Retroperitoneal Tunnel VNOTES Mesh-Free Sacrocolpopexy: Initial Clinical Experience

Background and Objectives: To describe the initial clinical experience with retroperitoneal tunnel-assisted mesh-free vaginal natural orifice transluminal endoscopic surgery (vNOTES) sacrocolpopexy and assess its anatomical and functional outcomes in women with apical pelvic organ prolapse. Materials and Methods: This exploratory retrospective case series included 20 sexually active women whose ages ranged from 30 to 80 years. Anatomical outcomes were evaluated using the POP-Q system, and sexual function was assessed using the Female Sexual Function Index (FSFI) preoperatively and at the 12-month postoperative follow-up. A paired-samples t-test was used for statistical analysis (p < 0.05). Results: The mean age was 48.0 ± 5.26 years, and the mean Body Mass Index (BMI) was 30.0 ± 2.17 kg/m2. The mean operative time was 80.10 ± 9.37 min, and the mean estimated blood loss was 83.50 ± 20.33 mL. No intraoperative complications were observed. Five postoperative complications occurred, each affecting one patient (5%), corresponding to an overall postoperative complication rate of 25%. These included vaginal cuff hematoma, urinary retention, urinary tract infection, de novo urge urinary incontinence, and de novo stress urinary incontinence. Four complications were managed without surgery, while one patient with persistent de novo stress urinary incontinence required a tension-free vaginal tape (TVT) procedure. Significant improvements were noted in all POP-Q parameters; point C improved from 3.05 ± 0.89 cm to −7.25 ± 1.02 cm (p < 0.001). Total vaginal length was largely preserved (from 8.05 ± 0.76 cm to 7.85 ± 0.67 cm; p = 0.042). The FSFI total score increased from 22.11 ± 3.36 to 25.05 ± 2.51 (p < 0.001). Conclusions: This exploratory retrospective case series suggests that retroperitoneal tunnel-assisted mesh-free vNOTES sacrocolpopexy is technically feasible and is associated with favorable anatomical and functional outcomes at 12 months. However, the small sample size, absence of a control group, and limited follow-up prevent definitive conclusions regarding its efficacy, safety, and long-term durability. Larger prospective comparative studies with longer follow-up are needed to further evaluate this technique.