Department of Gynecology and Obstetrics, Shengjing Hospital of China Medical University, Shenyang, China.
J Surg Res. 2014 Jan;186(1):179-83. doi: 10.1016/j.jss.2013.08.026. Epub 2013 Sep 20.
The vagina is the most widely used approach to natural orifice transluminal endoscopic surgery. However, a gas leak can significantly affect transvaginal operations during pneumoperitoneum laparoscopy. We tried to establish the proper technique for transvaginal appendectomy under gasless laparoscopy.
Five patients with chronic appendicitis were selected to receive gasless laparoscopic transvaginal appendectomy with concurrent vaginal hysterectomy. An abdominal wall-lifting device was applied after removal of the uterus, and the appendix was removed transvaginally. Clinical data such as operative duration, bleeding volume, morbidity, and hospital stay duration were analyzed.
All procedures were performed successfully, without intraoperative or major postoperative complications. The appendectomy portion of the procedure took approximately 20-30 minutes, with minimal blood loss. All patients were discharged, scar-free, 3 d after surgery.
Transvaginal appendectomy with gasless laparoscopy after vaginal hysterectomy appears to be a feasible and safe modification of established techniques, with acceptable outcomes.
阴道是经自然腔道内镜手术（NOTES）最常使用的入路方式。然而，在气腹腹腔镜手术期间，气体泄漏会显著影响经阴道手术。我们尝试建立一种新的无气腹腹腔镜经阴道阑尾切除术技术。
选择 5 例慢性阑尾炎患者，同期行经阴道子宫切除术后行经阴道无气腹腹腔镜阑尾切除术。子宫切除术后应用腹壁提拉装置，经阴道切除阑尾。分析手术时间、出血量、发病率和住院时间等临床资料。
所有手术均成功完成，无术中或主要术后并发症。手术的阑尾切除部分大约需要 20-30 分钟，出血量很少。所有患者术后 3 天均无疤痕出院。
经阴道子宫切除术后无气腹腹腔镜经阴道阑尾切除术似乎是一种可行且安全的改良方法，具有可接受的结果。
