Peri Lluis, Musquera Mireia, Vilaseca Antoni, Garcia-Cruz Eduard, Ribal Maria J, Carrión Albert, Castañeda Roberto, Alcaraz Antonio
Department of Urology, Institut d'Investigacions Biomèdiques August Pi i Sunyer (IDIBAPS), Hospital Clínic de Barcelona, Universitat de Barcelona (UB), C/Villarroel 170, 08036, Barcelona, Spain.
World J Urol. 2015 Dec;33(12):2009-14. doi: 10.1007/s00345-015-1573-9. Epub 2015 May 6.
There is a concern about the impact that this surgery could have on a patient's sexuality, although this has not been well documented. The objective of our study is to describe the surgical results and assess sexual function and patient satisfaction after transvaginal NOTES-assisted laparoscopic radical and living donor nephrectomy.
Between March 2008 and October 2014, 100 women underwent transvaginal NOTES-assisted nephrectomy (78 living donor and 22 radical nephrectomy) in our centre. The procedure was performed using two different techniques depending on the indication as described previously, but using the same vaginal approach. Variables evaluated were operative time, blood loss, intra-operative complications, hospital stay, satisfaction, first-month creatinine and warm ischaemia time in donors. Sexual function was assessed with the Female Sexual Function Index questionnaire before and after surgery. All variables were accrued in a prospective database.
The procedure was completed in all cases. Mean age and body mass index was higher in the radical nephrectomy group. Mean operative time and hospital stay were similar for both techniques. All sexually active women reported unaltered sexual function after surgery and satisfaction with the results. The pre- and post-FSFI scores for living donor (n = 54) and radical nephrectomy (n = 4) were 27.47 ± 1.02/27.27 ± 1.10 (p > 0.05) and 31.17 ± 0.81/31.87 ± 0.97 (p > 0.05).
Transvaginal NOTES-assisted or hybrid NOTES nephrectomy offers a safe technique with excellent cosmetic results and no sexual effect. Despite promising results, randomized controlled studies with longer follow-up are warranted to further elucidate the potential of this novel technique.
尽管目前尚无充分的文献记载，但人们担心这种手术可能会对患者的性功能产生影响。我们研究的目的是描述经阴道NOTES辅助腹腔镜根治性肾切除术和活体供肾肾切除术的手术结果，并评估性功能和患者满意度。
2008年3月至2014年10月期间，我们中心有100名女性接受了经阴道NOTES辅助肾切除术（78例活体供肾肾切除术和22例根治性肾切除术）。根据先前描述的适应症，采用两种不同的技术进行手术，但采用相同的经阴道入路。评估的变量包括手术时间、失血量、术中并发症、住院时间、满意度、术后第一个月的肌酐水平以及供体的热缺血时间。术前和术后使用女性性功能指数问卷对性功能进行评估。所有变量均记录在前瞻性数据库中。
所有病例手术均顺利完成。根治性肾切除术组的平均年龄和体重指数较高。两种技术的平均手术时间和住院时间相似。所有有性生活的女性术后均报告性功能未改变，对手术结果满意。活体供肾组（n = 54）和根治性肾切除术组（n = 4）术前和术后的FSFI评分分别为27.47±1.02/27.27±1.10（p>0.05）和31.17±0.81/31.87±0.97（p>0.05）。
经阴道NOTES辅助或混合NOTES肾切除术提供了一种安全的技术，具有出色的美容效果且对性功能无影响。尽管取得了令人鼓舞的结果，但仍需要进行更长时间随访的随机对照研究，以进一步阐明这种新技术的潜力。
