Lateral suspension with V-NOTES for the treatment of pelvic organ prolapse with the Salman-Ketenci Gencer technique

A comparative study of prone split-leg position and lithotomy position in posterior uterine myomectomy by transvaginal natural orifice transluminal endoscopic surgery

BACKGROUND

To assess and compare the efficiency and outcomes between prone split-leg position and lithotomy position in posterior uterine myomectomy by transvaginal natural orifice transluminal endoscopic surgery (vNOTES).

METHODS

33 patients with posterior uterine myomectomy by vNOTES in the prone split-leg position and 15 patients in the lithotomy position were retrospectively recruited. Important baseline characteristics and outcome parameters such as age, body mass index, volume of myoma, delivery mode, hospital length, intraoperative blood loss, hemoglobin values before and 72 h after operation, VAS score, operation time and operation preparation time were compared between two patient groups.

RESULTS

The operation time of the prone split-leg position group was significantly shorter than that of the lithotomy position group (P < 0.05), but the operation preparation time of the prone split-leg position group was longer than that of the lithotomy position group (P < 0.05). No significant difference was found in other indicators between the two patient groups.

CONCLUSIONS

Our study suggests the potential application of the prone split-leg position in posterior uterine myomectomy by vNOTES.

Erroneous and Incomplete Reporting of the Pelvic Organ Prolapse Quantification System

INTRODUCTION AND HYPOTHESIS

Accurate and complete reporting of the Pelvic Organ Prolapse Quantification (POP-Q) system is essential for reporting research outcomes in POP. We aimed to assess the accuracy and completeness of POP-Q reporting in studies published from selected journals in 2023 and evaluate the validity of available POP-Q calculators.

METHODS

A systematic search of Medline and Embase was conducted following Preferred Reporting Items for Systematic Reviews and Meta-Analyses guidelines to identify eligible studies from selected journals in 2023 that utilised the POP-Q system. An assessment of available POP-Q calculators was also performed.

RESULTS

Of the 134 studies identified, 18 (13.4%) met the inclusion criteria. Twelve studies reported complete quantitative POP-Q data of which 9 (75%) contained identifiable POP-Q reporting errors. These included 5 studies reporting mean Aa > Ba, 2 reporting mean Ap > Bp, 6 reporting C > Bp, 5 reporting mean C > Ba, 1 reporting mean Aa > + 3, and 1 reporting mean D > C. The remaining 6 of the 18 studies reported incomplete POP-Q measurements, which restricted our ability to identify further reporting errors, except for 2 studies reporting C > Ba and C > Bp respectively. The evaluated POP-Q calculator permitted the input of inaccurate POP-Q data.

CONCLUSIONS

Erroneous and/or incomplete quantitative POP-Q data were identified in 15 of the 18 studies reviewed (83.3%). Our findings highlight the need for improved POP-Q data reporting. Journal editors and reviewers should ensure that publications provide complete and accurate quantitative POP-Q data. POP-Q calculators should be based on algorithms that ensure complete and accurate data inputs and outputs.

Innovative minimally invasive technique for pelvic organ prolapse: V-Notes lateral suspension

BACKGROUND

This study aimed to develop a novel antiprolapse surgical technique utilizing minimally invasive methods with lateral suspension in natural orifice surgeries.

AIMS

The primary objective of this study was to describe a modified V-Notes lateral suspension (VNLS) technique as a viable alternative for antiprolapse surgery.

STUDY DESIGN

This was a prospective clinical trial evaluating a new surgical technique.

METHODS

Patients indicated for lateral suspension underwent the procedure using the V-Notes technique through natural orifices. No additional incisions were made on the anterior abdominal wall, except for the mesh exit points.

RESULTS

Post-operation, the only incisions present were the two lateral mesh outlet incisions on the anterior abdominal wall. Additionally, there was no need for peritonization as the Alexis wound protector/retractor was used extraperitoneally. The outcomes were comparable to those achieved with laparoscopic lateral suspension (LLS). The VNLS technique demonstrated favorable results, including shorter hospital stays and improved cosmetic outcomes compared to traditional LLS. This innovative approach has the potential to become the new gold standard in antiprolapse surgery, providing benefits such as minimal invasiveness and enhanced aesthetics.

CONCLUSION

While the optimal treatment for pelvic organ prolapse remains undetermined, natural orifice surgeries like V-Notes offer promising advantages, including reduced invasiveness and superior cosmetic results, suggesting their potential for future standard practice.

Transvaginal Natural Orifice Transluminal Endoscopic Surgery (vNOTES) in Urogynecological Surgery: A Systematic Review

Background: Minimally invasive surgery could improve cosmetic outcomes and reduce the risks of surgical injury with less postoperative pain and a quicker patient's discharge. Recently, transvaginal natural orifice transluminal endoscopic surgery (vNOTES) has been introduced in urogynecology with exciting results. Evidence Acquisition: After PROSPERO registration (n°CRD42023406815), we performed a comprehensive literature search on Pubmed, Embase, and Cochrane CENTRAL, including peer-reviewed studies evaluating transvaginal natural orifice transluminal endoscopic surgery. No limits on time or type of study were applied. Evidence synthesis: Overall, 12 manuscripts were included in the analysis. Seven studies evaluated uterosacral ligament suspension, four studies evaluated sacral colpopexy, three evaluated sacrospinous ligament suspension, and one study evaluated lateral suspension. Overall success rates were high (>90%); however, definitions of success were heterogeneous. In terms of complication, most of the studies reported low-grade complications (Clavien-Dindo I and II); only two patients needed mesh removal because of mesh exposure. The risk of bias of the trials was rated in the medium to high-risk category. Conclusions: The present review highlights important initial results for vNOTES. Future randomized clinical trials are needed to better define its role in the management of urogynecological procedures.

Transvaginal natural Orifical transluminal Endoscopy for sacrocolpopexy: A case series report

Background

To describe the surgical technique and operative outcomes of transvaginal natural orifice transluminal endoscopic surgery (V-NOTES) for sacrocolpopexy with or without robotic surgical system in patients with pelvic organ prolapse (POP).

Methods

Patients with POP undergoing traditional transvaginal natural orifice transluminal endoscopic surgery (TV-NOTES) or robotic transvaginal natural orifice transluminal endoscopic surgery (RV-NOTES) for sacrocolpopexy performed by one surgeon from Sep 2020 to Jan 2023 in our hospital were included in this study. The baseline demographics and operative outcomes were collected and analyzed. In addition, some surgical skills were presented. The operative outcomes of V-NOTES for sacrocolpopexy performed by three beginners were also presented.

Results

Eight patients who underwent TV-NOTES, and two patients who underwent RV-NOTES were included in this study. The mean operative time was 180 ± 49 min, and the estimated blood loss was 107 ± 82 ml for these ten cases. Particularly, the operative time of the two patients who underwent RV-NOTES was 275 and 132 min, while the estimated blood loss (EBL) was 100 and 50 ml respectively. During the follow-up period, no mesh exposure and recurrence were observed. In addition, five cases of TV-NOTES for sacrocolpopexy by beginners were all successfully completed.

Conclusion

Both TV-NOTES and RV-NOTES appeared to be feasible and safe for sacrocolpopexy.