Kita Masato, Sumi Genichiro, Butsuhara Yusuke, Hisamatsu Yoji, Okada Hidetaka
Department of Obstetrics and Gynecology, Kansai Medical University, Osaka, Japan.
Gynecol Oncol Rep. 2021 Mar 9;36:100743. doi: 10.1016/j.gore.2021.100743. eCollection 2021 May.
Vaginal surgery is a classic and unique gynecologic procedure. However, the operation field is narrow, which may make surgery difficult to perform. While vaginoscopy or vaginal endoscopy could be the solution of choice, they are mainly used for diagnosis due to the lack of adequate equipment to perform complicated surgery (Johary et al., 2015). Laparoscopy, especially single-port surgery, has been introduced in gynecologic surgery, and excellent equipment has been developed to perform complex surgical procedures through narrow inlets. And vaginal endoscopy using such single-port surgery devices, so-called vaginal natural orifice transluminal endoscopic surgery (vNOTES), has recently been introduced in the gynecologic field (Li and Hua, 2019 Aug) and allows the easier performance of endoscopic surgery through the vagina for ovarian cystectomy (Baekelandt, 2018 Feb 1), salpingo-oophorectomy (Baekelandt et al., 2018) and hysterectomy (Housmans et al., xxxx) for benign pathology. However, vNOTES has been used mainly as an alternative laparoscopic pathway to reduce abdominal wounds or bypass transabdominal approaches into the abdominal cavity. This report including the surgical video demonstrates the first case, to our knowledge, of successful tumor resection of a rare vaginal recurrence of ovarian granulosa cell tumor (Fujita et al., 2015 May, Levin et al., 2018) by pneumovaginoscopy using single-port surgery devices. A 39-year-old woman with an adult-type ovarian granulosa cell tumor had undergone left salpingo-oophorectomy. At 23 years after surgery, a recurrent mass was detected in her left vaginal wall. The patient had no history of pregnancy, and her vagina was too narrow to secure a good field of operation. Therefore, we underwent pneumovaginoscopic surgery. The total operating time was 88 min, and the blood loss volume was minimal. Complete tumor clearance (R0 resection) was achieved microscopically. There were no postoperative complications, and a one-year follow-up revealed no recurrence. Institutional Review Board approval was obtained through our local Ethics Committee of Kansai Medical University (#2019208).
阴道手术是一种经典且独特的妇科手术。然而，手术视野狭窄，这可能导致手术操作困难。虽然阴道镜检查或阴道内镜检查可能是首选解决方案，但由于缺乏用于进行复杂手术的适当设备，它们主要用于诊断（乔哈里等人，2015年）。腹腔镜检查，尤其是单孔手术，已被引入妇科手术领域，并且已经开发出了精良的设备，可通过狭窄的入口进行复杂的手术操作。而使用这种单孔手术设备的阴道内镜检查，即所谓的经阴道自然腔道内镜手术（vNOTES），最近已被引入妇科领域（李和华，2019年8月），并使得通过阴道进行内镜手术更容易，可用于卵巢囊肿切除术（贝克兰特，2018年2月1日）、输卵管卵巢切除术（贝克兰特等人，2018年）以及针对良性病变的子宫切除术（豪斯曼斯等人，年份未给出）。然而，vNOTES主要被用作减少腹部伤口或绕过经腹途径进入腹腔的替代腹腔镜手术路径。据我们所知，本报告包括手术视频展示了首例使用单孔手术设备通过充气阴道镜成功切除罕见的卵巢颗粒细胞瘤阴道复发肿瘤的病例（藤田等人，2015年5月，莱文等人，2018年）。一名患有成人型卵巢颗粒细胞瘤的39岁女性接受了左侧输卵管卵巢切除术。术后23年，在其左侧阴道壁发现复发性肿块。该患者无妊娠史，且其阴道过于狭窄，无法获得良好的手术视野。因此，我们进行了充气阴道镜手术。总手术时间为88分钟，失血量极少。显微镜下实现了肿瘤的完全清除（R0切除）。术后无并发症，一年随访未发现复发。通过关西医科大学当地伦理委员会获得了机构审查委员会的批准（编号2019208）。
