Department of Obstetrics and Gynecology, Chang Gung Memorial Hospital at Linkou and University, Tao-Yuan, Taiwan.
Department of Obstetrics and Gynecology, Far Eastern Memorial Hospital, New Taipei City, Taiwan.
Taiwan J Obstet Gynecol. 2022 Mar;61(2):345-352. doi: 10.1016/j.tjog.2022.02.026.
This study aims to describe the feasibility of treating early-stage endometrial cancer with hysterectomy, bilateral salpingo-oophorectomy, sentinel lymph node biopsy, and bilateral pelvic lymphadenectomy by vaginal Natural Orifice Transluminal Endoscopic Surgery (vNOTES).
A longitudinal study of prospectively registered patients was conducted at an academic tertiary care center. 15 patients who underwent vNOTES surgical staging of early endometrial carcinoma between January 2014 and December 2020 were included in the study.
15 patients between 20 and 80yrs of age with histologically proven Stage1 Gr1-2 endometrial cancer underwent vNOTES surgical staging. The mean age of the study population was 52.8 years (Standard Deviation [SD] 6.8) and the mean BMI was 27.8 kg/m (SD 6.4). The average operative time was 231.4 min (SD 41.0) with the mean estimated blood loss of 122.0 mL (SD 104.4). A total of 12 (80%) patients underwent SNL biopsy with ICG guided system, whereas 3 (20%) had pelvic lymph node dissection. There was one case with the surgical complication of bladder injury requiring conversion to conventional laparoscopy.
With this study, we studied the feasibility of vNOTES surgery for early-stage endometrial cancer with minimal complications and the best long-term surgical outcome. The surgeries were performed by a single skilled endoscopist surgeon with previous experience with vNOTES surgery for adnexal tumors and hysterectomy. Our results showed the practicality of vNOTES in staging surgery for early-stage endometrial cancer. However, application to a larger cohort is required for more extensive surgical outcome studies.
本研究旨在描述经阴道自然腔道内镜手术（vNOTES）行子宫切除术、双侧输卵管卵巢切除术、前哨淋巴结活检和双侧盆腔淋巴结清扫术治疗早期子宫内膜癌的可行性。
本研究为在学术性三级护理中心进行的前瞻性注册患者的纵向研究。纳入 2014 年 1 月至 2020 年 12 月期间接受 vNOTES 手术分期的早期子宫内膜癌患者 15 例。
15 例年龄在 20 至 80 岁之间、经组织学证实为Ⅰ期 G1-2 子宫内膜癌的患者接受了 vNOTES 手术分期。研究人群的平均年龄为 52.8 岁（标准差 [SD] 6.8），平均 BMI 为 27.8kg/m（SD 6.4）。手术时间平均为 231.4 分钟（SD 41.0），估计出血量平均为 122.0ml（SD 104.4）。共有 12 例（80%）患者行 SNL 活检，采用吲哚菁绿引导系统，3 例（20%）患者行盆腔淋巴结清扫术。有 1 例患者发生膀胱损伤手术并发症，需转为传统腹腔镜。
通过本研究，我们研究了 vNOTES 手术治疗早期子宫内膜癌的可行性，其并发症最少，长期手术效果最佳。手术由一名具有 vNOTES 手术治疗附件肿瘤和子宫切除术经验的熟练内镜外科医生完成。我们的结果表明 vNOTES 在早期子宫内膜癌分期手术中的实用性。然而，需要更大的队列研究来进行更广泛的手术结果研究。
