Gasless transvaginal natural orifice transluminal endoscopic surgery (vNOTES) for sacrospinous fixation: An anatomical study.

OBJECTIVE

Minimally invasive sacrospinous fixation is the gold standard procedure for management of apical pelvic organ prolapse. However, as it is a blind and palpatory technique, there may be a relevant risk of neurovascular injury due to the proximity of neurovascular structures. The vNOTES (transvaginal Natural Orifice Transluminal Endoscopic Surgery) approach is a surgical technique that appears promising in the management of pelvic organ prolapse. We propose an anatomical study concerning the vNOTES anterior sacrospinous fixation.

STUDY

DESIGN

Bilateral gasless vNOTES anterior sacrospinous fixation was performed in two female cadavers without any synthetic mesh.

RESULTS

Identification of ischial spine and sacrospinous ligament as well as feasibility of gasless vNOTES sacrospinous fixation were always possible on both sides.

CONCLUSIONS

The vNOTES sacrospinous fixation may be relevant and could be an advantage in terms of safety and better placement of the suture on the sacrospinous ligament thanks to endoscopic vision.