Up to 50% of patients suffer from pelvic organ prolapse. Hystero-sacrocolpoplexy helps reposition the uterus to the sacrum and provides support to prevent further prolapse and relieve patient symptoms. Natural orifice transluminal endoscopic surgery (NOTES) sacrocolpoplexy represents a pioneering minimally invasive approach for treating pelvic organ prolapse and offers patients the potential for improved cosmetic outcomes and enhanced postoperative comfort.

We performed a stepwise video to demonstrate the tips and tricks for performing NOTES hystero-sacrocolpoplexy. First, a posterior colpotomy was done at the cul-de-sac before inserting the NOTES device. Then, after entering the pelvic cavity, we opened the peritoneum of the presacral area and fixed one end of the mesh on it. A retroperitoneal tunnel was made from the sacral promontory to the cul-de-sac along the paracolic gutter, and the mesh was pulled through the tunnel with the other end fixed beneath the cervix. After that, we closed the peritoneal window and vaginal window sequentially.

The technique of NOTES hystero-sacrocolpoplexy was successfully performed in the video using the Gyrus PK cutting forceps energy device and titanium screw. The patient's symptoms were relieved, with no ureter injury after surgery.

NOTES hystero-sacrocolpoplexy is an effective procedure for improving uterine prolapse symptoms. Compared to laparoscopic sacrocolpoplexy, it is a novel minimally invasive approach that avoids abdominal incisions and provides improved visualization.

Continence 12S (2024) 101523
DOI: 10.1016/j.cont.2024.101523