(Poster 55) vNOTES USL Hysteropexy; A Prospective Study, Perioperative & Short-term Outcomes

Objectives: The study aimed to evaluate the safety and efficacy of vaginal natural orifice transluminal endoscopic surgery (vNOTES) hysteropexy for apical pelvic organ prolapse (POP). The primary outcome is subjective cure of POP, assessed by a negative response to question 3 of the Pelvic Floor Distress Inventory (PFDI-20) at 6 weeks.

Methods: This is a prospective cohort study involving patients with symptomatic stage II or higher uterovaginal prolapse (Pelvic Organ Prolapse Quantification (POP-Q) system). Participants desired uterine preservation and underwent vNOTES bilateral uterosacral ligament hysteropexy. Baseline demographics, intraoperative variables, and peri-operative complications were recorded. Six-weeks postoperative follow-up assessed objective cure, patient-reported symptoms (using PFDI-20, Pelvic Floor Impact Questionnaire: PFIQ-7, and Patient Global Index of Improvement: PGI-I), and any adverse events. Data is presented as N (%) or mean (SD). Paired t-test evaluated the change in PFDI-20 and PFIQ-7 from baseline to 6-week.

Results: 22 patients underwent vNOTES uterosacral ligament hysteropexy. Mean age was 62.8 (10.6). Mean BMI was 26.6 (5.2). Fourteen (63.6%) were menopausal. At baseline, 9 (40.9%) patients reported mild distress from their pelvic floor symptoms, and 13 (59.1%) reported moderate distress (PFDI-20). Fifty nine percent were sexually active, and out of those, 67% noted that fear of urinary or fecal incontinence, or the prolapse bulge was affecting their sexual life.
Concomitant procedures included 13 (65%) adnexal procedures, 16 (80%) anterior colporrhaphy, 22 (100%) posterior colporrhaphy, and 10 (50%) incontinence procedures (6 urethral bulking, 3 retropubic mid-urethral sling and 1 rectus fascial sling). The only perioperative complication was a bowel injury that occurred during a concomitant rectovaginal fistula repair, unrelated to the vNOTES part of the surgery. No ureteric injury was noted. Nine (45%) patients were discharged on the day of surgery, 10 (50%) were admitted for 1 night and 1 (5%) was admitted for more than 1 night.
Eighteen women completed 6 weeks postoperative visit. 14 (78%) had subjective cure of POP. Objective cure was achieved in 94%. Improvement in pelvic floor symptoms were reflected in significant reductions in PFDI-20 and PFIQ-7 scores (Mean difference 83.3 and 58.7 respectively, paired T-test p-value < 0.01 for both). Seventeen (94%) were improved at 6 weeks, including 14 (78%) noting to be very much or much better, according to the PGI-I scale. There were no cases of reoperation within the first 6 weeks post-op.

Conclusions: This study showed low risk of complication of vNOTES uterosacral ligament hysteropexy as a minimally invasive approach for uterovaginal prolapse repair, with high success rate at 6 weeks postoperatively. If continued success is shown at 1 year postoperatively, the findings may support broader adoption of vNOTES hysteropexy as an alternative to traditional laparoscopic and vaginal surgical techniques, potentially improving patient outcomes and reducing recovery times.