High uterosacral ligament suspension with vaginal natural orifice transluminal endoscopic surgery: A better alternative to sacrospinous fixation in postmenopausal women?

IF 1.5 4区医学 Q3 OBSTETRICS & GYNECOLOGY

Journal of Obstetrics and Gynaecology Research Pub Date : 2025-07-25 DOI:10.1111/jog.70017

Ayşe Betül Albayrak Denizli, Eralp Bulutlar, Gizem Berfin Uluutku Bulutlar, Sadık Şahin

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引用次数: 0

Abstract

Objective

Pelvic organ prolapse (POP) significantly impacts women's quality of life, often necessitating surgical intervention. Sacrospinous ligament fixation (SSF) and uterosacral ligament suspension (USLS) are commonly performed, mesh-free procedures for apical prolapse repair. While SSF provides durable support, it may alter vaginal axis alignment and compromise visualization, whereas traditional USLS is associated with ureteral complications. This study compares the perioperative and postoperative outcomes of SSF and Vaginal Natural Orifice Transluminal Endoscopic Surgery (vNOTES) high uterosacral ligament suspension (VN-HUSLS).

Methods

This retrospective case series was conducted at Zeynep Kamil Hospital and included 50 patients with Stage 3 or 4 POP who underwent vaginal hysterectomy followed by SSF (n = 27) or VN-HUSLS (n = 23). Demographic data, operative times, hospitalization duration, POP-Q scores, recurrence rates, and complications were analyzed using SPSS (p < 0.05).

Results

No significant differences were found in age, BMI, or preoperative POP stage (p > 0.05). Prolapse-specific surgical time was significantly shorter in the VN-HUSLS group (p < 0.05). All VN-HUSLS patients underwent bilateral adnexectomy with preoperative indications, compared to five in the SSF group. Postoperative POP-Q scores showed better anatomical correction in the VN-HUSLS group, with sustained improvements at 6- and 12-month follow-ups. In the SSF group, two patients experienced recurrence, one at 6 months (Ba point +2) and the other at 12 months (Ba point +3). In the VN-HUSLS group, one patient was found to have Ba point at +1 at the 12-month follow-up, but this did not result in any additional symptoms for the patient.

Conclusion

VN-HUSLS is a promising alternative to SSF, improving surgical outcomes while reducing recurrence and postoperative morbidity. Further studies are needed to evaluate long-term outcomes and postoperative sexual function.

Abstract Image

查看原文本刊更多论文

高子宫骶韧带悬吊与阴道自然孔腔内内镜手术：绝经后妇女骶棘固定的更好选择？

目的盆腔器官脱垂（POP）严重影响女性的生活质量，经常需要手术干预。骶棘韧带固定（SSF）和子宫骶韧带悬吊（USLS）通常用于根尖脱垂修复的无网手术。虽然SSF提供了持久的支持，但它可能改变阴道轴的对齐并损害视觉，而传统的USLS与输尿管并发症有关。本研究比较了SSF和阴道自然口腔内内镜手术（vNOTES）高位子宫骶韧带悬吊（VN-HUSLS）的围术期和术后疗效。方法回顾性分析Zeynep Kamil医院3期或4期POP患者50例，经阴道子宫切除术后行SSF （n = 27）或VN-HUSLS （n = 23）。统计学资料、手术次数、住院时间、POP-Q评分、复发率、并发症采用SPSS分析（p < 0.05）。结果两组患者年龄、BMI、术前POP分期差异无统计学意义（p > 0.05）。VN-HUSLS组脱垂特异性手术时间明显缩短（p < 0.05）。所有VN-HUSLS患者均行术前指征双侧附件切除术，而SSF组只有5例。VN-HUSLS组术后POP-Q评分显示解剖矫正效果较好，在6个月和12个月的随访中持续改善。SSF组2例患者复发，1例在6个月（Ba点+2），另1例在12个月（Ba点+3）。在VN-HUSLS组中，1例患者在12个月的随访中发现Ba点为+1，但这并未导致患者出现任何其他症状。结论VN-HUSLS是一种很有前途的替代SSF的方法，可以改善手术效果，减少复发和术后发病率。需要进一步的研究来评估长期结果和术后性功能。

本文章由计算机程序翻译，如有差异，请以英文原文为准。

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来源期刊

Journal of Obstetrics and Gynaecology Research 医学-妇产科学

CiteScore

3.10

自引率

0.00%

发文量

376

审稿时长

3-6 weeks

期刊介绍： The Journal of Obstetrics and Gynaecology Research is the official Journal of the Asia and Oceania Federation of Obstetrics and Gynecology and of the Japan Society of Obstetrics and Gynecology, and aims to provide a medium for the publication of articles in the fields of obstetrics and gynecology. The Journal publishes original research articles, case reports, review articles and letters to the editor. The Journal will give publication priority to original research articles over case reports. Accepted papers become the exclusive licence of the Journal. Manuscripts are peer reviewed by at least two referees and/or Associate Editors expert in the field of the submitted paper.