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

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Resumo

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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Sobre autores

I. Musin

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

Autor responsável pela correspondência
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

Rússia, Ufa; Ufa

E. 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

Rússia, Ufa

A. 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

Rússia, Ufa

A. Molokanova

Ufa City Clinical Perinatal Center

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

PhD, Head of the Maternity Department

Rússia, Ufa

G. 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

Rússia, Ufa

Е. 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

Rússia, Ufa

Bibliografia

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  2. Barber M.D., Brubaker L., Burgio K.L., Richter H.E., Nygaard I., Weidner A.C. et al. Comparison of 2 transvaginal surgical approaches and perioperative behavioral therapy for apical vaginal prolapse: the OPTIMAL randomized trial. JAMA 2014; 311(10): 1023-34. https://dx.doi.org/10.1001/jama.2014.1719
  3. Chene G., Tardieu A.S., Savary D., Krief M., Boda C., Anton-Bousquet M.C. et al. Anatomical and functional results of McCall culdoplasty in the prevention of enteroceles and vault prolapse after vaginal hysterectomy. Int. Urogynecol. J. 2008; 19(7): 1007-11. https://dx.doi.org/10.1007/s00192-007-0549-8
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  5. Lowenstein L., Baekelandt J., Paz Y., Lauterbach R., Matanes E. Transvaginal natural orifce transluminal endoscopic hysterectomy and apical suspension of the vaginal cuf to the uterosacral ligament. J. Minim. Invasive Gynecol. 2019; 26(6): 1015. https://doi.org/10.1016/j.jmig.2019.04.007
  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
  7. Приказ Министерства здравоохранения Российской Федерации от 20.10.2020 № 1130н «Об утверждении Порядка оказания медицинской помощи по профилю "акушерство и гинекология"» (зарегистрирован 12.11.2020 № 60869). Доступно по: http://publication.pravo.gov.ru/Document/View/0001202011130037 [Order of the Ministry of Health of the Russian Federation of 20.10.2020 No. 1130n "On approval of the Procedure for the provision of medical care in the field of obstetrics and gynecology" (registered 12.11.2020 No. 60869). Available at: http://publication.pravo.gov.ru/Document/View/0001202011130037 (in Russian)].
  8. Министерство здравоохранения Российской Федерации. Клинические рекомендации. Выпадение женских половых органов. М.; 2024. 38с. [Ministry of Health of the Russian Federation. Clinical guidelines. Female genital prolapse. Moscow; 2024. 38p. (in Russian)].
  9. Unger C.A., Walters M.D., Ridgeway B., Jelovsek J.E., Barber M.D., Paraiso M.F. Incidence of adverse events after uterosacral colpopexy for uterovaginal and posthysterectomy vault prolapse. Am. J. Obstet. Gynecol. 2015; 212(5): 603.e1-603.e7. https://dx.doi.org/10.1016/j.ajog.2014.11.034
  10. Торубаров С.Ф., Духин А.О., Чмыр Е.Н. Fast track в гинекологии: реалии сегодняшнего дня. Акушерство и гинекология. 2019; 10: 60-5. [Torubarov S.F., Dukhin A.O., Chmyr E.N. Fast track in gynecology: the realities of today. Obstetrics and Gynecology. 2019; (10): 60-5 (in Russian)]. https://dx.doi.org/10.18565/aig.2019.10.60-65
  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

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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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