(Video Poster 08) vNOTES Uterosacral Ligament Suspension Following vNOTES Hysterectomy

Objectives: vNOTES, or vaginal natural orifice trans luminal-endoscopic surgery, is a laparoscopic modality using a single gel port at the vagina to gain access to the abdominal cavity. VNOTES is a relatively new modality, first seen in gynecologic literature in 2012. An advantage of a vNOTES approach is that it allows for increased visibility and access to anatomy compared to a traditional vaginal approach for gynecologic surgery. This video shows a vNOTES approach to uterosacral ligament suspension (USLS) and demonstrates clear visualization of pelvic anatomy during placement of uterosacral stitches.

Methods: Following completion of a vNOTES laparoscopic assisted vaginal hysterectomy and bilateral salpingectomy, the patient’s right pelvic sidewall anatomy was explored. The ureter was directly visualized vermiculating. Pulling on uterosacral stitches placed during the hysterectomy shows the uterosacral ligament medial to the ureter. VNOTES allows for clear visualization of this anatomic relationship during the placement of uterosacral stitches.

Clinical Relevance: The most common complication of uterosacral ligament suspension is ureteral obstruction. VNOTES allows for clear visualization of the ureter while placing uterosacral stitches in a USLS.