Bilateral fixation of the vaginal stump to the uterosacral ligaments using vNOTES and considering S1-S3 nerve roots
Musin I.I., Berg E.A., Yaschuk A.G., Molokanova A.R., Murtazina G.Kh., Popova E.M.
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.
Authors’ contributions: Musin I.I. – developing the design of the study, collecting the material; Berg E.A. – writing the article, collecting the material; Yaschuk A.G. – developing the concept of the study, editing the text, approving the final variant of the article; Murtazina G.Kh. – editing the text, collecting the material; Molokanova A.R. – collecting the material, editing the text; Popova E.M. – writing the article, collecting the material.
Conflicts of interest: Authors declare lack of the possible conflicts of interest.
Funding: The study was conducted without sponsorship.
Ethical Approval: The study was approved by the Ethical Review Board of the Bashkir State Medical University, Ministry of Health of Russia.
Patient Consent for Publication: The patients signed informed consent for the publication of their data and associated images.
Authors' Data Sharing Statement: The data supporting the findings of this study are available on request from the corresponding author after approval from the principal investigator.
For citation: Musin I.I., Berg E.A., Yaschuk A.G., Molokanova A.R., Murtazina G.Kh., Popova E.M. Bilateral fixation of the vaginal stump to the uterosacral ligaments using vNOTES and considering S1-S3 nerve roots.
Akusherstvo i Ginekologiya/Obstetrics and Gynecology. 2025; (7): 138-144 (in Russian)
https://dx.doi.org/10.18565/aig.2025.61
Keywords
pelvic organ prolapse
vNOTES
apical prolapse
surgical correction of prolapse
neuropelviology
References
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Received 05.03.2025
Accepted 27.05.2025
About the Authors
Ilnur I. Musin, Dr. Med. Sci., Professor at the Department of Obstetrics and Gynecology No. 2, Bashkir State Medical University, Ministry of Health of Russia,450008, Russia, Ufa, Lenin str., 3; Deputy Chief Physician for Obstetrics and Gynecology Care, City Clinical Perinatal Center of Ufa, 450065, Russia, Ufa, Koltsevaya str., 131,
+7(347)264-96-50, ilnur-musin@yandex.ru, https://orcid.org/0000-0001-5520-5845
Edvard A. Berg, PhD, Associate Professor at the Department of Obstetrics and Gynecology No. 2, Bashkir State Medical University, Ministry of Health of Russia,
450008, Russia, Ufa, Lenin str., 3, +7(927)337-90-03, nucleardeer@gmail.com, https://orcid.org/0000-0002-2028-7796
Alfiya G. Yashchuk, Dr. Med. Sci., Professor, Head of the Department of Obstetrics and Gynecology No. 2, Bashkir State Medical University, Ministry of Health of Russia, 450008, Russia, Ufa, Lenin str., 3, +7(347)264-96-50, alfiya_galimovna@mail.ru, https://orcid.org/0000-0003-2645-1662
Angela R. Molokanova, PhD, Head of the Maternity Department, City Clinical Perinatal Center of Ufa, 450065, Russia, Ufa, Koltsevaya str., 131, +7(929)755-77-55, angella1210@mail.ru, https://orcid.org/0000-0003-1115-6775
Gulnaz Kh. Murtazina, PhD, Associate Professor at the Department of Obstetrics and Gynecology No. 2, Bashkir State Medical University, Ministry of Health of Russia, 450008, Russia, Ufa, Lenin str., 3, +7(987)587-61-72, karamelka5@inbox.ru, https://orcid.org/0000-0002-3856-8094
Elena M. Popova, Teaching Assistant at the Department of Obstetrics and Gynecology No. 2, Bashkir State Medical University, Ministry of Health of Russia,
450008, Russia, Ufa, Lenin str., 3, +7(987)133-59-69, kafedraagidpo2@mail.ru, https://orcid.org/0000-0001-7298-3489
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