• Murat Ekin, Sukru Yildiz, Aysun Fendal Tunca, Yagmur Yucebas Yildiz, Berk Gursoy, Kardelen Basli Kasim, Keziban Dogan, and Cihan Kaya.
• University of Health Sciences Turkey, Bakirkoy Dr. Sadi Konuk Training and Research Hospital, Department of Obstetrics and Gynecology - Istanbul, Turkey.
• Rev Assoc Med Bras (1992). 2024 Jan 1; 70 (11): e20240759e20240759.

ObjectiveThe objective of this study was to describe the single-surgeon experience on transvaginal natural orifice transluminal endoscopic surgery for uterosacral ligament suspension in patients with severe prolapse who had concomitant vaginal hysterectomy.MethodsA total of 53 patients with severe uterine prolapse who underwent vaginal hysterectomy and transvaginal natural orifice transluminal endoscopic surgery for uterosacral ligament suspension between January 2021 and March 2023 were included in the study. Operation time, intraoperative and postoperative complications, de novo urinary continence, and duration of hospitalization were obtained from the patient records. Initial postoperative follow-up visits were scheduled for the first week of the month. Patients were followed up yearly, and they had the opportunity to reach the surgical team at any time. Symptomatic prolapse beyond the hymen is defined as recurrence.ResultsPatients had a mean age of 61.7 years ±7.7 SD. All patients received bilateral opportunistic salpingectomy and salpingo-oophorectomy. The total operation time was 162±31 min, with transvaginal natural orifice transluminal endoscopic surgery taking 32.3±5.37 min. There were no intraoperative complications. 12 patients had recurrence; 8 anterior, 3 apical, and 1 posterior prolapse. The mean recurrence time was 11.5 months (range 5-23 months). The reoperation rate was 13.2% (n:7). Three of the patients had obliterative vaginal surgery, three of the patients had anterior, and one patient had posterior repair. Overall failure of apical surgical procedure was 5.6%. Two patients had de novo incontinence postoperatively.ConclusionsTransvaginal natural orifice transluminal endoscopic surgery uterosacral ligament suspension is a feasible technique to treat severe pelvic organ prolapse with promising results for short-term efficacy and safety in patients who had concomitant vaginal hysterectomy. Longer follow-up periods are needed to evaluate the long-term efficacy profile of transvaginal natural orifice transluminal endoscopic surgery for uterosacral ligament suspension.

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