Department of General, Visceral, and Transplant Surgery, University of Heidelberg, Im Neuenheimer Feld 110, Heidelberg, Germany.
Endoscopy. 2012 Jul;44(7):684-9. doi: 10.1055/s-0032-1309390. Epub 2012 Apr 23.
Animal data and limited clinical evidence suggest a low incidence of infection following transvaginal natural orifice transluminal endoscopic surgery (NOTES). However, a systematic microbiological evaluation has not yet been carried out. The aim of this prospective cohort study was to evaluate the extent of microbiological contamination of the peritoneal cavity caused by the transvaginal access for NOTES and the impact of preoperative vaginal disinfection on vaginal colonization.
Consecutive female patients with symptomatic cholecystolithiasis were offered either transvaginal rigid-hybrid cholecystectomy (tvCCE) or conventional laparoscopic cholecystectomy. Patients who opted for tvCCE were prospectively evaluated between February and June 2010. Disinfection in patients undergoing tvCCE included hexetidine tablets and octenidine applied vaginally. All patients received a single dose of perioperative cefuroxime. Swabs were obtained from the posterior fornix and the peritoneal cavity at different intervals.
Of 32 patients, 27 (84 %) opted to undergo tvCCE. One patient (4 %; 95 % confidence interval [CI] 0.7 % - 18.3 %) had a positive bacterial culture in the Douglas pouch prior to transvaginal access compared with two patients (7 %; 95 %CI 2.1 % - 23.4 %) following colpotomy closure (P = 1.000). Vaginal disinfection significantly decreased vaginal bacterial load (P = 0.001) and bacterial growth in routine cultures (P < 0.001); in 16 patients (59 %; 95 %CI 40.7 % - 75.5 %) vaginal swabs were sterile after disinfection. No postoperative surgical site infections occurred (95 %CI 0 % - 12.5 %).
In selected patients and following vaginal antisepsis, transvaginal access for NOTES is associated with microbiological contamination of the peritoneal cavity in a minority of patients, indicating a low risk of peritoneal contamination caused by the transvaginal access.
动物数据和有限的临床证据表明，经阴道自然腔道内镜手术（NOTES）后感染发生率较低。然而，尚未进行系统的微生物学评估。本前瞻性队列研究旨在评估经阴道NOTES 入路引起的腹腔微生物污染程度，以及术前阴道消毒对阴道定植的影响。
连续患有症状性胆囊结石的女性患者被提供经阴道硬性杂交胆囊切除术（tvCCE）或传统腹腔镜胆囊切除术。选择接受 tvCCE 的患者于 2010 年 2 月至 6 月期间进行前瞻性评估。接受 tvCCE 的患者接受了己脒定片剂和奥替尼定阴道消毒。所有患者均接受了单次围手术期头孢呋辛治疗。在不同时间点从后穹窿和腹腔获得拭子。
在 32 名患者中，27 名（84%）选择接受 tvCCE。与经阴道切开关闭后 2 名患者（7%；95%CI 2.1% - 23.4%）相比，1 名患者（4%；95%CI 0.7% - 18.3%）在经阴道入路前Douglas 袋中细菌培养阳性（P = 1.000）。阴道消毒显著降低阴道细菌负荷（P = 0.001）和常规培养中的细菌生长（P < 0.001）；在 16 名患者（59%；95%CI 40.7% - 75.5%）中，消毒后阴道拭子无菌。无术后手术部位感染（95%CI 0% - 12.5%）。
在选定的患者中，并且在阴道消毒后，经阴道NOTES 入路与少数患者的腹腔微生物污染相关，表明经阴道入路引起的腹膜污染风险较低。
