Vaginal Natural Orifice Transluminal Endoscopic Surgery for High Uterosacral Ligament Suspension: Initial Experience in Advanced Pelvic Organ Prolapse Repair

OBJECTIVE: To evaluate the feasibility and short-term outcomes of Vaginal Natural Orifice Transluminal Endoscopic Surgery (vNOTES) High Uterosacral Ligament Suspension (USLS) in patients with advanced apical pelvic organ prolapse (POP). METHODS: This retrospective case series included 20 patients with Stage III or IV apical prolapse who underwent vNOTES High USLS. Primary outcomes were surgical feasibility, anatomical success defined as postoperative POP-Q Stage 0 or I, and symptomatic improvement defined as absence of bulge sensation or pelvic pressure. Secondary outcomes included operative time, estimated blood loss, and 30-day complications. All procedures were performed under direct endoscopic visualization with ureteral lateralization before suture placement. RESULTS: Anatomical and symptomatic success rates were both 100%. Mean patient age was 62.35 years and mean BMI was 25.2 kg/m². Mean operative time was 128.05 min, including a mean USLS duration of 54 min. Mean blood loss was 86 ml. No intraoperative or postoperative complications, including ureteral injury or hemorrhage, were observed. All patients were discharged within 48 h. CONCLUSIONS: vNOTES High USLS appears to be a feasible and safe mesh-free alternative for advanced apical prolapse. Larger prospective studies are needed to confirm long-term outcomes.