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Objective: The aim of this study was to describe our experience with transvaginal natural orifice transluminal endoscopic surgery (vNOTES) uterosacral ligament suspension (USLS) and to evaluate the learning curve of mastering the skills to operate this procedure.

Methods: This is a prospective study of the first 35 vNOTES hysterectomy and USLS surgeries performed between October 2018 and April 2019 at Rambam Health Care Campus (Israel) (n = 26) and Imelda Hospital (Belgium) (n = 9). The primary outcome was surgical time. Secondary outcomes included intraoperative bleeding, length of hospitalization, pain during the first 24 hours postoperative pain, and the need for analgesia, intraoperative, and postoperative adverse events.

Results: The median age was 55 years (range, 40-81). The median operative time was 113 minutes (range, 89-233). For the procedures performed at Rambam, total operative time decreased from the first 13 to the following 13: from 149 minutes (range, 89-233 minutes) to 103 (89-170) (<0.001); Pearson correlation demonstrated a moderate negative significant correlation of surgery duration with surgeon experience (rho = -0.445, P < 0.001). The median estimated blood loss was 30 mL (20-200). The median hospital stay was 2 days (1-3). There were no intraoperative adverse events. The median visual analogue scale score for pain assessment during the first 24 hours after surgery was 1 (range, 1-3).

Conclusions: vNOTES USLS is a feasible procedure that showed marked improvement in surgical performance in a short period, as evidenced by the decrease in surgical time and the low rate of minor associated perioperative complications. Outcomes of long-term follow-up should be investigated.

Competing Interests: Disclosure statement: Dr Baekelandt discloses consultancy for Applied Medical. Other authors report no conflict of interest.

Titel:	Feasibility and Learning Curve of Transvaginal Natural Orifice Transluminal Endoscopic Surgery for Hysterectomy and Uterosacral Ligament Suspension in Apical Compartment Prolapse.
Autor/in / Beteiligte Person:	Lowenstein, L ; Matanes, E ; Lauterbach, R ; Mor, O ; Burke, YZ ; Weiner, Z ; Baekelandt, J
Zeitschrift:	Female pelvic medicine & reconstructive surgery, Jg. 27 (2021), Heft 1, S. e171
Veröffentlichung:	Hagerstown, MD : Lippincott Williams & Wilkins, 2021
Medientyp:	academicJournal
ISSN:	2154-4212 (electronic)
DOI:	10.1097/SPV.0000000000000875
Schlagwort:	Adult Aged Aged, 80 and over Feasibility Studies Female Humans Middle Aged Prospective Studies Hysterectomy, Vaginal methods Learning Curve Natural Orifice Endoscopic Surgery Uterine Prolapse surgery
Sonstiges:	Nachgewiesen in: MEDLINE Sprachen: English Publication Type: Journal Article Language: English [Female Pelvic Med Reconstr Surg] 2021 Jan 01; Vol. 27 (1), pp. e171-e176. MeSH Terms: Learning Curve* ; Natural Orifice Endoscopic Surgery* ; Hysterectomy, Vaginal / methods ; Uterine Prolapse / surgery ; Adult ; Aged ; Aged, 80 and over ; Feasibility Studies ; Female ; Humans ; Middle Aged ; Prospective Studies References: Wu JM, Hundley AF, Fulton RG, et al. Forecasting the prevalence of pelvic floor disorders in U.S. women: 2010 to 2050. Obstet Gynecol 2009;114(6):1278–1283. ; Wu JM, Matthews CA, Conover MM, et al. Lifetime risk of stress urinary incontinence or pelvic organ prolapse surgery. Obstet Gynecol 2014;123(6):1201–1206. ; Abrams P, Cardozo L, Fall M, et al. The standardisation of terminology of lower urinary tract function: report from the standardisation sub-committee of the international continence society. Neurourol Urodyn 2002;21(2):167–178. ; Rardin CR, Erekson EA, Sung VW, et al. Uterosacral colpopexy at the time of vaginal hysterectomy: comparison of laparoscopic and vaginal approaches. J Reprod Med 2009;54(5):273–280. ; Amundsen CL, Flynn BJ, Webster GD. Anatomical correction of vaginal vault prolapse by uterosacral ligament fixation in women who also require a pubovaginal sling. J Urol 2003;169(5):1770–1774. ; Barber MD, Visco AG, Weidner AC, et al. Bilateral uterosacral ligament vaginal vault suspension with site-specific endopelvic fascia defect repair for treatment of pelvic organ prolapse. Am J Obstet Gynecol 2000;183(6):1402–1410; discussion 1410–1401. ; Karram M, Goldwasser S, Kleeman S, et al. High uterosacral vaginal vault suspension with fascial reconstruction for vaginal repair of enterocele and vaginal vault prolapse. Am J Obstet Gynecol 2001;185(6):1339–1342; discussion 1342–1333. ; Miller N. A new method of correcting complete inversion of the vagina. Surg Gynecol Obstet 1927;44:550–554. ; McCall ML. Posterior culdeplasty; surgical correction of enterocele during vaginal hysterectomy; a preliminary report. Obstet Gynecol 1957;10(6):595–602. ; Shull BL, Bachofen C, Coates KW, et al. A transvaginal approach to repair of apical and other associated sites of pelvic organ prolapse with uterosacral ligaments. Am J Obstet Gynecol 2000;183(6):1365–1373; discussion 1373–1364. ; Barber MD, Brubaker L, Burgio KL, et al. Comparison of 2 transvaginal surgical approaches and perioperative behavioral therapy for apical vaginal prolapse: the OPTIMAL randomized trial. JAMA 2014;311(10):1023–1034. ; Jeffery ST, Doumouchtsis SK, Franco AV, et al. High uterosacral ligament vault suspension at vaginal hysterectomy: objective and subjective outcomes of a modified technique. J Obstet Gynaecol Res 2009;35(3):539–544. ; Baekelandt J. Total vaginal NOTES hysterectomy: a new approach to hysterectomy. J Minim Invasive Gynecol 2015;22(6):1088–1094. ; Baekelandt JF, De Mulder PA, Le Roy I, et al. Hysterectomy by transvaginal natural orifice transluminal endoscopic surgery versus laparoscopy as a day-care procedure: a randomised controlled trial. BJOG 2019;126(1):105–113. ; Baekelandt JF, De Mulder PA, Le Roy I, et al. Transvaginal natural orifice transluminal endoscopic surgery (vNOTES) adnexectomy for benign pathology compared with laparoscopic excision (NOTABLE): a protocol for a randomised controlled trial. BMJ Open 2018;8(1):e018059. ; Baekelandt J. Transvaginal natural orifice transluminal endoscopic surgery: a new approach to ovarian cystectomy. Fertil Steril 2018;109(2):366. ; Baekelandt J, Vercammen J. IMELDA transvaginal approach to ectopic pregnancy: diagnosis by transvaginal hydrolaparoscopy and treatment by transvaginal natural orifice transluminal endoscopic surgery. Fertil Steril 2017;107(1):e1–e2. ; Lowenstein L, Baekelandt J, Paz Y, et al. Transvaginal natural orifice transluminal endoscopic hysterectomy and apical suspension of the vaginal cuff to the utero-sacral ligament. J Minim Invasive Gynecol 2019;26:1015. ; Bump RC, Mattiasson A, Bo K, et al. The standardization of terminology of female pelvic organ prolapse and pelvic floor dysfunction. Am J Obstet Gynecol 1996;175(1):10–17. ; Richter LA, Boileau J, Janni M, et al. Intraoperative ureteral kinking during uterosacral ligament suspension: effect of training level on occurrence. J Reprod Med 2016;61(1–2):17–21. ; Lowenstein L, Fitz A, Kenton K, et al. Transabdominal uterosacral suspension: outcomes and complications. Am J Obstet Gynecol 2009;200(6):656.e1–656.e5. ; Filmar GA, Fisher HW, Aranda E, et al. Laparoscopic uterosacral ligament suspension and sacral colpopexy: results and complications. Int Urogynecol J 2014;25(12):1645–1653. ; Maher C, Feiner B, Baessler K, et al. Transvaginal mesh or grafts compared with native tissue repair for vaginal prolapse. Cochrane Database Syst Rev 2016;2:CD012079. Entry Date(s): Date Created: 20200611 Date Completed: 20211208 Latest Revision: 20211214 Update Code: 20231215

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Feasibility and Learning Curve of Transvaginal Natural Orifice Transluminal Endoscopic Surgery for Hysterectomy and Uterosacral Ligament Suspension in Apical Compartment Prolapse.