Department of Obstetrics and Gynecology, Baylor College of Medicine, Houston, TX.
Department of Obstetrics and Gynecology, Baylor College of Medicine, Houston, TX.
J Minim Invasive Gynecol. 2018 Nov-Dec;25(7):1135-1136. doi: 10.1016/j.jmig.2018.01.028. Epub 2018 Feb 7.
Transvaginal surgery is the most minimally invasive surgery for a gynecologic procedure but can be challenging for many to perform as evidenced by its declining rate. Vaginal removal of the adnexal structures can be difficult because of poor visualization. Factors such as abnormal pathology, incidental finding of early-stage endometriosis or adhesions from previous cesarean section or surgery, and obesity may further complicate the procedure. Transvaginal natural orifice transluminal endoscopic surgery (NOTES) may be performed during vaginal surgery using basic laparoscopic single-site skills as a "rescue" procedure for the complete removal of the adnexae. This allows the surgeon to complete the procedure vaginally without requiring conversion or addition of abdominal incisions. The combination of total vaginal hysterectomy (TVH) with NOTES as a "rescue" procedure may be a useful tool for gynecologic surgeons for removal of the adnexae and performance of other pelvic procedures.
To demonstrate various common pelvic procedures that can be performed by transvaginal NOTES after completion of TVH.
Variety demonstrations of the transvaginal NOTES technique as a "rescure" for total vaginal hysterectomy with narrated video footage (Canadian Task Force classification III).
Academic tertiary care hospital.
Patients with various surgeries including prophylactic bilateral salpingectomy, salpingo-oophorectomy, adhesiolysis, and incidental finding of superficial endometriosis resection. This video is exempt from institutional review board review at our institution.
Transvaginal NOTES adnexal surgery and other procedures using basic laparoscopic single-site surgical skills.
Salpingectomy, oophorectomy, lysis of adhesions, and resection of endometriosis can be performed using NOTES at the time of vaginal hysterectomy.
NOTES allows the surgeon to survey the pelvis for pathology and to complete other pelvic procedures transvaginally during TVH with no additional abdominal incisions. Transvaginal NOTES can be considered a "rescue" approach and can be a helpful tool for the pelvic surgeon.
经阴道手术是妇科最微创的手术，但由于其下降率，许多人认为该手术具有挑战性。由于可视性差，阴道附件结构的切除可能很困难。异常病理、早期子宫内膜异位症或剖宫产或手术粘连的偶然发现、肥胖等因素可能会使手术进一步复杂化。经阴道自然腔道内镜手术（NOTES）可在阴道手术中进行，使用基本的腹腔镜单部位技能作为附件完全切除的“救援”程序。这使得外科医生可以在不要求转换或增加腹部切口的情况下经阴道完成手术。经阴道全子宫切除术（TVH）与NOTES 相结合作为“救援”程序可能是妇科医生切除附件和进行其他盆腔手术的有用工具。
展示 TVH 完成后经阴道 NOTES 可进行的各种常见盆腔手术。
经阴道 NOTES 技术作为 TVH 的“救援”的各种常见盆腔手术演示，配有解说视频（加拿大任务组分类 III）。
学术三级保健医院。
接受各种手术的患者，包括预防性双侧输卵管切除术、输卵管卵巢切除术、粘连松解术和偶然发现的浅表子宫内膜异位症切除术。本视频在我们的机构免于机构审查委员会审查。
经阴道 NOTES 附件手术和其他使用基本腹腔镜单部位手术技能的手术。
在阴道子宫切除术时，可以使用 NOTES 进行输卵管切除术、卵巢切除术、粘连松解术和子宫内膜异位症切除术。
NOTES 允许外科医生在阴道子宫切除术中对盆腔进行病理检查，并在不增加腹部切口的情况下经阴道完成其他盆腔手术。经阴道 NOTES 可被视为“救援”方法，是盆腔外科医生的有用工具。
