Güngördük Kemal, Gülseren Varol, Özdemir İsa Aykut
Department of Obstetrics and Gynecology, Division of Gynecologic Oncology, Faculty of Medicine, Sıtkı Koçman University, Muğla, Turkey.
Department of Obstetrics and Gynecology, Division of Gynecologic Oncology, Faculty of Medicine, Erciyes University, Kayseri, Turkey.
J Obstet Gynaecol. 2022 Oct;42(7):3112-3116. doi: 10.1080/01443615.2022.2106556. Epub 2022 Aug 10.
This study was performed to compare the transumbilical (TU) and transvaginal (TV) routes for adnexal mass removal from the abdominal cavity. Data from 93 women who underwent laparoscopic (LS) surgery for the removal of benign adnexal masses at three centres between January 2016 and December 2020 were examined retrospectively. The specimen retrieval times in the TU and TV groups were 9.0 ± 2.0 and 9.8 ± 2.5 min, respectively ( = .373). Additional analgesic was required in 13.8% and 14.3% of cases in the TU and TV groups, respectively. The mean 3-month (2-4 months) postoperative visual analogue scale (VAS) score was lower in the TV group than in the TU group. The postoperative vaginal length did not differ between the TU and TV groups (8.9 (8.7-9.1) vs. 8.7 (8.4-9.1) cm; = .465). Oophorectomy and the TU route were found to be independent risk factors for the worsening of the VAS score. Sexual function index scores were similar in the two groups. The TV method for specimen removal in LS surgery may cause less pain in the early postoperative period and less dyspareunia in the later period without shortening the length of the vagina.Impact Statement Compared with open procedures, minimally invasive surgery (MIS) is associated with faster recovery times, better patient quality of life and lower postoperative complication rates. The removal of an adnexal mass from the abdominal cavity is performed most commonly using the suprapubic, transumbilical (TU) or transvaginal (TV) route. The specimen retrieval times in the TU and TV groups were 9.0 ± 2.0 and 9.8 ± 2.5 min, respectively ( = .373). The mean 3-month (2-4 months) postoperative visual analogue scale (VAS) score was lower in the TV group than in the TU group. Oophorectomy and the TU route were found to be independent risk factors for the worsening of the VAS score. Sexual function index scores were similar in the two groups. In conclusion, specimen removal via the TV route in LS surgery may cause less pain in the early postoperative period and less dyspareunia in the later period without reducing the length of the vagina.
本研究旨在比较经脐（TU）和经阴道（TV）途径从腹腔切除附件包块的情况。对2016年1月至2020年12月期间在三个中心接受腹腔镜（LS）手术切除良性附件包块的93例女性的数据进行回顾性分析。TU组和TV组的标本取出时间分别为9.0±2.0分钟和9.8±2.5分钟（P=0.373）。TU组和TV组分别有13.8%和14.3%的病例需要额外镇痛。TV组术后3个月（2 - 4个月）的视觉模拟评分（VAS）平均得分低于TU组。TU组和TV组术后阴道长度无差异（8.9（8.7 - 9.1）cm对8.7（8.4 - 9.1）cm；P=0.465）。发现卵巢切除术和TU途径是VAS评分恶化的独立危险因素。两组的性功能指数评分相似。LS手术中经TV途径取出标本在术后早期可能引起的疼痛较轻，后期性交困难较少且不缩短阴道长度。
与开放手术相比，微创手术（MIS）恢复时间更快、患者生活质量更好且术后并发症发生率更低。从腹腔切除附件包块最常用耻骨上、经脐（TU）或经阴道（TV）途径。TU组和TV组的标本取出时间分别为9.0±2.0分钟和9.8±2.5分钟（P=0.373）。TV组术后3个月（2 - 4个月）的视觉模拟评分（VAS）平均得分低于TU组。发现卵巢切除术和TU途径是VAS评分恶化的独立危险因素。两组的性功能指数评分相似。总之，LS手术中经TV途径取出标本在术后早期可能引起的疼痛较轻，后期性交困难较少且不缩短阴道长度。
