the uterine cervix or vaginal vault, requires surgical
correction in symptomatic cases if conservative or first-line treatment
methods provide inadequate resolution of symptoms. Traditional surgical
approaches-vaginal, abdominal, or laparoscopic- have limitations.
This video article presents the suspension of the vaginal vault to the
uterosacral ligaments after vaginal hysterectomy using the vaginal Natural
Orifice Transluminal Endoscopic Surgery (vNOTES) approach.
Combining the advantages of vaginal surgery with the precision of
endoscopic technology, vNOTES offers an innovative solution for
restoring pelvic support.
Objective:
This video demonstrates the step-by-step technique of vNOTES uterosacral
ligament suspension of the vaginal vault, focusing on restoring
the anatomy while reducing postoperative complications.
Methods:
A 55-year-old patient with stage 2 apical prolapse underwent vaginal
hysterectomy, and the vaginal vault was fixated on the uterosacral ligaments
using the vNOTES approach under general anesthesia. After
completion of the hysterectomy,anterior colporrhaphy was performed
and a self-made pessary port (70 mm ring pessary) was inserted for
endoscopic visualization. The procedure included bilateral salpingooophorectomy
and identification of uterosacral ligaments. Using No.
0 Vicryl sutures, the vaginal vault was secured to the mid-portion of
the bilateral uterosacral ligaments, ensuring proper tension for support.
Hemostasis was confirmed, the incision was closed, and cystoscopy
was performed to check ureteral integrity.
Results:
The surgery was completed without any complications. The patient
experienced minimal blood loss and was discharged on the following
day. At the three-month follow-up, she reported significant symptom
improvement, and pelvic examination confirmed restored apical support
with no recurrence.
Conclusions:
vNOTES uterosacral ligament suspension seems to be a safe, effective,
and minimally invasive option for vaginal apex support after
vaginal hysterectomy. Additionally, it has the advantage of performing
salpingo-oophorectomy with better visualization. Further studies
are needed to evaluate the long-term outcomes and broader clinical
applications.
Disclosure: No