Transvaginal Natural Orifice Transluminal Endoscopic Surgery for Sacrocolpopexy: A Pilot Study of 26 Cases

Study Objective: To describe the surgical technique and short-term outcomes for 26 cases of transvaginal natural orifice transluminal endoscopic surgery (vNOTES) sacrocolpopexy for the treatment of pelvic organ prolapse (POP). Design: Retrospective case series study (Canadian Task Force classification II-2). Setting: Academic tertiary care university hospital in Guangdong, China. Patients: Women diagnosed with stages II to IV POP between May 2017 and May 2018. Interventions: vNOTES sacrocolpopexy. Measurements and Main Results: A total of 26 patients were identified. vNOTES sacrocolpopexy was standardized after case 4, and 23 cases were completed successfully. Operative duration was a median of 184 minutes (interquartile range, 158.5–202.5), and mean estimated blood loss was 30.87 ± 20.8 mL. Mean pre- and postoperative POP Quantification System scores for the Aa point were, respectively, 1.4 ± 1.7 cm (range, –2 to 3) versus –1.85 ±.6 cm (p <.0001) and for the C point were 2.2 ± 1.9 cm (range, –1 to 5) versus –6.1±.7 cm (p <.0001). Mean pre- and postoperative Pelvic Floor Impact Questionnaire scores were 163.1 ± 46.2 versus 18.4 ± 29.3 (p <.0001). These suggest significant improvements in both physical prolapse and quality of life at 1 month after surgery. There were no complications of mesh exposure, pain, hematoma, infection, or new urinary incontinence. Conclusion: vNOTES is a feasible approach for sacrocolpopexy, with promising short-term efficacy and safety data. Larger studies across multiple sites and surgeons should evaluate the long-term efficacy and safety profile of vNOTES sacrocolpopexy.