Thele F, Zygmunt M, Glitsch A, Heidecke C-D, Schreiber A
Department of Gynecology and Obstetrics, Greifswald University Hospital, Ernst-Moritz-Arndt University of Greifswald, Germany.
Endoscopy. 2008 Jul;40(7):576-80. doi: 10.1055/s-2008-1077379.
Natural-orifice transluminal endoscopic surgery (NOTES) is regarded as safer and less invasive than laparoscopic surgery. However, there has been no documentation of the opinions of surgically active, experienced gynecologists about the indications, contraindications, risks, and complications of transvaginal access.
A two-page questionnaire was distributed to the heads of the gynecological departments at 181 university and major teaching hospitals across Germany, Austria, and Switzerland. Fifty-two questionnaires (28.7 %) were returned and evaluated. The questionnaire contained ten questions, four of which were yes/no questions and another five of which allowed between four and seven answers. The questionnaire contained one additional open question.
Of the respondents, 69.2 % classified transvaginal access for extrapelvic abdominal surgery as ethical; the remaining 30.8 % described it as experimental. Only 28.8 % would recommend NOTES to their patients if NOTES presented the same surgical risks as the laparoscopic approach. When asked about NOTES-associated complications, 73.1 % mentioned the risk of infection, 61.5 % visceral lesions, 44.2 % infertility, and 34.6 % adhesions. In terms of long-term problems, gynecologists are concerned about dyspareunia and infertility. Adopting their patients' point of view, 17.3 % voted the lack of scarring compared to laparoscopy as important and 57.6 % as unimportant.
While transvaginal NOTES is argued to be a promising access for scarless surgery, gynecologists mention postoperative infection, visceral lesions, infertility, and adhesions as conceivable complications. Since long-term experience has not yet been achieved, potential problems such as dyspareunia, infertility, and the spread of pre-existing endometriosis remain definitely conceivable complications.
自然腔道内镜手术（NOTES）被认为比腹腔镜手术更安全且侵入性更小。然而，目前尚无关于活跃在手术领域的经验丰富的妇科医生对经阴道入路的适应证、禁忌证、风险及并发症看法的文献记录。
向德国、奥地利和瑞士181所大学及主要教学医院的妇科主任发放了一份两页的调查问卷。共收回52份问卷（28.7%）并进行了评估。问卷包含10个问题，其中4个为是/否问题，另外5个允许有4至7个答案。问卷还包含一个附加的开放式问题。
在受访者中，69.2%将盆腔外腹部手术的经阴道入路归类为符合伦理；其余30.8%将其描述为试验性的。如果NOTES与腹腔镜手术具有相同的手术风险，只有28.8%的人会向患者推荐NOTES。当被问及NOTES相关并发症时，73.1%提到了感染风险，61.5%提到了内脏损伤，44.2%提到了不孕，34.6%提到了粘连。就长期问题而言，妇科医生担心性交困难和不孕。从患者角度看，17.3%认为与腹腔镜手术相比无瘢痕很重要，57.6%认为不重要。
虽然经阴道NOTES被认为是无痕手术的一种有前景的入路，但妇科医生提到术后感染、内脏损伤、不孕和粘连是可能出现的并发症。由于尚未积累长期经验，诸如性交困难、不孕以及原有子宫内膜异位症扩散等潜在问题肯定仍是可能出现的并发症。
