Albayrak Denizli Ayşe Betül, Bulutlar Eralp, Uluutku Bulutlar Gizem Berfin, Şahin Sadık
Department of Obstetrics and Gynecology, University of Health Sciences Zeynep Kamil Women's and Children's Disease Training and Research Hospital, Istanbul, Turkey.
Department of Obstetrics and Gynecology, University of Health Sciences Haydarpaşa Numune Training and Research Hospital, Istanbul, Turkey.
J Obstet Gynaecol Res. 2025 Aug;51(8):e70017. doi: 10.1111/jog.70017.
Pelvic organ prolapse (POP) significantly impacts women's quality of life, often necessitating surgical intervention. Sacrospinous ligament fixation (SSF) and uterosacral ligament suspension (USLS) are commonly performed, mesh-free procedures for apical prolapse repair. While SSF provides durable support, it may alter vaginal axis alignment and compromise visualization, whereas traditional USLS is associated with ureteral complications. This study compares the perioperative and postoperative outcomes of SSF and Vaginal Natural Orifice Transluminal Endoscopic Surgery (vNOTES) high uterosacral ligament suspension (VN-HUSLS).
This retrospective case series was conducted at Zeynep Kamil Hospital and included 50 patients with Stage 3 or 4 POP who underwent vaginal hysterectomy followed by SSF (n = 27) or VN-HUSLS (n = 23). Demographic data, operative times, hospitalization duration, POP-Q scores, recurrence rates, and complications were analyzed using SPSS (p < 0.05).
No significant differences were found in age, BMI, or preoperative POP stage (p > 0.05). Prolapse-specific surgical time was significantly shorter in the VN-HUSLS group (p < 0.05). All VN-HUSLS patients underwent bilateral adnexectomy with preoperative indications, compared to five in the SSF group. Postoperative POP-Q scores showed better anatomical correction in the VN-HUSLS group, with sustained improvements at 6- and 12-month follow-ups. In the SSF group, two patients experienced recurrence, one at 6 months (Ba point +2) and the other at 12 months (Ba point +3). In the VN-HUSLS group, one patient was found to have Ba point at +1 at the 12-month follow-up, but this did not result in any additional symptoms for the patient.
VN-HUSLS is a promising alternative to SSF, improving surgical outcomes while reducing recurrence and postoperative morbidity. Further studies are needed to evaluate long-term outcomes and postoperative sexual function.
盆腔器官脱垂（POP）严重影响女性生活质量，常需手术干预。骶棘韧带固定术（SSF）和子宫骶骨韧带悬吊术（USLS）是常用于修复顶端脱垂的无网片手术。虽然SSF提供持久支撑，但可能改变阴道轴对齐并影响视野，而传统USLS与输尿管并发症相关。本研究比较了SSF与经阴道自然腔道内镜手术（vNOTES）高位子宫骶骨韧带悬吊术（VN-HUSLS）的围手术期和术后结果。
本回顾性病例系列研究在Zeynep Kamil医院进行，纳入50例3期或4期POP患者，这些患者接受了阴道子宫切除术，随后接受了SSF（n = 27）或VN-HUSLS（n = 23）。使用SPSS分析人口统计学数据、手术时间、住院时间、POP-Q评分、复发率和并发症（p < 0.05）。
在年龄、体重指数或术前POP分期方面未发现显著差异（p > 0.05）。VN-HUSLS组的脱垂特异性手术时间显著更短（p < 0.05）。所有VN-HUSLS患者均根据术前指征进行了双侧附件切除术，而SSF组有5例。术后POP-Q评分显示VN-HUSLS组的解剖学矫正更好，在6个月和12个月随访时持续改善。在SSF组，2例患者复发，1例在6个月时（Ba点+2），另1例在12个月时（Ba点+3）。在VN-HUSLS组，1例患者在12个月随访时Ba点为+1，但这未给患者带来任何额外症状。
VN-HUSLS是SSF的一种有前景的替代方法，可改善手术结果，同时降低复发率和术后发病率。需要进一步研究来评估长期结果和术后性功能。
