Feasibility, safety, and short term outcomes of v-notes assisted sacrocolpopexy for vaginal cuff support following hysterectomy for uterine prolapse

Background Effective apical support following hysterectomy is crucial for preventing subsequent vaginal vault prolapse. While abdominal sacrocolpopexy is the gold standard for durable apical repair, it necessitates abdominal incisions. Vaginal natural orifice transluminal endoscopic surgery (vNOTES) presents a promising scarless platform to perform this gold-standard procedure entirely transvaginally. Objective To evaluate the feasibility, safety, and short-term clinical outcomes of concomitant hysterectomy and vNOTES-assisted sacrocolpopexy in patients with uterine prolapse. Methods This retrospective cohort study included 30 consecutive patients with stage 2 uterine prolapse who underwent the combined procedure at a single tertiary center. Pre- and postoperative anatomical outcomes were assessed using the Pelvic Organ Prolapse Quantification (POP-Q) system at a 1-year follow-up. The primary outcome was objective anatomical success, defined as a postoperative C-point of ≤ − 1 cm. Secondary outcomes included operative time, estimated blood loss, hospital stay, postoperative pain (Visual Analog Scale), and complication rates, including mesh-related adverse events. Results The mean age of the cohort (n = 30) was 57.1 ± 10.8 years, and the mean operative time was 100.2 ± 11.7 minutes. The procedure resulted in a significant restoration of apical support, with the mean POP-Q C-point improving from + 0.2 ± 0.4 cm preoperatively to − 1.4 ± 1.1 cm postoperatively (p < 0.001). Objective anatomical success was achieved in 73.3% of patients (22/30). The clinical recurrence rate was 3.3% (1/30). Postoperative pain was minimal, with mean VAS scores decreasing to 0.80 ± 0.85 at 24 hours. The most common long-term complications were de novo dyspareunia (10.0%) and mesh exposure (6.7%). No major intraoperative complications were observed. Conclusion Concomitant hysterectomy and vNOTES-assisted sacrocolpopexy is a feasible, safe, and effective procedure for the management of uterine prolapse. This novel, scarless technique successfully combines the principles of a gold-standard apical repair with the benefits of a truly minimally invasive approach, offering a promising alternative to conventional laparoscopic and robotic surgery.