Tian Yu, Wu Shuo-Dong, Chen Ying-Han, Wang Dan-Bo
Department of General Surgery, Shengjing Hospital, China Medical University, Shenyang, China (mainland).
Department of Gynecology, Shengjing Hospital, China Medical University, Shenyang, China (mainland).
Med Sci Monit. 2014 Oct 10;20:1897-901. doi: 10.12659/MSM.890895.
Natural orifice transluminal endoscopic surgery (NOTES) involves the introduction of instruments through a natural orifice into the peritoneal cavity to perform surgical interventions. The vagina is the most widely used approach to NOTES. We report the utilization of the vaginal opening at the time of vaginal hysterectomy as a natural orifice for laparoscopic appendectomy.
We reviewed cases of 10 patients with chronic appendicitis who underwent transvaginal laparoscopic appendectomy simultaneously with vaginal hysterectomy. A laparoscopic approach was established after removal of the uterus, and the appendix was removed transvaginally. Among the 10 cases, 5 were conducted under gasless laparoscopy by using a simple abdominal wall-lifting instrument.
All procedures were performed successfully without intraoperative or major postoperative complications. The appendectomy portion of the procedure took approximately 21 minutes to 34 minutes. All patients were discharged less than 4 days after surgery, without external scars.
Transvaginal appendectomy with rigid laparoscopic instruments following vaginal hysterectomy appears to be a feasible and safe modification of established techniques, with acceptable outcomes.
经自然腔道内镜手术（NOTES）是指通过自然腔道将器械插入腹腔以进行手术干预。阴道是NOTES最常用的入路。我们报告了在阴式子宫切除术时利用阴道口作为腹腔镜阑尾切除术的自然腔道。
我们回顾了10例慢性阑尾炎患者同时行阴式腹腔镜阑尾切除术和阴式子宫切除术的病例。子宫切除术后建立腹腔镜入路，经阴道切除阑尾。10例病例中，5例使用简单的腹壁提升器械在无气腹腔镜下进行。
所有手术均成功完成，无术中或术后严重并发症。手术的阑尾切除部分耗时约21分钟至34分钟。所有患者术后不到4天出院，无体表瘢痕。
阴式子宫切除术后使用硬质腹腔镜器械经阴道阑尾切除术似乎是对现有技术可行且安全的改良，效果良好。
