Division of Minimally Invasive Gynecologic Surgery, Department of Obstetrics & Gynecology and Women's Health, Montefiore Medical Center and Albert Einstein College of Medicine, Bronx, New York, USA.
Curr Opin Obstet Gynecol. 2022 Aug 1;34(4):220-226. doi: 10.1097/GCO.0000000000000799.
Natural orifice transluminal endoscopic surgery (NOTES) is an emerging approach used across surgical disciplines. This review seeks to assess the growing body of literature on experiences and outcomes using vaginal NOTES (vNOTES) in gynecologic surgery.
Many limitations of vaginal surgery including lack of descensus or restricted vaginal space can be overcome with vNOTES whereas avoiding risks of abdominal incisions in traditional laparoscopy. vNOTES may have superior outcomes in pain, length of stay, and satisfaction for multiple gynecologic indications however additional data is needed to assess cost-effectiveness and long-term outcomes. Surgeons implementing this technique should have adequate experience with both traditional vaginal and laparoscopic approaches. The current body of high-quality studies is heavily influenced by single site, single surgeon studies and as such may not be fully applicable to all practices incorporating this novel technique, and adequate training should precede implementation of Vnotes.
Vaginal surgery is considered the least invasive approach, however, may not be appropriate in all cases. vNOTES presents a novel approach that combines the access and visualization afforded by endoscopy whereas avoiding the risks associated with transabdominal entry and can be considered as a feasible option in gynecologic surgery.
目的综述：经自然腔道内镜手术（NOTES）是一种跨外科专业领域应用的新兴方法。本综述旨在评估在妇科手术中应用阴道NOTES（vNOTES）的经验和结果的不断增加的文献。
最新发现：阴道手术的许多局限性，包括缺乏下降或限制的阴道空间，可以通过 vNOTES 来克服，同时避免传统腹腔镜手术中的腹部切口风险。vNOTES 可能在多种妇科适应证的疼痛、住院时间和满意度方面具有更好的结果，然而需要更多的数据来评估成本效益和长期结果。实施该技术的外科医生应具备传统阴道和腹腔镜方法的充分经验。目前高质量研究的主体受到单一地点、单一外科医生研究的严重影响，因此可能不完全适用于所有采用这种新技术的实践，应在实施 vNOTES 之前进行充分的培训。
总结：阴道手术被认为是最具侵入性的方法，但并非在所有情况下都适用。vNOTES 提出了一种新的方法，它结合了内窥镜提供的通道和可视化效果，同时避免了与经腹进入相关的风险，可被视为妇科手术中的一种可行选择。
