Department of Obstetrics and Gynecology, Southwest Hospital, Third Military Medical University, Chongqing, China (all authors).
Department of Obstetrics and Gynecology, Southwest Hospital, Third Military Medical University, Chongqing, China (all authors).
J Minim Invasive Gynecol. 2021 Jun;28(6):1254-1261. doi: 10.1016/j.jmig.2021.01.022. Epub 2021 Jan 29.
To explore the technique and clinical value of transvaginal natural orifice transluminal endoscopic surgery (vNOTES) in hysterectomy and sentinel lymph node (SLN) mapping for endometrial cancer by comparing its perioperative outcomes with those of laparoscopic staging.
Retrospective cohort study.
Department of gynecology at a tertiary medical center.
All women diagnosed with endometrial cancer who underwent minimally invasive surgery at our center between August 2017 and May 2020.
Both vNOTES and laparoscopic approaches were used for hysterectomy and SLN mapping. The success of SLN detection as well as perioperative outcomes were subsequently analyzed.
This study included 74 patients; 23 patients underwent vNOTES surgery, whereas 51 underwent standard laparoscopic surgery. The total successful SLN detection was 95.7% in the vNOTES group and 92.2% in the laparoscopy group (p >.05), whereas the bilateral success rates were 87.0% and 90.2%, respectively. No difference in SLN detection was observed between the 2 groups in terms of the side-specific mapping efficacy quotient (91.3% vs 91.2%, p = .47). The number of harvested SLNs, operative time, estimated blood loss, and intraoperative complications in the 2 groups were similar. One (4.3%) postoperative complication occurred in the vNOTES group vs 4 (7.9%) in the laparoscopy group (p = .029), and the median postoperative hospital stay was 3 days vs 4 days (p = .003).
This study suggests that the vNOTES procedure is feasible, with a potentially decreased postoperative hospital stay, faster recovery, and better cosmetic results. However, prospective research is needed to validate its broader clinical application.
通过比较经阴道自然腔道内镜手术（vNOTES）与腹腔镜分期在子宫内膜癌子宫切除和前哨淋巴结（SLN）检测中的围手术期结果，探讨 vNOTES 技术在子宫内膜癌中的应用价值。
回顾性队列研究。
三级医学中心妇科。
2017 年 8 月至 2020 年 5 月期间在我院接受微创治疗的所有子宫内膜癌患者。
vNOTES 和腹腔镜方法均用于子宫切除术和 SLN 检测。随后分析 SLN 检测成功率和围手术期结果。
本研究纳入 74 例患者；23 例行 vNOTES 手术，51 例行标准腹腔镜手术。vNOTES 组总 SLN 检测成功率为 95.7%，腹腔镜组为 92.2%（p>0.05），双侧成功率分别为 87.0%和 90.2%。两组间侧别特异性 SLN 检测效能比无差异（91.3% vs 91.2%，p=0.47）。两组间 SLN 检测数量、手术时间、估计出血量和术中并发症无差异。vNOTES 组发生 1 例（4.3%）术后并发症，腹腔镜组发生 4 例（7.9%）（p=0.029），vNOTES 组术后中位住院时间为 3 天，腹腔镜组为 4 天（p=0.003）。
该研究表明 vNOTES 手术具有可行性，可能减少术后住院时间，加快恢复，美容效果更好。然而，需要前瞻性研究来验证其更广泛的临床应用。
