Department of Obstetrics and Gynaecology, Imelda Hospital, Bonheiden, Belgium (all authors).
Department of Obstetrics and Gynaecology, Imelda Hospital, Bonheiden, Belgium (all authors).
J Minim Invasive Gynecol. 2021 Jul;28(7):1351-1356. doi: 10.1016/j.jmig.2020.10.003. Epub 2020 Oct 14.
To evaluate the outcome of hysterectomy through vaginal natural orifice transluminal endoscopic surgery (vNOTES) in cases with a large uterus.
A retrospective cohort study.
Belgian teaching hospital.
Women who underwent a vNOTES hysterectomy from March 2015 to March 2020 for benign gynecologic disease with a uterine weight of 280 g or more on pathologic examination (N = 114).
All women underwent vaginally assisted NOTES hysterectomy. We performed a retrospective analysis of baseline patient characteristics and clinical outcomes.
The mean age was 50 ± 3.5 years. Twenty-two (19%) patients were obese (body mass index ≥30 kg/m), and 4 (3.5%) were morbidly obese (body mass index ≥40 kg/m). Thirty-five (31%) patients were nulliparous, and 15 (13%) women had 1 or more cesarean sections in their medical history. Uterine weight varied from 281 g to 3361 g, with a mean weight of 559 ± 425 g. Mean surgical time was 63 ± 34 minutes. Surgical time was positively associated with uterine size. There were 4 complications: 3 bleeding complications in the first 24 hours after surgery and 1 minor late complication. Conversion to laparotomy for specimen extraction was performed in 1 case (conversion rate 0.9%). There were no conversions to laparoscopy. No ureteric, bladder, or intestinal injuries occurred in this case series, and there were neither life-threatening complications nor intensive care unit admissions.
The vNOTES technique can offer a safe and effective alternative to laparoscopy or laparotomy in cases with a large to very large uterus, even if the patient has a history of cesarean section, obesity, or nulliparity. In 99% of all women in this study, hysterectomy was successfully performed through vNOTES without conversion. By making use of the advantages of endoscopic surgery, vNOTES might broaden the indications of vaginal hysterectomy. Randomized controlled trials are needed to evaluate whether vaginally assisted NOTES hysterectomy is superior to laparoscopic or abdominal hysterectomy in large uteri cases.
评估经阴道自然腔道内镜手术（vNOTES）治疗大子宫患者的疗效。
回顾性队列研究。
比利时教学医院。
2015 年 3 月至 2020 年 3 月期间因良性妇科疾病接受 vNOTES 子宫切除术的患者，术前病理检查子宫重量为 280g 或以上（N=114）。
所有患者均行阴道辅助 NOTES 子宫切除术。我们对患者的基线特征和临床结局进行了回顾性分析。
患者平均年龄为 50±3.5 岁。22 例（19%）患者肥胖（体重指数≥30kg/m2），4 例（3.5%）患者病态肥胖（体重指数≥40kg/m2）。35 例（31%）患者为初产妇，15 例（13%）患者有 1 次或多次剖宫产史。子宫重量为 281g 至 3361g，平均重量为 559±425g。手术时间平均为 63±34 分钟。手术时间与子宫大小呈正相关。有 4 例并发症：术后 24 小时内 3 例出血，1 例迟发性轻微并发症。为取出标本，1 例转为开腹手术（中转率 0.9%）。无腹腔镜中转。本研究无输尿管、膀胱或肠损伤病例，无危及生命的并发症，无需入住重症监护病房。
对于大子宫或超大子宫患者，vNOTES 技术可作为腹腔镜或开腹手术的安全有效替代方法，即使患者有剖宫产史、肥胖或初产妇。在本研究的所有女性中，99%的患者均成功通过 vNOTES 完成了子宫切除术，无需中转。通过利用内镜手术的优势，vNOTES 可能拓宽阴道子宫切除术的适应证。需要开展随机对照试验来评估经阴道辅助 NOTES 子宫切除术在大子宫病例中是否优于腹腔镜或经腹子宫切除术。
