Hospital of Guangzhou Medical University, Guangzhou, Guangdong, China.
Baylor College of Medicine, Houston, Texas.
J Minim Invasive Gynecol. 2018 Sep-Oct;25(6):959-960. doi: 10.1016/j.jmig.2018.01.011. Epub 2018 Feb 2.
Transvaginal surgery is the most minimally invasive surgery for a gynecologic procedure, but it has the limitation of lack of exposure and limited surgical space when using traditional vaginal surgical instrumentation, such as in a hysterectomy for a uterus without descent or for a myomectomy. Transvaginal natural orifice transluminal endoscopic surgery (NOTES) offers similar benefits of traditional vaginal surgery but also expands the horizon of transvaginal surgery by allowing the surgeon to perform procedures that are typically limited to an abdominal approach. The advantages of NOTES may include no incisional pain as well as a better cosmetic outcome. These benefits help outweigh the obstacle of learning this novel approach. Our objective is to demonstrate the transvaginal NOTES technique as a combination of traditional vaginal surgical skill with single-site surgical skill.
Stepwise demonstration of the transvaginal NOTES technique for myomectomy with narrated video footage (Canadian Task Force classification III).
Academic tertiary care hospital.
A 42-year-old woman.
Transvaginal NOTES myomectomy with combined transvaginal surgical and single-site surgical skills.
A 42-year-old woman (gravida 2 para 2) with a preoperative transvaginal ultrasound diagnosis of a 6-cm left anterior myoma requested myoma removal with uterine preservation. She presented with a 2-year history of left pelvic pain and menorrhagia. The myoma was removed with minimal blood loss, and pathology revealed a necrotic myoma. The patient had resolution of her left-sided pelvic pain.
Combined with traditional transvaginal anterior colpotomy, single-site surgical skills allow the surgeon to access the entire abdomen and perform myomectomy through a transvaginal single port. Transvaginal NOTES myomectomy is not only possible but allows myomectomy to be performed with no abdominal incision.
经阴道手术是妇科手术中最微创的手术，但在使用传统阴道手术器械（如无脱垂子宫的子宫切除术或子宫肌瘤切除术）时，存在暴露不足和手术空间有限的局限性。经阴道自然腔道内镜手术（NOTES）提供了与传统阴道手术相似的益处，但也通过允许外科医生进行通常仅限于腹部入路的手术来扩展经阴道手术的视野。NOTES 的优势可能包括无切口疼痛和更好的美容效果。这些益处有助于克服学习这种新方法的障碍。我们的目的是展示经阴道 NOTES 技术，即将传统阴道手术技能与单点手术技能相结合。
经阴道 NOTES 子宫肌瘤切除术的分步演示，配有解说视频（加拿大任务组分类 III）。
学术三级保健医院。
一名 42 岁女性。
经阴道 NOTES 子宫肌瘤切除术，结合经阴道手术和单点手术技能。
一名 42 岁女性（孕 2 产 2），术前经阴道超声诊断为左侧前壁 6cm 肌瘤，要求保留子宫切除肌瘤。她因左盆腔疼痛和月经过多就诊，病史 2 年。肌瘤切除出血少，病理显示为坏死肌瘤。患者左侧盆腔疼痛缓解。
结合传统经阴道前侧切开术，单点手术技能使外科医生能够进入整个腹部，并通过经阴道单孔进行子宫肌瘤切除术。经阴道 NOTES 子宫肌瘤切除术不仅是可行的，而且可以避免腹部切口进行子宫肌瘤切除术。
