Department of Urology, IDIBAPS, Hospital Clinic - Universitat de Barcelona, Barcelona, Spain.
Eur Urol. 2011 Jun;59(6):1019-25. doi: 10.1016/j.eururo.2011.03.021. Epub 2011 Mar 23.
Natural orifice transluminal endoscopic surgery (NOTES) uses natural orifices to access the abdominal cavity. We adapted NOTES to perform transvaginal NOTES-assisted laparoscopic nephrectomy in living donors.
To assess the feasibility and reproducibility of this procedure and compare it with conventional laparoscopic living donor nephrectomy (LLDN).
DESIGN, SETTING, AND PARTICIPANTS: From July 2009 to October 2010, 20 women underwent transvaginal NOTES-assisted living donor nephrectomy (LDN) in our centre. We compared the prospectively collected clinical data of each donor with those of a contemporaneous matched pair of conventional LLDNs (40 donors).
The procedure was performed using three abdominal trocars and one trocar through the vaginal wall.
Variables evaluated for donors were procedure length, blood loss, warm ischaemia time (WIT), complications, hospital stay, and first-month creatinine nadir. In the transvaginal LDN group, sexual function was assessed with the Female Sexual Function Index questionnaire before and after surgery. Variables evaluated for recipients were complications, graft function, and creatinine evolution.
The procedure was completed in all cases. Operative variables were similar for both groups except for WIT, which was longer in the transvaginal LDN group (p<0.001) without consequences for graft functioning. One transvaginal LDN case had postoperative bleeding requiring immediate open surgery. All transvaginal LDN donors reported unaltered sexual function after surgery and satisfaction with the results. All recipients had immediate urine output, and all had a functioning graft at last follow-up except for one recipient of the transvaginal LDN group who required transplantectomy. Despite promising results, randomised controlled studies with longer follow-up are warranted to further elucidate the potential of this novel technique.
Transvaginal NOTES-assisted LDN appears to be a feasible and reproducible surgical technique. The WIT was longer in the transvaginal group, and there was no effect on graft function after the short follow-up.
经自然腔道内镜手术（NOTES）使用自然腔道进入腹腔。我们将 NOTES 应用于活体供者经阴道NOTES 辅助腹腔镜肾切除术。
评估该手术的可行性和可重复性，并与传统腹腔镜活体供肾切除术（LLDN）进行比较。
设计、地点和参与者：2009 年 7 月至 2010 年 10 月，本中心对 20 名女性进行了经阴道 NOTES 辅助活体供肾切除术（LDN）。我们将每位供者的前瞻性收集的临床数据与同期 40 例传统 LLDN 的配对数据进行比较。
该手术使用三个腹部套管针和一个经阴道壁的套管针进行。
评估供者的变量包括手术时间、失血量、热缺血时间（WIT）、并发症、住院时间和术后第一个月肌酐最低值。在经阴道 LDN 组，用女性性功能指数问卷评估手术前后的性功能。评估受者的变量包括并发症、移植物功能和肌酐演变。
所有病例均完成手术。两组的手术变量相似，但经阴道 LDN 组的 WIT 较长（p<0.001），但对移植物功能没有影响。一例经阴道 LDN 术后出血，需立即行开放手术。所有经阴道 LDN 供者术后报告性功能未改变，对结果满意。所有受者术后即刻排尿，最后一次随访时所有受者均有功能移植物，除经阴道 LDN 组一名受者需要移植切除术外。尽管结果有希望，但需要进行更长随访时间的随机对照研究来进一步阐明这项新技术的潜力。
经阴道 NOTES 辅助 LDN 似乎是一种可行且可重复的手术技术。经阴道组的 WIT 较长，但在短期随访中对移植物功能没有影响。
