Third Affiliated Hospital of Guangzhou Medical University, Guangzhou, Guangdong, China.
Baylor College of Medicine, Houston, Texas.
Fertil Steril. 2018 Jul 1;110(1):182. doi: 10.1016/j.fertnstert.2018.02.139. Epub 2018 Jun 21.
To demonstrate how a transvaginal natural orifice transluminal endoscopic surgery (NOTES) tubal reanastomosis is a novel route for tubal surgery. The surgical technique is a combination of traditional vaginal surgery with single-site surgical skills.
The surgical technique is explained in a stepwise fashion with the use of surgical video footage. The video uses a surgical case to demonstrate the specific techniques necessary to perform a NOTES tubal reanastomosis.
Teaching university.
PATIENT(S): A 42-year-old female G2P2 with a history of tubal ligation 11 years before presentation requesting a tubal recanalization.
INTERVENTION(S): Transvaginal NOTES tubal reanastomosis was initiated with a posterior colpotomy. A single-site gelport was placed. The fallopian tubes were hydrodissected, the blocked portion of each tube was removed, an epidural catheter was threaded through each lumen, and the two remaining segments of each tube were sutured together in an end-to-end fashion using single-site suturing skills.
MAIN OUTCOME MEASURE(S): Transvaginal NOTES tubal reanastomosis as an alternative route for tubal reanastomosis.
RESULT(S): The bilateral fallopian tubes were recanalized with bilateral tubal patency. This was confirmed 8 weeks postoperatively with a three-dimensional sonohystogram, which showed patency of the bilateral fallopian tubes.
CONCLUSION(S): The current preferred technique for reversal of a tubal sterilization is to perform a minimally invasive surgery with an end-to-end anastomosis. This gives the patient a 60%-90% intrauterine pregnancy rate postoperatively. NOTES has the benefits of a fast recovery, no abdominal incisional pain, and an extremely cosmetic outcome. Current research has shown a 0%-3.1% range for the risk of pelvic infection in transvaginal NOTES if prophylactic antibiotics are administered during the surgery. The NOTES tubal reanastomosis combines the traditional vaginal surgery technique of creating a posterior colpotomy with single-site surgical skills like suturing and knot tying. The surgery is completed through a single transvaginal port without an abdominal incision. In the hands of a skilled minimally invasive surgeon, transvaginal NOTES tubal reanastomosis is a feasible and alternative route for this procedure.
展示经阴道自然腔道内镜手术（NOTES）输卵管吻合术如何成为一种新的输卵管手术途径。该手术技术是传统阴道手术与单部位手术技能的结合。
分步详细说明手术技术，并使用手术视频片段。该视频使用一个手术病例演示了进行 NOTES 输卵管吻合术所需的具体技术。
教学型大学。
一名 42 岁的 G2P2 女性，在就诊前 11 年前行输卵管结扎术，现要求行输卵管再通术。
经阴道 NOTES 输卵管吻合术首先进行后阴道穹隆切开术。单部位凝胶端口置入。输卵管行水分离，切除堵塞部分，硬膜外导管穿过每个管腔，然后使用单部位缝合技术将每个管的两段剩余部分端端缝合在一起。
经阴道 NOTES 输卵管吻合术作为输卵管再吻合的替代途径。
双侧输卵管再通，双侧输卵管通畅。术后 8 周三维超声检查证实双侧输卵管通畅。
目前，输卵管绝育术复通的首选技术是行微创、端端吻合术。这可使患者术后宫内妊娠率达到 60%-90%。NOTES 具有恢复快、无腹部切口疼痛和极佳美容效果的优点。目前的研究表明，如果在手术期间给予预防性抗生素，经阴道 NOTES 发生盆腔感染的风险范围为 0%-3.1%。经阴道 NOTES 输卵管吻合术将传统的阴道手术技术（即后阴道穹隆切开术）与单部位手术技能（如缝合和打结）相结合。手术通过单个经阴道端口完成，无需腹部切口。在熟练的微创外科医生手中，经阴道 NOTES 输卵管吻合术是该手术的一种可行替代途径。
