Kaya Cihan, Yıldız Şükrü, Alay İsmail, Karakaş Sema, Durmuş Uğur, Güraslan Hakan, Ekin Murat
Department of Obstetrics and Gynecology, Acıbadem Mehmet Ali Aydınlar University, Acıbadem Bakirkoy Hospital, Istanbul, Turkey.
Department of Obstetrics and Gynecology, University of Health Sciences, Bakirkoy Dr Sadi Konuk Training and Research Hospital, Istanbul, Turkey.
J Invest Surg. 2022 Apr;35(4):918-923. doi: 10.1080/08941939.2021.1958111. Epub 2021 Aug 4.
This study aimed to compare the surgical outcomes of laparoscopic hysterectomy (LH) and vaginally assisted natural orifice transluminal endoscopic surgery (vNOTES) hysterectomy procedures in women with undescended-enlarged uteri.
This cross-sectional study was conducted with 78 women who underwent LH (48 patients) or vNOTES hysterectomy (30 patients) for benign gynecological pathologies. The dimension of the uterus, operation time, intraoperative blood loss, the presence of peri-, postoperative complications, conversion to laparotomy, pre-, postoperative hemoglobin (Hb), and hematocrit (Hct) levels, postoperative hospital stay, total dose of postoperative analgesics, VAS scores at the postoperative 6 and 24 hours, and the final pathology reports were recorded.
There was no significant difference between LH and vNOTES hysterectomy groups regarding age (47 vs. 47.5 years, p = 0.92), parity (2 vs. 2, p = 0.74), and BMI (30.8 vs. 28.2 kg/m2, p = 0.31). The patients in the vNOTES hysterectomy group had significantly shorter durations of surgery (45 vs. 160 min) and hospitalization (48 vs. 72 h) than the LH group (p < 0.001, p < 0.001, respectively). The 24 hour VAS score was lower (VAS score 2 vs. 3, p = 0.003) in favor of the vNOTES hysterectomy group. In matched group analysis, the 24 hour VAS score (2 vs. 3, p = 0.008), operation time (45 vs. 157, p < 0.001), and hospitalization (48 vs. 72, p < 0.001) were lower in the vNOTES hysterectomy group than the LH group.
vNOTES hysterectomy provides favorable outcomes compared to conventional LH considering the shorter operation time, hospitalization, and lower 24 h VAS score.
本研究旨在比较腹腔镜子宫切除术（LH）与经阴道自然腔道内镜手术辅助子宫切除术（vNOTES）治疗子宫增大且未降入盆腔的女性患者的手术效果。
本横断面研究纳入了78例因良性妇科疾病接受LH（48例患者）或vNOTES子宫切除术（30例患者）的女性。记录子宫大小、手术时间、术中出血量、围手术期及术后并发症情况、是否转为开腹手术、术前及术后血红蛋白（Hb）和血细胞比容（Hct）水平、术后住院时间、术后镇痛药物总剂量、术后6小时及24小时的视觉模拟评分（VAS）以及最终病理报告。
LH组与vNOTES子宫切除术组在年龄（47岁 vs. 47.5岁，p = 0.92）、产次（2次 vs. 2次，p = 0.74）和体重指数（BMI）（30.8 kg/m² vs. 28.2 kg/m²，p = 0.31）方面无显著差异。vNOTES子宫切除术组患者的手术时间（45分钟 vs. 160分钟）和住院时间（48小时 vs. 72小时）明显短于LH组（分别为p < 0.001，p < 0.001）。vNOTES子宫切除术组术后24小时VAS评分更低（VAS评分为2分 vs. 3分，p = 0.003）。在配对组分析中，vNOTES子宫切除术组术后24小时VAS评分（2分 vs. 3分，p = 0.008）、手术时间（45分钟 vs. 157分钟，p < 0.001）和住院时间（48小时 vs. 72小时，p < 0.001）均低于LH组。
与传统LH相比，vNOTES子宫切除术在手术时间、住院时间和术后24小时VAS评分方面具有优势，手术效果良好。
