Division of Gynecology, Department of Obstetrics and Gynecology, Geneva University Hospitals and University of Geneva, Geneva, Switzerland (all authors).
Division of Gynecology, Department of Obstetrics and Gynecology, Geneva University Hospitals and University of Geneva, Geneva, Switzerland (all authors).
J Minim Invasive Gynecol. 2022 Jun;29(6):705-706. doi: 10.1016/j.jmig.2022.03.008. Epub 2022 Mar 18.
To demonstrate the feasibility of transvaginal natural orifice transluminal endoscopic surgery (vNOTES) meshless anterior repair for the treatment of pelvic organ prolapse (POP).
Stepwise demonstration of the technique with narrated video footage.
The vNOTES approach is a recent and rapidly developing technique that allows safe endoscopic transvaginal treatment of benign uterine pathologies [1]. Its use in the treatment of POP is still in its early stages; however, the first results are encouraging in terms of anatomy, functionality, and safety [2].
We describe the vNOTES technique of meshless anterior POP repair using a vaginal plastron [3]. The "vaginal plastron" technique uses an autologous vaginal strip that is left attached to the bladder and suspended from the arcus tendineus. After the delimitation of a 6 cm square vaginal strip, a lateral dissection is performed on each side between the bladder and the vaginal fascia to enter the paravesical space. The vaginal strip is left attached to the bladder wall and will later be fixed laterally to the arcus tendineus with 6 nonabsorbable monofilament sutures, caliber 0 (3 on each side of the plastron). The fixation points on the arcus tendineus concern the internal obturator fascia ventrally and the iliococcygeus fascia dorsally. The sutures are placed under endoscopic view using a transvaginal access platform (GelPOINT V-Path, Applied Medical, Rancho Santa Margarita, CA). After deflation and removal of the platform, the sutures are attached to the vaginal strip. Once the vaginal plastron is secured, the anterior vaginal wall is closed.
The vNOTES approach offers an endoscopic anatomic view of the paravesical space, thus reducing any blind surgical procedure. It provides an alternative route in the performance of meshless anterior POP repair.
展示经阴道自然腔道内镜手术（vNOTES）无网片前修补术治疗盆腔器官脱垂（POP）的可行性。
分步演示技术，并配有解说视频。
vNOTES 方法是一种最近迅速发展的技术，可安全地经阴道内镜治疗良性子宫病变[1]。其在 POP 治疗中的应用仍处于早期阶段；然而，在解剖学、功能和安全性方面，初步结果令人鼓舞[2]。
我们描述了使用阴道帆状结构[3]的 vNOTES 无网片前 POP 修复技术。“阴道帆状结构”技术使用自体阴道带，该阴道带附着于膀胱并悬挂在腱弓上。在界定 6cm 见方的阴道带后，在膀胱和阴道筋膜之间的每一侧进行侧向解剖，以进入阔韧带间隙。阴道带附着于膀胱壁，稍后将用 6 根不可吸收的单丝缝线（缝线 0 号，每侧帆状结构 3 根）将其固定在腱弓上，缝线的固定点位于腱弓的内收肌筋膜下方和髂尾肌筋膜上方。在经阴道进入平台（GelPOINT V-Path，Applied Medical，Rancho Santa Margarita，CA）的内镜下放置缝线。平台充气和移除后，将缝线固定在阴道帆状结构上。一旦阴道帆状结构固定，就关闭前阴道壁。
vNOTES 方法提供了阔韧带间隙的内镜解剖视图，从而减少了任何盲目手术操作。它为无网片前 POP 修复术提供了另一种途径。
