Surgical Technique of VNOTES Sacrocolpopexy

Objectives: To describe the surgical technique of transvaginal natural orifice transluminal endoscopic surgery (vNOTES) sacrocolpopexy for apical support.

Methods: In this video, we demonstrate the key techniques: Dissection of anterior vaginal wall following vaginal hysterectomy, Y- mesh measurement and division, establishment of transvaginal access of instruments, incising peritoneum to reach presacral space, retroperitoneal tunneling, attaching mesh and completing the peritonealisation, hand suturing to anchor mesh to the vaginal wall and measurement of final post procedure vaginal length.

Clinical Relevance: The vNOTES approach is feasible, safe, and efficient for sacrocolpopexy. It avoids incisions on the abdomen achieving excellent cosmetic results.