Department of Obstetrics and Gynecology, University of Health Sciences, Bakirkoy Dr. Sadi Konuk Training and Research Hospital, Istanbul, Turkey.
Department of Obstetrics and Gynecology, Istanbul Aydin University Faculty of Medicine, Istanbul, Turkey.
Asian J Endosc Surg. 2021 Jul;14(3):346-352. doi: 10.1111/ases.12863. Epub 2020 Sep 23.
Natural orifice transluminal endoscopic surgery has been used for gynecologic operations in recent years. The aim of the study is to describe our initial experience using vaginal-assisted natural orifice transluminal endoscopic surgery (vNOTES) for apical pelvic organ prolapse repair.
After patients underwent vaginal hysterectomy, vNOTES sacrocolpopexy (n = 4) or vNOTES high uterosacral ligament suspension (n = 7) were performed to treat symptomatic apical pelvic organ prolapse. Sociodemographic and clinical characteristics, Pelvic Organ Prolapse Quantification results, and recorded surgical data (eg, duration of surgery, intraoperative complications, additional prolapse and incontinence surgeries) were obtained from patient files and the hospital's database. Information from postoperative follow-up visits, including complications and anatomical results, were also recorded.
The mean age of the patients was 60.7 ± 9.1 years. The mean total operative time was 121.3 ± 22.7 minutes. The mean operative time for vaginal hysterectomy, vNOTES sacrocolpopexy, and vNOTES uterosacral ligament suspension was 46 ± 11.9, 65 ± 38, 25 ± 8.2 minutes, respectively. There were no intraoperative and postoperative complications observed. The mean postoperative 24-hour visual analog scale score was 3.5 ± 1.9 for vNOTES sacrocolpopexy patients and 3.2 ± 0.9 for vNOTES uterosacral ligament suspension patients. Only one patient in the vNOTES sacrocolpopexy group had a recurrence; she experienced stage 2 anterior compartment prolapse 8 months after surgery.
As a treatment for apical pelvic organ prolapse, vNOTES is a feasible approach in both sacrocolpopexy and uterosacral ligament suspension.
近年来，自然腔道内镜手术已应用于妇科手术。本研究旨在描述我们使用阴道辅助自然腔道内镜手术（vNOTES）治疗 apical pelvic organ prolapse 的初步经验。
在患者接受阴道子宫切除术之后，进行 vNOTES 骶骨阴道固定术（n=4）或 vNOTES 高子宫骶韧带悬吊术（n=7），以治疗有症状的 apical pelvic organ prolapse。从患者病历和医院数据库中获得社会人口学和临床特征、盆腔器官脱垂量化结果以及记录的手术数据（例如手术持续时间、术中并发症、额外的脱垂和尿失禁手术）。还记录了术后随访的信息，包括并发症和解剖结果。
患者的平均年龄为 60.7±9.1 岁。总手术时间的平均值为 121.3±22.7 分钟。阴道子宫切除术、vNOTES 骶骨阴道固定术和 vNOTES 子宫骶韧带悬吊术的平均手术时间分别为 46±11.9、65±38、25±8.2 分钟。术中及术后均无并发症。vNOTES 骶骨阴道固定术患者的术后 24 小时视觉模拟评分平均为 3.5±1.9，vNOTES 子宫骶韧带悬吊术患者的平均为 3.2±0.9。vNOTES 骶骨阴道固定术组仅 1 例患者复发，术后 8 个月她出现 2 期前盆腔器官脱垂。
作为 apical pelvic organ prolapse 的治疗方法，vNOTES 在骶骨阴道固定术和子宫骶韧带悬吊术中都是一种可行的方法。
