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Transvaginal Natural Orifice Transluminal Endoscopic Hysterectomy and Apical Suspension of the Vaginal Cuff to the Uterosacral Ligament.
J Minim Invasive Gynecol. 2019 Sep-Oct; 26(6):1015.JM

Abstract

STUDY OBJECTIVE

Transvaginal natural orifice transluminal endoscopic surgery (vNOTES) offers similar advantages of traditional vaginal surgery including no incisional pain as well as a better cosmetic outcome. Furthermore, vNOTES allows the surgeon to overcome the limited surgical space and lack of exposure when using the traditional vaginal instrumentation. Vaginal uterosacral ligament suspension subsequent to vaginal hysterectomy has the advantages of a mesh-free, minimally invasive approach for the treatment of pelvic organ prolapse. The objective of this video is to demonstrate a surgical technique and a few tips and tricks for vNOTES hysterectomy and uterosacral ligament suspension.

DESIGN

Stepwise demonstration of the vNOTES technique for hysterectomy and vaginal apical suspension to the uterosacral ligament with narrated video footage.

SETTING

An academic tertiary referral center. The ethics committee ruled that approval was not required for this study.

PATIENTS

A 53-year-old woman.

INTERVENTIONS

vNOTES hysterectomy and apical suspension to the uterosacral ligament.

MEASUREMENTS AND MAIN RESULTS

A 53-year-old woman (gravida 5, para 4) presented with Pelvic Organ Prolapse Quantification System stage III symptomatic uterine prolapse. The patient was selected to be operated on via a vaginal port. The video presents some tips and tricks to aid the surgeon to perform this surgery in a safe and timely manner using the vaginal GelPOINT system (Applied Medical, Rancho Santa Margarita, CA).

CONCLUSION

vNOTES for repair of POP by uterosacral ligament suspension via a vaginal port is a feasible technique with promising cosmetic results. This technique allows the surgeon to expose the ureter well and lower the risk of ureteric injury. Additionally, this approach avoids mesh complications and should also decrease the risk of abdominal wound infection because of the absence of incisions on the abdomen.

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Publisher Full Text (DOI)

Authors+Show Affiliations

Lowenstein L
Department of Obstetrics and Gynecology, Rambam Health Care Campus, Haifa, Israel (Drs. Lowenstein, Paz, Lauterbach, and Matanes); Ruth and Bruce Rappaport Faculty of Medicine, Technion, Haifa, Israel (Drs. Lowenstein, Paz, Lauterbach, and Matanes).
Baekelandt J
Gynecological Oncology and Endoscopy, Imelda Hospital, Bonheiden, Antwerpen, Belgium (Dr. Baekelandt).
Paz Y
Department of Obstetrics and Gynecology, Rambam Health Care Campus, Haifa, Israel (Drs. Lowenstein, Paz, Lauterbach, and Matanes); Ruth and Bruce Rappaport Faculty of Medicine, Technion, Haifa, Israel (Drs. Lowenstein, Paz, Lauterbach, and Matanes).
Lauterbach R
Department of Obstetrics and Gynecology, Rambam Health Care Campus, Haifa, Israel (Drs. Lowenstein, Paz, Lauterbach, and Matanes); Ruth and Bruce Rappaport Faculty of Medicine, Technion, Haifa, Israel (Drs. Lowenstein, Paz, Lauterbach, and Matanes).
Matanes E
Department of Obstetrics and Gynecology, Rambam Health Care Campus, Haifa, Israel (Drs. Lowenstein, Paz, Lauterbach, and Matanes); Ruth and Bruce Rappaport Faculty of Medicine, Technion, Haifa, Israel (Drs. Lowenstein, Paz, Lauterbach, and Matanes). Electronic address: emad.matanes@gmail.com.

MeSH

FasciaFasciotomyFemaleHumansHysterectomy, VaginalLigamentsMiddle AgedNatural Orifice Endoscopic SurgeryPelvic Organ ProlapseTreatment OutcomeUterusVagina

Pub Type(s)

Case Reports
Journal Article
Technical Report
Video-Audio Media

Language

eng

PubMed ID

30980991

Citation

Lowenstein, Lior, et al. "Transvaginal Natural Orifice Transluminal Endoscopic Hysterectomy and Apical Suspension of the Vaginal Cuff to the Uterosacral Ligament." Journal of Minimally Invasive Gynecology, vol. 26, no. 6, 2019, p. 1015.
Lowenstein L, Baekelandt J, Paz Y, et al. Transvaginal Natural Orifice Transluminal Endoscopic Hysterectomy and Apical Suspension of the Vaginal Cuff to the Uterosacral Ligament. J Minim Invasive Gynecol. 2019;26(6):1015.
Lowenstein, L., Baekelandt, J., Paz, Y., Lauterbach, R., & Matanes, E. (2019). Transvaginal Natural Orifice Transluminal Endoscopic Hysterectomy and Apical Suspension of the Vaginal Cuff to the Uterosacral Ligament. Journal of Minimally Invasive Gynecology, 26(6), 1015. https://doi.org/10.1016/j.jmig.2019.04.007
Lowenstein L, et al. Transvaginal Natural Orifice Transluminal Endoscopic Hysterectomy and Apical Suspension of the Vaginal Cuff to the Uterosacral Ligament. J Minim Invasive Gynecol. 2019;26(6):1015. PubMed PMID: 30980991.
* Article titles in AMA citation format should be in sentence-case
TY - JOUR T1 - Transvaginal Natural Orifice Transluminal Endoscopic Hysterectomy and Apical Suspension of the Vaginal Cuff to the Uterosacral Ligament. AU - Lowenstein,Lior, AU - Baekelandt,Jan, AU - Paz,Yuri, AU - Lauterbach,Roy, AU - Matanes,Emad, Y1 - 2019/04/10/ PY - 2018/12/16/received PY - 2019/2/27/revised PY - 2019/4/3/accepted PY - 2019/4/14/pubmed PY - 2020/4/22/medline PY - 2019/4/14/entrez KW - Natural orifice transluminal endoscopic surgery KW - Pelvic organ prolapse KW - Uterosacral suspension SP - 1015 EP - 1015 JF - Journal of minimally invasive gynecology JO - J Minim Invasive Gynecol VL - 26 IS - 6 N2 - STUDY OBJECTIVE: Transvaginal natural orifice transluminal endoscopic surgery (vNOTES) offers similar advantages of traditional vaginal surgery including no incisional pain as well as a better cosmetic outcome. Furthermore, vNOTES allows the surgeon to overcome the limited surgical space and lack of exposure when using the traditional vaginal instrumentation. Vaginal uterosacral ligament suspension subsequent to vaginal hysterectomy has the advantages of a mesh-free, minimally invasive approach for the treatment of pelvic organ prolapse. The objective of this video is to demonstrate a surgical technique and a few tips and tricks for vNOTES hysterectomy and uterosacral ligament suspension. DESIGN: Stepwise demonstration of the vNOTES technique for hysterectomy and vaginal apical suspension to the uterosacral ligament with narrated video footage. SETTING: An academic tertiary referral center. The ethics committee ruled that approval was not required for this study. PATIENTS: A 53-year-old woman. INTERVENTIONS: vNOTES hysterectomy and apical suspension to the uterosacral ligament. MEASUREMENTS AND MAIN RESULTS: A 53-year-old woman (gravida 5, para 4) presented with Pelvic Organ Prolapse Quantification System stage III symptomatic uterine prolapse. The patient was selected to be operated on via a vaginal port. The video presents some tips and tricks to aid the surgeon to perform this surgery in a safe and timely manner using the vaginal GelPOINT system (Applied Medical, Rancho Santa Margarita, CA). CONCLUSION: vNOTES for repair of POP by uterosacral ligament suspension via a vaginal port is a feasible technique with promising cosmetic results. This technique allows the surgeon to expose the ureter well and lower the risk of ureteric injury. Additionally, this approach avoids mesh complications and should also decrease the risk of abdominal wound infection because of the absence of incisions on the abdomen. SN - 1553-4669 UR - https://www.unboundmedicine.com/medline/citation/30980991/Transvaginal_Natural_Orifice_Transluminal_Endoscopic_Hysterectomy_and_Apical_Suspension_of_the_Vaginal_Cuff_to_the_Uterosacral_Ligament_ DB - PRIME DP - Unbound Medicine ER -