Tabutsadze T, Kipshidze N
Academician N. Kipshidze Central University Hospital, Tbilisi, Georgia.
Georgian Med News. 2009 Mar(168):7-10.
Natural Orifice Transluminal Endoscopic Surgery is a new method of mini invasive surgery, which involves passing surgical instruments, and a tiny camera, through a natural orifice, such as the mouth, vagina, urethra or rectum, what provides the access to the desired organ. The procedure is approved due to its benefits - less pain, quicker recoveries, fewer complications and no scar - as it lets us avoid major incisions through the skin, muscle and nerves of the abdomen. Besides that the transluminal access is considered to be the most safe and feasible for clinical application. Here are discussed the two operations of Transvaginal Appendectomy performed in Caucasus - Academician N. Kipshidze University Hospital in Tbilisi. The first patient - a 28-year woman, weight - 72 kg, height - 180 cm, married, has one child - was submitted to the hospital with anamnesis of 48 hours acute appendicitis, typical clinical semiotics and laboratory records. In the second case the patient was a 22-year old woman, height - 170 cm, weight - 68 kg, married, with 2 children. She was hospitalized with 24 hours acute appendicitis anamnesis and typical clinical semiotics and laboratory records. Both operations were performed under general anesthesia, using Karl Storz GmbH & Co. equipment. The duration of the first procedure was 76 minutes and the second operation lasted for 88 minutes. The operations were made without any technical difficulties or complications. None of the patients had the need of non-narcotic analgesia during the post-operational period. No gynecological or surgical problems or any complications were detected during the observation period. The patients had superior postoperative evolution, so the stationary stay made up 36 hours after the first operation and 30 hours after the second. Essentially NOTES is a new trend in endoscopic surgery - the non-scar surgery with major advantages compared to the conventional - the NOTES takes endoscopic surgery one step further in terms of reducing pain and avoiding long hospitalization and is much more effective. The doctors hope to have more developed and flexible endoscopic surgical tools as they are planning to perform more complicated procedures in the future. Taking in consideration the appropriate experience of the operator the procedure is safe, more physiological and precise. Natural-orifice surgery becomes more familiar and as more procedures are successfully performed, the acceptance of it will grow. We consider NOTES is a challenge in surgery and in the nearest future in case of suitable technical support it will replace not only conventional medicine but laparoscopic too.
经自然腔道内镜手术是一种新型微创手术方法，该方法通过口腔、阴道、尿道或直肠等自然腔道插入手术器械及微型摄像头，从而进入目标器官。由于其具有疼痛轻、恢复快、并发症少及无疤痕等优点，该手术方法已获批准，因为它避免了腹部皮肤、肌肉和神经的大切口。此外，经腔道入路在临床应用中被认为是最安全可行的。本文讨论了在格鲁吉亚第比利斯的院士N. 基普希泽大学医院进行的两例经阴道阑尾切除术。首例患者为一名28岁女性，体重72千克，身高180厘米，已婚，育有一子，因48小时急性阑尾炎病史、典型临床症状及实验室检查结果入院。第二例患者为一名22岁女性，身高170厘米，体重68千克，已婚，育有两子。因24小时急性阑尾炎病史、典型临床症状及实验室检查结果入院。两台手术均在全身麻醉下进行，使用卡尔史托斯公司的设备。第一例手术持续76分钟，第二例手术持续88分钟。手术过程无任何技术困难或并发症。术后观察期间，所有患者均无需非麻醉性镇痛。未发现妇科或外科问题及任何并发症。患者术后恢复良好，第一例手术后住院36小时，第二例手术后住院30小时。本质上，经自然腔道内镜手术是内镜手术的新趋势——一种无疤痕手术，与传统手术相比具有显著优势——经自然腔道内镜手术在减轻疼痛和避免长期住院方面使内镜手术更进一步，且效果更佳。医生们希望拥有更先进、更灵活的内镜手术工具，因为他们计划在未来开展更复杂的手术。考虑到术者的适当经验，该手术安全、更符合生理且精确。随着经自然腔道手术变得更加常见且更多手术成功实施，其接受度将会提高。我们认为经自然腔道内镜手术是外科领域的一项挑战，在不久的将来，若有合适的技术支持它不仅会取代传统手术，还会取代腹腔镜手术。
