Department of General Surgery, Peking Union Medical College Hospital, Chinese Academy of Medical Sciences, Beijing, China.
Peking Union Medical College, Chinese Academy of Medical Sciences, Beijing, China.
J Surg Oncol. 2021 May;123 Suppl 1:S36-S42. doi: 10.1002/jso.26363. Epub 2021 Mar 2.
The application of pure natural orifice translumenal endoscopic surgery (NOTES) to intra-abdominal visceral resections remains limited due to the complexity of the dissection. This study aimed to assess the safety and feasibility of laparoscopic right colectomy using a purely transvaginal approach.
The data of 12 continuous patients with colon neoplasia who underwent transvaginal right colectomy from November 2018 to July 2020 were prospectively collected, and their perioperative events were recorded.
The patients' median age was 70.4 years. Four were diagnosed with colon adenoma and eight with adenocarcinoma. The median operative time was 185 min, with a median blood loss of 25 ml. The median time to gas passing was 32.5 h after surgery. The median postoperative hospital stay was 6 days. One operation was converted to hybrid NOTES due to difficulty with the anastomosis, and one was converted to laparoscopic surgery because of vascular injury. Three cases were grades I, II, and III according to the Clavien-Dindo classification.
Pure NOTES right colectomy using the transvaginal approach is feasible and safe with good short-term outcomes. We recommend this novel technique for highly-selected patients with no more than a D2 dissection performed by experienced colorectal surgeons.
由于解剖的复杂性，纯自然腔道内镜手术（NOTES）在腹腔内脏切除中的应用仍然有限。本研究旨在评估经阴道完全入路腹腔镜右半结肠切除术的安全性和可行性。
前瞻性收集了 2018 年 11 月至 2020 年 7 月连续 12 例接受经阴道右半结肠切除术的结肠肿瘤患者的数据，并记录了他们的围手术期事件。
患者的中位年龄为 70.4 岁，4 例诊断为结肠腺瘤，8 例诊断为腺癌。中位手术时间为 185 分钟，中位出血量为 25ml。术后中位排气时间为 32.5 小时，术后中位住院时间为 6 天。1 例因吻合困难转为混合NOTES，1 例因血管损伤转为腹腔镜手术。根据 Clavien-Dindo 分级，有 3 例为 I 级、II 级和 III 级。
经阴道入路的纯NOTES 右半结肠切除术具有良好的短期效果，是安全可行的。我们建议由经验丰富的结直肠外科医生对不超过 D2 清扫的高度选择患者采用这种新的技术。
