Huang Lu, He Li, Zhang Ling, Gan Xiaoqin, Jia Jigang, Yang Yue, Lin Yonghong
Department of Gynecology, Chengdu Women's and Children's Central Hospital, School of Medicine, University of Electronic Science and Technology of China, Chengdu, Sichuan, China.
Wideochir Inne Tech Maloinwazyjne. 2021 Mar;16(1):234-242. doi: 10.5114/wiitm.2020.95397. Epub 2020 May 15.
Natural orifice transluminal endoscopic surgery (NOTES) is a new concept of minimally invasive surgery. It could prevent complications related to the trocar in laparoscopic surgery, and help achieve ideal cosmetic outcomes.
To describe the safety and feasibility of the prone position in transvaginal NOTES (V-NOTES) resection of posterior uterine myoma.
Seventeen patients were included in the study from February to December 2019. All the patients were diagnosed with solitary posterior uterine myoma and underwent V-NOTES myomectomy in the prone position. We measured the characteristics and the surgical outcomes of these patients, to evaluate the safety and feasibility of the prone position in V-NOTES myomectomy.
The mean age of the patients was 38.71 ±7.68 years and the mean body mass index was 22 ±2.02 kg/m. Five patients had a cesarean section once, and 1 patient had a history of two operations (cesarean section and laparoscopic cholecystectomy). The remaining patients had no history of surgery. The mean myoma volume in the ultrasound report was 121.99 ±125.24 cm. The mean operation time was 107.48 ±34.16 min. The mean hemoglobin decrease 48 h after the operation was 1.37 ±0.66 g/dl. The mean weight of the myoma was 183.88 ±144.29 g. The mean VAS score 12 h and 24 h after surgery was 2 ±0.87 and 1.18 ±0.73, respectively. The mean postoperative hospital stay was 3.18 ±0.39 days. One patient was converted to TU-LESS. No other complications such as massive hemorrhage, infection or injury occurred.
The prone position in V-NOTES myomectomy is safe and feasible. It expands the operative space and reduces the difficulty of surgery. Perhaps it can be used as a standard position for posterior uterine myomectomy by V-NOTES.
经自然腔道内镜手术（NOTES）是一种微创外科的新概念。它可以预防腹腔镜手术中与套管针相关的并发症，并有助于实现理想的美容效果。
描述俯卧位经阴道NOTES（V-NOTES）切除后壁子宫肌瘤的安全性和可行性。
2019年2月至12月，17例患者纳入本研究。所有患者均诊断为孤立性后壁子宫肌瘤，并接受了俯卧位V-NOTES子宫肌瘤切除术。我们测量了这些患者的特征和手术结果，以评估俯卧位在V-NOTES子宫肌瘤切除术中的安全性和可行性。
患者的平均年龄为38.71±7.68岁，平均体重指数为22±2.02kg/m²。5例患者有1次剖宫产史，1例患者有2次手术史（剖宫产和腹腔镜胆囊切除术）。其余患者无手术史。超声报告中肌瘤的平均体积为121.99±125.24cm³。平均手术时间为107.48±34.16分钟。术后48小时血红蛋白平均下降1.37±0.66g/dl。肌瘤的平均重量为183.88±144.29g。术后12小时和24小时的平均视觉模拟评分（VAS）分别为2±0.87和1.18±0.73。术后平均住院时间为3.18±0.39天。1例患者转为经脐单孔腹腔镜手术（TU-LESS）。未发生其他并发症，如大出血、感染或损伤。
俯卧位V-NOTES子宫肌瘤切除术安全可行。它扩大了手术空间，降低了手术难度。也许它可以作为V-NOTES切除后壁子宫肌瘤的标准体位。
