Transvaginal natural orifice transluminal endoscopic surgery for presacral-uterosacral ligament compound suspension in apical compartment prolapse

Introduction and hypothesis We aimed to describe a novel mesh-free pelvic repair surgery for apical prolapse and to evaluate the effect of this technique and early outcomes. Methods We demonstrate the key techniques in a video: exposing the anterior longitudinal ligament (ALL) of the presacral space; securing a non-absorbable suture to the ALL by horoscope stitch; shortening the right uterosacral ligament (USL); placing a non-absorbable suture around the intermediate portion of the left USL for three stitches; placing the non-absorbable suture in the transverse portion of the pubocervical and rectovaginal fascia; locking sutures in place to approximate anterior to posterior connective tissue. Fifteen patients were enrolled to undergo this procedure between December 2020 and April 2021. Results The mean age of the patients was 60.67 (range 46-69) years, the mean body mass index was 24.25 kg/m(2) (range 19.61-30.08). The mean operation time was 103.6 min (range 65-166), and the mean blood loss was 82 ml (range 50-200). No intraoperative complications occurred. All patients gained a significant improvement in anatomical and objective outcomes during a mean 9.93-month follow-up, and there was no recurrence. Conclusions Our experience showed that this mesh-free repair surgery was a feasible and safe technique for apical prolapse.