A Retrospective Cohort Study of vNOTES Extraperitoneal Versus Laparoscopic Sacral Hysteropexy with Uterine Preserving Regarding Surgical Outcomes and Two Year Follow-up Results

Study Objective To explore the effectiveness of transvaginal natural orifice transluminal endoscopic surgery extraperitoneal sacral hysteropexy (vNOTES-ESH) in women with symptomatic uterine prolapse over a two year follow-up. Design Retrospective cohort study. Setting Gynaecological minimally invasive centre. Patients Women undergoing sacral hysteropexy either by vNOTES (n=25) or laparoscopic (n=74) between November 2016 and December 2020. Interventions Both vNOTES-ESH and laparoscopic sacral hysteropexy (LAP-SH) were used for uterine prolapse. Demographic data, operative characteristics, perioperative outcomes, and follow-up information two years post-surgery in the two groups were retrospectively evaluated. Results Both procedures showed similar operation time, estimated blood loss, hospital stays, and pain scores(P>0.05). During a median follow-up of 59 (24-72) months, the surgical success rate was 96% for vNOTES-ESH and 97.3% for LAP-SH (P > 0.05), with no differences in anatomical position or pelvic organ function after the operation. Women in the LAP-SH group experienced more bothersome symptoms of constipation compared to those in the vNOTES-ESH group (5.41% VS. 0, P < 0.05). Lastly, one case in the vNOTES-ESH group had a mesh exposed area of less than 1 cm2, and one patient in the LAP-SH group experienced stress incontinence. Conclusions In this retrospective study, vNOTES-ESH met our patients’ preference for uterine preservation and was a successful and effective treatment for uterine prolapse, providing good functional improvement in our follow up. This procedure should be considered as an option for patients with pelvic organ prolapse.