Interdonato Maria Lieta, Scollo Paolo, Bignardi Tommaso, Massimello Francesca, Ferrara Martina, Donatiello Gianluca, Caretto Marta, Mannella Paolo, Pecorino Basilio, Meroni Mario Giuseppe, Simoncini Tommaso
Department of Obstetrics and Gynecology, Niguarda Hospital, Milan, Italy.
Department of Obstetrics and Gynecology, Cannizzaro Hospital, Catania, Italy.
Front Med (Lausanne). 2022 Dec 13;9:1018232. doi: 10.3389/fmed.2022.1018232. eCollection 2022.
The aim of this study is to evaluate the initial feasibility, safety, and outcomes of hysterectomy performed by transvaginal natural orifice transluminal endoscopic surgery (vNOTES) at three institutions in Italy.
All women who underwent vNOTES hysterectomy ± salpingo-oophorectomy for benign indications at three tertiary referral medical centers between July 2019 and April 2021 were included in a retrospective analysis. All vNOTESs were performed with the use of Alexis and Vpath Gel paths (Applied Medical). Perioperative data were extracted from patient records. Patient satisfaction and dyspareunia were prospectively inquired about at 60 days and 6 months.
Forty-six patients underwent vNOTES in the study period. Indications for surgery included myomas ± metrorrhagia (52.2%), H-Sil/ cervical cancer (10.7%), adenomyosis ± metrorrhagia (8.7%), BRCA 1-2 mutations (6.5%), endometrial hyperplasia (6.5%), ovarian cyst + history of breast cancer (6.5%), metrorrhagia (6.5%), and hydatidiform mole (2.2%). The mean operation time was 91.1 (±32.6) minutes. The mean hemoglobin drop was 1.2 (±0.8). The mean visual analog scale at 24 h for post-operative pain was 3.3 (±1.8). Secondary to our limited experience with the surgical technique, we favor discharge only from day 1. The mean length of hospital stay was 2 (±1.4) days. Two conversions to conventional laparoscopy were reported (4.3%), due to an obliterated pouch of Douglas and a preoperative complication. Two post-operative complications were reported (4.3%). Overall, our data on peri- and post-operative outcomes are similar to those already published for vNOTES.
Our initial experience suggests that introducing vNOTES as an alternative to conventional surgery is feasible and may offer some advantages in selected women.
本研究旨在评估意大利三家机构经阴道自然腔道内镜手术（vNOTES）行子宫切除术的初步可行性、安全性及结果。
对2019年7月至2021年4月期间在三家三级转诊医疗中心因良性指征接受vNOTES子宫切除术±输卵管卵巢切除术的所有女性进行回顾性分析。所有vNOTES手术均使用Alexis和Vpath Gel路径（应用医疗公司）。围手术期数据从患者记录中提取。前瞻性询问患者在60天和6个月时的满意度及性交困难情况。
研究期间46例患者接受了vNOTES手术。手术指征包括肌瘤±月经过多（52.2%）、高级别鳞状上皮内病变/宫颈癌（10.7%）、子宫腺肌病±月经过多（8.7%）、BRCA 1-2基因突变（6.5%）、子宫内膜增生（6.5%）、卵巢囊肿+乳腺癌病史（6.5%）、月经过多（6.5%）及葡萄胎（2.2%）。平均手术时间为91.1（±32.6）分钟。平均血红蛋白下降1.2（±0.8）。术后24小时疼痛的平均视觉模拟评分是3.3（±1.8）。由于我们在手术技术方面经验有限，我们倾向于仅在术后第1天出院。平均住院时间为2（±1.4）天。报告了2例转为传统腹腔镜手术（4.3%），原因是Douglas陷凹闭塞和术前并发症。报告了2例术后并发症（4.3%）。总体而言，我们关于围手术期和术后结果的数据与已发表的vNOTES相关数据相似。
我们的初步经验表明，引入vNOTES作为传统手术的替代方法是可行的，并且可能在特定女性中具有一些优势。
