Bilateral fixation of the vaginal stump to the uterosacral ligaments using vNOTES and considering S1–S3 nerve roots

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Abstract

Natural orifice transluminal endoscopic surgery (NOTES) is a new approach in various surgical disciplines. In this paper, we present our experience of using vaginal NOTES (vNOTES) for reconstructive surgery for apical prolapse.

Objective: To describe and illustrate transluminal bilateral fixation of the vaginal stump to the uterosacral ligaments using vNOTES.

Materials and methods: The study included 73 women with stage III–IV pelvic organ prolapse, according to the POP-Q classification. Surgical treatment consisted of extirpation of the uterus followed by surgical correction of pelvic organ prolapse using various methods: transluminal endoscopic fixation of the vaginal stump to the uterosacral ligaments using the vNOTES technique (46 patients), McCall culdeplasty (27 patients). The study was conducted in the Department of Obstetrics and Gynecology No. 2, Bashkir State Medical University.

Results: The advantages of vNOTES compared to traditional vaginal surgery include reduced postoperative pain, improved cosmetic effect and reduced risk of intraoperative damage to the internal organs.

Conclusion: The technical result of using this operative technique is the surgical effectiveness of fixing the vaginal stump with suturing the uterosacral ligament at a distance of 45 mm parallel to the ischium. This distance is considered to be safe in terms of the trajectory of S1–S3 nerve roots.

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About the authors

I. I. Musin

Bashkir State Medical University, Ministry of Health of Russia; Ufa City Clinical Perinatal Center

Author for correspondence.
Email: ilnur-musin@yandex.ru
ORCID iD: 0000-0001-5520-5845

Dr. Med. Sci., Professor at the Department of Obstetrics and Gynecology No. 2, Deputy Chief Physician for Obstetrics and Gynecology Care

Russian Federation, Ufa; Ufa

E. A. Berg

Bashkir State Medical University, Ministry of Health of Russia

Email: nucleardeer@gmail.com
ORCID iD: 0000-0002-2028-7796

PhD, Associate Professor at the Department of Obstetrics and Gynecology No. 2

Russian Federation, Ufa

A. G. Yaschuk

Bashkir State Medical University, Ministry of Health of Russia

Email: alfiya_galimovna@mail.ru
ORCID iD: 0000-0003-2645-1662

Dr. Med. Sci., Professor, Head of the Department of Obstetrics and Gynecology No. 2

Russian Federation, Ufa

A. R. Molokanova

Ufa City Clinical Perinatal Center

Email: angella1210@mail.ru
ORCID iD: 0000-0003-1115-6775

PhD, Head of the Maternity Department

Russian Federation, Ufa

G. Kh. Murtazina

Bashkir State Medical University, Ministry of Health of Russia

Email: karamelka5@inbox.ru
ORCID iD: 0000-0002-3856-8094

PhD, Associate Professor at the Department of Obstetrics and Gynecology No. 2

Russian Federation, Ufa

Е. M. Popova

Bashkir State Medical University, Ministry of Health of Russia

Email: kafedraagidpo2@mail.ru
ORCID iD: 0000-0001-7298-3489

Teaching Assistant at the Department of Obstetrics and Gynecology No. 2

Russian Federation, Ufa

References

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  6. Maldonado P.A., Stuparich M.A., McIntire D.D., Wai C.Y. Proximity of uterosacral ligament suspension sutures and S3 sacral nerve to pelvic landmarks. Int. Urogynecol. J. 2017; 28(1): 77-84. https://dx.doi.org/10.1007/ s00192-016-3039-z
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  11. Мусин И.И., Ящук А.Г., Колодяжная Е.А., Насырова С.Ф., Галанова З.М., Молоканова А.Р., Имельбаева А.Г. Транслюминальная эндоскопия (vNOTES): тотальная гистерэктомия. Акушерство и гинекология. 2024; 4: 126-31. [Musin I.I., Yashchuk A.G., Kolodyazhnaya E.A., Nasyrova S.F., Galanova Z.M., Molokanova A.R., Imelbaeva A.G. Transluminal endoscopy (vNOTES): total hysterectomy. Obstetrics and Gynecology. 2024; (4): 126-31 (in Russian)]. https://dx.doi.org/10.18565/ aig.2023.305

Supplementary files

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1. JATS XML
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2. Fig. 1. Anatomical definition of the ischial spines

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3. Fig. 2. Suturing of the uterosacral ligament with non-absorbable suture material 2-0 on both sides

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4. Fig. 3. Control of suturing of the uterosacral ligaments by tensioning the threads

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5. Fig. 4. Fixation of the vaginal dome to the uterosacral ligaments

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6. Рис. 5. Статическая МРТ расположения культи влагалища после транслюминальной эндоскопической фиксации культи влагалища к крестцово-маточным связкам

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