Transvaginal natural orifice transluminal endoscopic surgery for uterosacral ligament suspension: pilot study of 35 cases of severe pelvic organ prolapse

Abstract Background To describe the short-term outcomes of transvaginal natural orifice transluminal endoscopic surgery (vNOTES) for uterosacral ligament suspension (USLS) in patients with severe prolapse. Methods This was a retrospective study of patients with severe prolapse (≥ stage 3) who underwent vNOTES for USLS between May 2019 and July 2020. The Pelvic Organ Prolapse Quantification (POP-Q) score, Pelvic Organ Prolapse/Urinary Incontinence Sexual Questionnaire short form (PISQ-12) and Pelvic Floor Inventory-20 (PFDI-20) were used to evaluate physical prolapse and quality of life before and after vNOTES for USLS. Results A total of 35 patients were included. The mean operative duration was 111.7 ± 39.4 min. The mean blood loss was 67.9 ± 35.8 ml. Statistically significant differences were observed between before and after vNOTES USLS in Aa (+ 0.6 ± 1.7 versus − 2.9 ± 0.2), Ba (+ 1.9 ± 2.2 versus − 2.9 ± 0.3), C (+ 1.5 ± 2.2 versus − 6.9 ± 0.9), Ap (− 1.4 ± 1.0 versus − 3.0 ± 0.1) and Bp (− 1.1 ± 1.4 versus − 2.9 ± 0.1) (P < 0.05 for all). The mean pre- and postoperative PFDI-20 score was 19.9 ± 6.7 and 3.2 ± 5.4, respectively, and the mean pre- and postoperative PISQ-12 score was 24.8 ± 2.3 and 38.3 ± 4.1, respectively (P < 0.05 for both). During 1–13 months of follow-up, there were no cases of severe complications or recurrence. Conclusions vNOTES for USLS may be a feasible technique to manage severe prolapse, with promising short-term efficacy and safety. Larger studies with more patients and longer follow-up periods should be performed to evaluate the long-term efficacy and safety profile of vNOTES for USLS.

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Transvaginal Natural Orifice Transluminal Endoscopic Surgery for Uterosacral Ligament Suspension: a Pilot Study of 35 Caseswith Severe Pelvic Organ Prolapse

10.21203/rs.3.rs-194855/v1 ◽

2021 ◽

Author(s):

Zhiying Lu ◽

Yisong Chen ◽

Xiaojuan Wang ◽

Junwei Li ◽

Keqin Hua ◽

...

Keyword(s):

Pelvic Organ Prolapse ◽

Endoscopic Surgery ◽

Pelvic Organ ◽

Uterosacral Ligament ◽

Uterosacral Ligament Suspension ◽

Natural Orifice ◽

Short Term ◽

Before And After ◽

The Mean

Abstract Background To describe the short-term outcomes of transvaginal natural orifice transluminal endoscopic surgery (vNOTES) for uterosacral ligament suspension (USLS) in patients with severe prolapse.Methods This is a retrospective study conducted for patients with severe prolapsed (≥stage 3) who underwent vNOTES USLS between May 2019 and July 2020. The Pelvic Organ Prolapse Quantification (POP-Q) score, Pelvic Organ Prolapse/Urinary Incontinence Sexual Questionnaire short form (PISQ-12) and Pelvic Floor Inventory-20 (PFDI-20) were used to evaluate physical prolapse and quality of life before and after vNOTES USLS.Results A total of 35 patients were included. The mean operative time was 111.7±39.4 minutes. The mean blood loss was 67.9±35.8 ml. Statistically significant differences were observed before and after vNOTES USLS in regard to Aa (+0.6±1.7 versus −2.9±0.2), Ba (+1.9±2.2 versus −2.9±0.3), C (+1.5±2.2 versus -6.9±0.9), Ap (-1.4±1.0 versus −3.0±0.1) and Bp (-1.1±1.4 versus −2.9±0.1) (P < 0.05 for all). The mean pre- and post-operative PFDI-20 score was 19.9±6.7 versus 3.2±5.4, and the PISQ-12 score was 24.8±2.3 versus 38.3±4.1 (P < 0.05 for both). During 1–13 months of follow-up, no severe complications or recurrence.Conclusions vNOTES USLS may be a feasible technique to manage severe prolapse, with promising short-term efficacy and safety data. However, a study with a larger number of patients and a longer follow-up period should be conducted.

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Laparoscopic uterosacral ligament suspension vs laparoscopic sacral colpopexy in patients with pelvic organ prolapse: intermediate term follow-up of a retrospective study

JAPANESE JOURNAL OF GYNECOLOGIC AND OBSTETRIC ENDOSCOPY ◽

10.5180/jsgoe.36.2_130 ◽

2020 ◽

Vol 36 (2) ◽

pp. 130-135

Author(s):

Go Hirata ◽

Yuichiro Hotta ◽

Ryoko Kajiyama ◽

Tamina Kino ◽

Misaki Toda ◽

...

Keyword(s):

Retrospective Study ◽

Pelvic Organ Prolapse ◽

Pelvic Organ ◽

Uterosacral Ligament ◽

Uterosacral Ligament Suspension ◽

Sacral Colpopexy ◽

Laparoscopic Sacral Colpopexy ◽

Laparoscopic Uterosacral Ligament Suspension

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Does Pelvic Organ Prolapse Quantification Exam (POPQ) D-Point Predict Uterosacral Ligament Suspension Outcomes?

Journal of Minimally Invasive Gynecology ◽

10.1016/j.jmig.2014.12.037 ◽

2015 ◽

Vol 22 (3) ◽

pp. S14-S15

Author(s):

L.A. Richter ◽

A.J. Park ◽

J.E. Boileau ◽

M. Janni ◽

S. Desale ◽

...

Keyword(s):

Pelvic Organ Prolapse ◽

Pelvic Organ ◽

Uterosacral Ligament ◽

Uterosacral Ligament Suspension ◽

Pelvic Organ Prolapse Quantification

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To Compare the Effectiveness of Vaginal High Uterosacral Ligament Suspension and McCall's Culdoplasty during Vaginal Hysterectomy for Pelvic Organ Prolapse

The Journal of South Asian Federation of Menopause Societies ◽

10.5005/jp-journals-10032-1112 ◽

2017 ◽

Vol 5 (2) ◽

pp. 81-86

Author(s):

Krutika Bhalerao ◽

Anuja V Bhalerao ◽

Richa Garg

Keyword(s):

Pelvic Organ Prolapse ◽

Coming Out ◽

Vaginal Hysterectomy ◽

Pelvic Organ ◽

Uterosacral Ligament ◽

Vaginal Vault ◽

Care Hospital ◽

Uterosacral Ligament Suspension ◽

Vaginal Length ◽

Vault Suspension

ABSTRACT Introduction Vaginal vault prolapse can be prevented by supporting the vaginal cuff, which is an essential part of hysterectomy, whether done abdominally or vaginally. The American Association of Gynecologic Laparoscopists (AAGL) has recommended for future research, specifically, a randomized trial comparing McCall's culdoplasty (with uterosacral ligament plication) with vaginal high uterosacral ligament suspension (HUSLS) (without plication), since both procedures are accessible to gynecological surgeons without urologic background. Hence, this study was carried out. Aim To compare both anatomic and functional outcomes of patients undergoing vaginal HUSLS or McCall's culdoplasty at the time of vaginal hysterectomy. Materials and methods This hospital-based prospective comparative study was carried out at a tertiary care hospital from January 1, 2013 to December 31, 2015 over a period of 3 years after obtaining Ethical Committee approval. All women attending gynecological outpatient department having symptom of mass coming out of vagina were subjected to detailed history, examination, and later underwent either HUSLS (43) or McCall's culdoplasty (42), for vault suspension with concomitant hysterectomy. The effectiveness of both the procedures was assessed by preoperative and postoperative pelvic organ prolapse quantification (POP-Q) and both were compared. Observations There was statistically significant improvement in all the sites of POP-Q points by HUSLS and McCall's culdoplasty as a method of vault suspension except in total vaginal length (TVL). Vault suspension by HUSLS is better than McCall's culdoplasty. All the points of POP-Q showed better results but the point C was significantly placed at a higher level by HUSLS (p = 0.000) as compared with McCall's culdoplasty. The time required for HUSLS was statistically more as compared with repair by McCall's culdoplasty (81.55/74.53 minutes, T: 1.981, p: 0.05). Complications, such as hemorrhage and ureteric injuries were more in HUSLS (2/43, 4.8%) as compared with McCall's culdoplasty (0/42); this is statistically significant. Conclusion High uterosacral ligament suspension provides excellent suspensory support to vaginal vault. Vagina is suspended over the levator ani with normal axis toward sacrum. By doing HUSLS, the vagina is symmetrically supported directed toward the hollow of sacrum. High uterosacral ligament suspension is highly recommended for young women with POP as vaginal length is not altered at all and so is the quality of life. How to cite this article Bhalerao AV, Bhalerao K, Garg R. To Compare the Effectiveness of Vaginal High Uterosacral Ligament Suspension and McCall's Culdoplasty during Vaginal Hysterectomy for Pelvic Organ Prolapse. J South Asian Feder Menopause Soc 2017;5(2):81-86.

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Ilizarov technique combined with limited adjunctive surgical procedures for correction of relapsed talipes equinovarus in children

Journal of International Medical Research ◽

10.1177/0300060517724710 ◽

2017 ◽

Vol 46 (2) ◽

pp. 802-810 ◽

Cited By ~ 2

Author(s):

Xiao-Jian Wang ◽

Feng Chang ◽

Yun-Xing Su ◽

Xiao-Chun Wei ◽

Lei Wei

Keyword(s):

Study Group ◽

Ilizarov Technique ◽

Efficacy And Safety ◽

Limited Surgery ◽

Talipes Equinovarus ◽

Before And After ◽

Lateral Plane ◽

The Mean ◽

Surgical Operations

Objective To evaluate the efficacy and safety of using the Ilizarov invasive distraction technique combined with limited surgical operations in the treatment of relapsed talipes equinovarus in children. Methods This retrospective study analysed the outcomes of paediatric patients with relapsed talipes equinovarus who were treated with the Ilizarov technique with moderate open limited soft tissue or bony operations. The International Clubfoot Study Group (ICFSG) classification system score was used to evaluate the deformities before and after surgery. Results The study evaluated 16 feet in 14 patients (nine boys). The correction time ranged from 6 to 12 weeks. The mean duration of frame application was 5.9 months. The gait was improved significantly in all patients. At final follow-up, the mean ankle dorsiflexion and plantarflexion ranges were 8.3° and 34.6°, respectively. The talocalcaneal angle improved from 10.0° preoperatively to 28.3° postoperatively in the anteroposterior plane; and from 4.1° preoperatively to 42.1° postoperatively in the lateral plane. The differences in the angle of plantarflexion, dorsiflexion, range of motion of the ankle joint and talocalcaneal angles pre- and postoperation were significant. Conclusions These current findings suggest that the Ilizarov technique combined with limited surgery effectively corrects relapsed talipes equinovarus in children.

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