Bates Andrew T, Capes Tracy, Krishan Rachna, LaBombardi Vincent, Pipia Giuseppe, Jacob Brian P
Surg Endosc. 2014 Mar;28(3):886-90. doi: 10.1007/s00464-013-3242-7.
Although still experimental, natural orifice translumenal endoscopic surgery (NOTES) aims to use the natural orifices for intraabdominal surgery. Pure transvaginal umbilical hernia repair has been reported. However, mesh protection devices were used to minimize mesh contamination during mesh insertion. The authors believe that before widespread implementation of this technique, more foundational research is indicated to establish the sterility of hernia mesh insertion through this route. This prospective study aimed to compare transvaginal ventral hernia mesh insertion sterility with laparoscopic trocar-site insertion sterility to establish baseline data to help promote the safety of NOTES tranvaginal hernia repair.
This was a prospective descriptive study (Canadian Task Force classification 2A). With institutional review board approval, 10 patients undergoing laparoscopic surgery for benign gynecologic disease were enrolled in the study. Atrium Prolite mesh (polypropylene monofilament) was inserted into the vagina before and after standard surgical preparation with 10 % povidone–iodine. As a control, mesh also was inserted through a prepped laparoscopic port site. The mesh was cultured for bacterial, fungal, and viral contamination. All patients received standard infection prophylaxis that included preoperative intravenous cefazolin and metronidazole.
The unprepped vaginal canal was cultured and demonstrated normal multiorganism vaginal flora in all 10 cases. Of the 10 skin incision mesh samples, 3 (30 %) grew bacteria, including Staphylococcus lugdunensis, a potentially pathogenic organism. In contrast, none of the prepped vaginal mesh specimens yielded any growth of microorganisms or potential pathogens.
This study showed that a surgically prepped vaginal canal can be a sterile conduit for insertion of polypropylene mesh for transvaginal ventral hernia repair without the use of additional mesh protection. Surprisingly, the prepped vaginal conduit in our patients was more sterile than a prepped skin incision.
尽管自然腔道内镜手术（NOTES）仍处于实验阶段，但其旨在利用自然腔道进行腹腔内手术。已有关于单纯经阴道脐疝修补术的报道。然而，在植入补片过程中使用了补片保护装置以尽量减少补片污染。作者认为，在广泛应用该技术之前，需要开展更多基础研究以确定通过该途径植入疝修补补片的无菌性。这项前瞻性研究旨在比较经阴道腹疝补片植入的无菌性与腹腔镜套管针穿刺部位植入的无菌性，以建立基线数据，帮助提高NOTES经阴道疝修补术的安全性。
这是一项前瞻性描述性研究（加拿大工作组分类2A）。经机构审查委员会批准，10例因良性妇科疾病接受腹腔镜手术的患者纳入本研究。在使用10%聚维酮碘进行标准手术准备前后，将Atrium Prolite补片（聚丙烯单丝）插入阴道。作为对照，补片也通过准备好的腹腔镜穿刺部位插入。对补片进行细菌、真菌和病毒污染培养。所有患者均接受标准的感染预防措施，包括术前静脉注射头孢唑林和甲硝唑。
对未准备的阴道管进行培养，所有10例均显示正常的多种阴道菌群。10个皮肤切口补片样本中，3个（30%）培养出细菌，包括潜在致病生物路邓葡萄球菌。相比之下，准备后的阴道补片标本均未出现任何微生物或潜在病原体生长。
本研究表明，经过手术准备的阴道管可作为经阴道腹疝修补术植入聚丙烯补片的无菌通道，无需使用额外的补片保护装置。令人惊讶的是，我们患者中准备后的阴道通道比准备后的皮肤切口更无菌。
