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

Abstract

<h4>Objective</h4>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.<h4>Study design</h4>Bilateral gasless vNOTES anterior sacrospinous fixation was performed in two female cadavers without any synthetic mesh.<h4>Results</h4>Identification of ischial spine and sacrospinous ligament as well as feasibility of gasless vNOTES sacrospinous fixation were always possible on both sides.<h4>Conclusions</h4>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.