Two-Year Follow-Up on Surgical Outcomes of vNOTES High Uterosacral Ligament Suspension for the Prophylaxis and Treatment of Pelvic Organ Prolapse: A Multicenter Prospective Cohort Study

Abstract

Study objective: We aimed to evaluate the medium-term outcomes of high uterosacral ligament suspension (HUSLS) with vaginal-assisted natural orifice transluminal endoscopic surgery (vNOTES) in patients either having pelvic organ prolapse or undergoing routine prophylaxis to prevent posthysterectomy vaginal vault prolapse.

Design: Multicenter prospective cohort study.

Setting: Three tertiary care hospitals.

Patients: Patients who received vNOTES-HUSLS between January 1, 2021, and January 1, 2023, were included in the study.

Interventions: vNOTES-HUSLS.

Measurements and main results: The data collected included surgery duration, intraoperative and postoperative complications, postoperative visual analog scores, and Female Sexual Function Index pain subdomain scores. The changes in prolapse levels were measured using modified Pelvic Organ Prolapse Quantifications System scores, including the C, Ba, and Bp scores recorded before surgery and during the postoperative follow-up examination. Patient satisfaction was assessed using the Patient Global Impression of Improvement questionnaire. The final analysis included 55 women. Of these, vNOTES-HUSLS was performed in 43 patients (78.2%) to treat apical prolapse, whereas the remaining 12 patients (21.8%) underwent prophylaxis after hysterectomy to prevent vaginal vault prolapse. The median follow-up period was 23.5 months, with a range of 12 to 37 months. Ba, C, and Bp points significantly improved in patients who underwent surgery for prolapse (p <.001). There was no recurrence in the apical compartment after vNOTES-HUSLS for both performed prophylactic and treatment purposes after hysterectomy. Two patients (3.6%) were diagnosed as having stage 3 anterior compartment prolapse. The overall vNOTES-HUSLS success rate was 96.4% at approximately 2-year follow-up. Bladder injury was detected as an intraoperative complication in 1 patient (1.8%). The overall satisfaction rate was 98.1% at the final follow-up.

Conclusion: vNOTES-HUSLS was effective in the treatment and prophylaxis of apical prolapse, demonstrating high anatomic success rates. The procedure demonstrated a low complication rate, with intraoperative and postoperative complications each observed in 1.8% of patients (n = 1).

Keywords: Gynecologic surgeries; Natural orifice transluminal endoscopic surgery; Pelvic organ prolapse; Uterosacral ligament suspension.