This study describes a technique that facilitates the identification of the ureter during radical excision of endometriosis. After dissection of the ureter, a biocompatible silicone sling is introduced into the pelvis through the trocar; the sling is applied around the ureter and the two ends of the sling are pulled until adequate traction on the ureter is obtained. Ureteral suspension was performed in 126 consecutive women with endometriotic lesions involving the ovarian fossa and/or the uterosacral ligaments. This surgical technique facilitated the identification of the ureter, preventing injuries.
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vNOTES as a salvage method for adnexectomy and high uterosacral ligament suspension after vaginal hysterectomy under epidural anesthesia: A feasibility and safety study.
Eur J Obstet Gynecol Reprod Biol
January 2025
Objective: To evaluate the feasibility and safety of transvaginal natural orifice transluminal endoscopic surgery (vNOTES) for performing adnexectomy and high uterosacral ligament suspension (HUSLS) after vaginal hysterectomy (VH) under epidural anesthesia.
Method: This was a retrospective case series of 42 women who underwent VH for stage II or greater apical prolapse according to pelvic organ prolapse quantification (POP-Q); however, adnexectomy could not performed and replace the vNOTES technique. The procedure continued with vNOTES adnexectomy and bilateral HUSLS under epidural anesthesia.
vNOTES versus Laparoscopic Uterosacral Ligament Suspension for Apical Pelvic Organ Prolapse: Perioperative and Short-Term Outcomes.
Int Urogynecol J
September 2024
Division of Urogynecology, Department of Obstetrics and Gynecology, McGill University, Montreal, QC, Canada.
Article Synopsis
- The study compares the outcomes of Vaginal Natural Orifice Transluminal Endoscopic Surgery (vNOTES) and laparoscopic surgery in treating pelvic organ prolapse through uterosacral ligament suspension (USLS).
- Data was gathered from women who underwent both procedures between 2017 and 2023, analyzing factors like operative outcomes, complication rates, and symptom improvement.
- While both techniques showed similar postoperative success rates, vNOTES achieved a higher anatomical success rate at 6 weeks, although the difference was not significant after corrections for other factors.
Outcomes of uterosacral ligaments suspension for uterovaginal prolapse native-tissue repair: Over 1000-patient single-center study.
Eur J Obstet Gynecol Reprod Biol
October 2024
Fondazione IRCCS San Gerardo dei Tintori, Monza, Italy.
Article Synopsis
- - The study evaluated the effectiveness and complications of high uterosacral ligament (USL) suspension as a surgery for managing pelvic organ prolapse (POP) in a large group of patients over a 12-year period.
- - Out of 1,099 patients, the surgery had a low complication rate of 3.4% and a recurrence rate of 12.4%, with only 0.9% requiring reoperation due to prolapse recurrence.
- - Postoperative results showed significant improvements in various pelvic dysfunctions, indicating that high USL suspension is a safe and effective primary treatment for POP.
Intraoperative Fluorescent Ureter Visualization for Transvaginal High Uterosacral Ligament Suspension for Severe Pelvic Organ Prolapse.
Int Urogynecol J
July 2024
Department of Gynecology, Fondazione IRCCS San Gerardo Dei Tintori-University of Milano-Bicocca, Via Pergolesi 33, Monza, Italy.
Article Synopsis
- The study aimed to explore the use of intra-ureteric indocyanine green (ICG) and near-infrared fluorescence (NIRF) imaging for safely navigating the ureters during transvaginal surgeries for prolapse repair to minimize the risk of ureter injuries.
- The methodology involved using a cystoscope and ureteral catheter to identify the ureter, allowing for clear visualization through NIRF imaging before placing sutures in the ligaments.
- Results showed no complications during or after the procedure, suggesting that using ICG-NIRF imaging is an effective, low-cost method to enhance ureteral detection during challenging surgical situations.
Laparoscopic Versus Vaginal Uterosacral Ligament Suspension in Women With Pelvic Organ Prolapse: A Systematic Review and Meta-Analysis of the Literature.
J Minim Invasive Gynecol
June 2024
Endoscopic Surgery Unit, 1(st) Department of Obstetrics and Gynecology, National and Kapodistrian University of Athens, "Alexandra" General Hospital, Vasilissis Sofias Avenue 80, 11528, Athens, Greece. (all authors).
Objective: Uterosacral ligament suspension (USLS) is one of the most frequently used operations for the restoration of apical support in women with uterovaginal prolapse. However, existing studies are inconclusive as to whether and which surgical access route is superior. The aim of the present meta-analysis is tentatively to compare the efficiency and the postoperative complications of laparoscopic USLS (L-USLS) and vaginal USLS (V-USLS), highlighting that current evidence remains inconclusive regarding the superiority of either surgical access route.
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