Third Affiliated Hospital of Guangzhou Medical University, Guangzhou, Guangdong, China.
Department of Obstetrics and Gynecology, Baylor College of Medicine, Houston, Texas.
J Minim Invasive Gynecol. 2019 Jan;26(1):38-39. doi: 10.1016/j.jmig.2018.03.021. Epub 2018 Mar 30.
To demonstrate helpful tips and tricks for the successful use of transvaginal natural orifice transluminal endoscopic surgery (NOTES) for performing sacrocolpopexy and salpingo-oophorectomy surgery. Minimally invasive approaches for treating pelvic organ prolapse via sacrocolpopexy have traditionally included laparoscopy either with or without robotic assistance. Transvaginal NOTES is a novel minimally invasive approach that both avoids abdominal incisions and provides improved visualization; however, it can be technically challenging.
Stepwise demonstration with narrated video footage (Canadian Task Force classification III).
An academic tertiary care hospital in Guangdong, China.
A 61-year-old gravida 3, para 3 woman with 3 spontaneous vaginal deliveries and stage III uterine prolapse, stage III cystocele, and stage III rectocele. The preoperative vaginal length was 6 cm.
After performing vaginal hysterectomy, we show the usefulness of NOTES for salpingo-oophorectomy. We also demonstrate useful techniques for transvaginal NOTES sacrocolpopexy including hydrodissection, division of the Y mesh, anchoring of the anterior mesh before reducing prolapse, retroperitoneal tunneling, and hand suturing of the mesh and vaginal cuff.
The procedure was successfully performed in approximately 190 minutes. The postoperative vaginal length was 5 cm. Postoperative pelvic organ prolapse quantification was stage 0.
The transvaginal NOTES approach is feasible and efficient for sacrocolpopexy and salpingo-oophorectomy; additionally, it is a reasonable option for patients who desire a minimally invasive approach with excellent cosmetic results. Surgical techniques that aid in effectively performing transvaginal NOTES sacrocolpopexy include the use of hydrodissection, Y mesh division, anterior mesh anchoring before reducing prolapse, retroperitoneal tunneling, and hand suturing. Using the techniques presented here, we were able to insert the port only 1 time, which improves the efficiency and safety of this surgery.
展示经阴道自然腔道内镜手术（NOTES）在经阴道骶骨阴道固定术和输卵管卵巢切除术中的成功应用的有用技巧和窍门。通过经阴道骶骨阴道固定术治疗盆腔器官脱垂的微创方法传统上包括腹腔镜，无论是否使用机器人辅助。经阴道 NOTES 是一种新的微创方法，既避免了腹部切口，又提供了更好的可视化效果；然而，它在技术上具有挑战性。
分步演示，配有解说视频（加拿大任务组分类 III）。
中国广东一家学术性三级保健医院。
一位 61 岁的产妇 3 次，经阴道分娩 3 次，子宫脱垂 3 期，阴道前壁脱垂 3 期，直肠前壁脱垂 3 期。术前阴道长度为 6cm。
在完成阴道子宫切除术之后，我们展示了 NOTES 在输卵管卵巢切除术方面的有用性。我们还展示了经阴道 NOTES 骶骨阴道固定术的一些有用技术，包括水分离、Y 型网片的分割、脱垂前前网片的锚定、腹膜后隧道和网片及阴道袖口的手工缝合。
该手术大约在 190 分钟内成功完成。术后阴道长度为 5cm。术后盆腔器官脱垂定量为 0 期。
经阴道 NOTES 方法对于骶骨阴道固定术和输卵管卵巢切除术是可行且有效的；此外，对于那些希望采用微创方法且获得良好美容效果的患者来说，这也是一种合理的选择。有助于有效实施经阴道 NOTES 骶骨阴道固定术的手术技术包括使用水分离、Y 型网片分割、脱垂前前网片的锚定、腹膜后隧道和手工缝合。使用这里介绍的技术，我们仅需要插入端口 1 次，这提高了手术的效率和安全性。
