Department of Urology, First Affiliated Hospital of Gannan Medical University, Ganzhou, People's Republic of China.
Department of Urology, First Affiliated Hospital of Gannan Medical University, Ganzhou, People's Republic of China.
Eur Urol. 2015 Aug;68(2):302-10. doi: 10.1016/j.eururo.2015.03.033. Epub 2015 Mar 31.
The feasibility of hybrid transvaginal NOTES (natural orifice transluminal endoscopic surgery) nephrectomy (HTNN) has already been demonstrated. However, pure transvaginal NOTES nephrectomy (PTNN) has been limited to animal experiments with only one report of its use in humans.
To describe our initial experience with HTNN and a stepwise transition towards PTNN.
DESIGN, SETTING, AND PARTICIPANTS: Between May 2010 and September 2011, 63 patients underwent nephrectomy (60 HTNNs and 3 PTNNs) in our institution, including 45 patients with benign renal disease and 18 patients with malignant renal disease.
Of the HTNNs, 33 were performed using two umbilical trocars and one transvaginal trocar, and 27 were performed using one umbilical trocar and a transvaginal multi-instrument access port; 3 PTNNs were performed using a self-developed, three-channel ZOU-port without any transumbilical assistance.
All data referring to patient demographics, surgery, pathology, and perioperative outcomes were recorded. Sexual function was assessed with the Female Sexual Function Index (FSFI) questionnaire before and after surgery. The cosmetic result was investigated by administering the Patient Scar Assessment Questionnaire and Scoring System (PSAQ).
A total of 59 HTNNs and 3 PTNNs were successfully performed. One patient was converted to open surgery because of injury to the inferior vena cava. The mean operative time was 130min (range: 100-260min) for HTNN and 193min (range: 180-210min) for PTNN. The mean estimated blood loss was 150ml. The mean postoperative hospital stay was 7.4 d. Forty-eight patients completed the FSFI questionnaire, and analysis did not show differences in FSFI scores before and after surgery. The better cosmetic results were confirmed by the PSAQ score.
HTNN is feasible and safe in appropriate patients. Existing instruments are adequate for HTNN, but significant improvement is still needed. PTNN is technically challenging, but is feasible and may be performed safely. Further improvement of instruments is necessary for PTNN. Clinical investigation in comparison to the established techniques should take place to evaluate the outcome of technique.
Pure transvaginal natural orifice transluminal endoscopic nephrectomy (PTNN) is technically challenging but feasible and may be performed safely. Further improvements in instruments are necessary for PTNN.
经自然腔道内镜手术（NOTES）的经阴道杂交肾切除术（HTNN）的可行性已经得到证实。然而，经阴道NOTES 肾切除术（PTNN）仅限于动物实验，仅有一份关于其在人类中应用的报告。
描述我们在 HTNN 方面的初步经验以及向 PTNN 的逐步过渡。
设计、地点和参与者：在 2010 年 5 月至 2011 年 9 月期间，我院对 63 例患者进行了肾切除术（60 例 HTNN 和 3 例 PTNN），其中 45 例患者为良性肾脏疾病，18 例患者为恶性肾脏疾病。
在 HTNN 中，33 例采用两个脐部套管和一个经阴道套管进行，27 例采用一个脐部套管和一个经阴道多器械进入端口进行；3 例 PTNN 采用自行开发的三通道 ZOU 端口进行，无需任何经脐协助。
记录了所有与患者人口统计学、手术、病理学和围手术期结果相关的数据。手术前后采用女性性功能指数（FSFI）问卷评估性功能。通过患者疤痕评估问卷和评分系统（PSAQ）调查美容效果。
共成功完成 59 例 HTNN 和 3 例 PTNN。1 例患者因下腔静脉损伤转为开放手术。HTNN 的平均手术时间为 130 分钟（范围：100-260 分钟），PTNN 的平均手术时间为 193 分钟（范围：180-210 分钟）。平均估计出血量为 150ml。平均术后住院时间为 7.4 天。48 例患者完成了 FSFI 问卷，分析显示手术前后 FSFI 评分无差异。PSAQ 评分证实了更好的美容效果。
在合适的患者中，HTNN 是可行和安全的。现有的器械足以进行 HTNN，但仍需要显著改进。PTNN 技术上具有挑战性，但可行且可能安全进行。PTNN 需要进一步改进器械。与现有技术相比，临床研究应评估技术的结果。
经阴道自然腔道内镜肾切除术（PTNN）技术上具有挑战性，但可行且可能安全进行。PTNN 需要进一步改进器械。
