脊髓麻醉下的单孔腹腔镜全子宫切除术：一项试点研究。
V-NOTES hysterectomy under spinal anaesthesia: A pilot study.
作者信息
Gündoğdu E C, Mat E, Aboalhasan Y, Yıldız G, Başol G, Tolga Saraçoğlu K, Arslan G, Kale A
出版信息
Facts Views Vis Obgyn. 2022 Sep;14(3):275-282. doi: 10.52054/FVVO.14.3.040.
BACKGROUND
Spinal anaesthesia has not been widely adopted for laparoscopic surgeries until now. There are a few studies that have shown that spinal anaesthesia is at least as safe as general anaesthesia. The need for additional analgesics can be reduced by utilising early postoperative analgesic effects of spinal anaesthesia, and maximum benefit can be obtained from minimally invasive approaches when V-NOTES surgery is performed under spinal anaesthesia.
OBJECTIVE
Combining V-NOTES with spinal anaesthesia to improve minimally invasive surgical techniques and provide maximum benefit to patients.
MATERIALS AND METHODS
Patients who were found to have benign pelvic organ pathologies, required a hysterectomy and were considered suitable for V-NOTES hysterectomy under spinal anaesthesia were included in this study. Spinal anaesthesia was achieved with 12.5 mg 0.5% hyperbaric bupivacaine in the sitting position. Perioperative events and complications related to spinal anaesthesia were noted. Postoperatively, the pain was evaluated using a visual analogue scale at the 6th, 12th, and 24th hours.
MAIN OUTCOME MEASURES
To evaluate the feasibility and safety of spinal anaesthesia in VNOTES hysterectomy and to increase the advantages of minimally invasive surgical procedures. Results: No conversion to conventional laparoscopy or laparotomy was required in all six operated patients. Conversion from spinal anaesthesia to general anaesthesia was unnecessary, and no major perioperative incident occurred in any of the cases.
CONCLUSION
In the current study by our team, we demonstrated that V-NOTES hysterectomy could be performed safely under spinal anaesthesia in well-selected patients. The need for additional analgesics can be reduced by utilising early postoperative analgesic effects of spinal anaesthesia, and maximum benefit can be obtained from minimally invasive approaches when VNOTES surgery is performed under spinal anaesthesia.
WHAT IS NEW?: V-NOTES hysterectomy could be performed safely under spinal anaesthesia in well-selected patients.
背景
迄今为止，脊髓麻醉尚未在腹腔镜手术中广泛应用。有一些研究表明，脊髓麻醉至少与全身麻醉一样安全。利用脊髓麻醉的术后早期镇痛效果可减少对额外镇痛药的需求，并且在脊髓麻醉下进行单孔经脐腹腔镜手术（V-NOTES）时，可从微创方法中获得最大益处。
目的
将V-NOTES与脊髓麻醉相结合，以改进微创手术技术并为患者提供最大益处。
材料与方法
本研究纳入了被发现患有良性盆腔器官病变、需要进行子宫切除术且被认为适合在脊髓麻醉下进行V-NOTES子宫切除术的患者。在坐位下使用12.5mg 0.5%的高压布比卡因实现脊髓麻醉。记录与脊髓麻醉相关的围手术期事件和并发症。术后，在第6、12和24小时使用视觉模拟量表评估疼痛情况。
主要观察指标
评估脊髓麻醉在V-NOTES子宫切除术中的可行性和安全性，并增加微创手术的优势。结果：所有6例接受手术的患者均无需转为传统腹腔镜手术或开腹手术。无需从脊髓麻醉转为全身麻醉，且所有病例均未发生重大围手术期事件。
结论
在我们团队目前的研究中，我们证明了在精心挑选的患者中，可在脊髓麻醉下安全地进行V-NOTES子宫切除术。利用脊髓麻醉的术后早期镇痛效果可减少对额外镇痛药的需求，并且在脊髓麻醉下进行V-NOTES手术时，可从微创方法中获得最大益处。
新进展
在精心挑选的患者中，可在脊髓麻醉下安全地进行V-NOTES子宫切除术。
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