Department of Gynecology and Obstetrics, IMELDA Hospital, Bonheiden, Belgium.
Asian J Endosc Surg. 2021 Oct;14(4):811-815. doi: 10.1111/ases.12940. Epub 2021 Apr 14.
This is a first feasibility on vaginal natural orifice transluminal endoscopic surgery (vNOTES) in patients with prior hysterectomy. Our aim was to gain initial experience on performing vNOTES surgery on prior hysterectomy cases, whereby the main concern is that pelvic adhesions may impede safe transvaginal access. Between January 2017 and February 2020, a single surgeon (J.B.) performed vNOTES surgery on nine patients with a history of hysterectomy. Conventional laparoscopic instruments were inserted transvaginally through a vNOTES port. No abdominal incisions were made. Patient data and perioperative data were analyzed. Mean operating time was 38 minutes and there were no operative complications. Postoperative pain scores were low. The mean size of the adnexal cysts that were removed was 26 mm. In this study, vNOTES surgery was successfully performed in nine patients with prior hysterectomy. Following the IDEAL principles, it is important to report on our initial findings of this IDEAL stage 1 study. The results warrant further investigation in IDEAL stage 2 studies but do not validate the widespread use of this approach.
这是一项关于经阴道自然腔道内镜手术（vNOTES）在既往子宫切除术后患者中应用的初步可行性研究。我们的目的是在既往子宫切除术后患者中开展 vNOTES 手术，获得初步经验，主要关注点在于盆腔粘连可能妨碍安全的经阴道入路。2017 年 1 月至 2020 年 2 月，一位外科医生（J.B.）对 9 例既往有子宫切除术史的患者实施了 vNOTES 手术。常规腹腔镜器械经阴道通过 vNOTES 端口插入。没有进行腹部切口。分析患者资料和围手术期数据。平均手术时间为 38 分钟，无手术并发症。术后疼痛评分较低。切除的附件囊肿的平均大小为 26mm。在这项研究中，vNOTES 手术成功地应用于 9 例既往有子宫切除术史的患者。根据 IDEAL 原则，报告该 IDEAL 阶段 1 研究的初步结果非常重要。这些结果支持在 IDEAL 阶段 2 研究中进一步调查，但不能验证这种方法的广泛应用。
