Department of Urology; State Key Laboratory of Molecular Oncology, National Cancer Center/National Clinical Research Center for Cancer/Cancer Hospital, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing, China.
Department of Urology; State Key Laboratory of Molecular Oncology, National Cancer Center/National Clinical Research Center for Cancer/Cancer Hospital, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing; Department of Urology, Shanxi Province Cancer Hospital/Shanxi Hospital Affiliated to Cancer Hospital, Chinese Academy of Medical Sciences/Cancer Hospital Affiliated to Shanxi Medical University, Shanxi, China.
J Cancer Res Ther. 2023 Aug;19(4):892-897. doi: 10.4103/jcrt.jcrt_1612_22.
Transvaginal natural orifice specimen extraction surgery (NOSES) has been widely used in laparoscopic surgery due to its benefits. However, laparoscopic radical cystectomy (LRC) with NOSES has rarely been reported.
A retrospective analysis of 25 patients who underwent 3D LRC with NOSES from November 2014 to November 2019 was performed. The clinical and perioperative related data, peri and postoperative complications, and oncologic outcomes were recorded.
Surgery was successfully completed in 25 patients, and none were converted to open surgery. Mean total operative time was 294.1 ± 48.80 min. Mean NOSES time was12 ± 6.48 min. The median post-op hospital stay was 10.5 d (range 6-27 d). The median visual analog pain score on post-op day 1, 2, and 3 was 2, 2, and 1, respectively. Thirteen patients had 30-day complications (3 had Clavien grade I and 11 had Clavien grade II). Pelvic floor distress inventory-short form 20 (PFDI-20) was 9.8 ± 1.9 after three months (compared with pre-PFDI-20, P = 0.06) and 9.3 ± 1.2 after six months (compared with pre-PFDI-20, P = 0.15). At the mean follow-up of 24.7 ± 12.05 months (range 11-60 months), one patient (4%) had recurrence, two (8%) had metastasis, and one (4%) died.
Transvaginal NOSES in 3D LRC is safe and feasible. Understanding the female vagina anatomy and comprehending the techniques is conducive to avoid incision-related complications. NOSES is minimally invasive with good cosmetic outcomes with few surgical complications or affecting pelvic floor function.
经阴道自然腔道取标本手术（NOSES）因其优势已在腹腔镜手术中得到广泛应用。然而，经阴道腹腔镜根治性膀胱切除术（LRC）联合 NOSES 鲜有报道。
回顾性分析 2014 年 11 月至 2019 年 11 月 25 例行 3D LRC 联合 NOSES 的患者的临床和围手术期相关资料、围手术期并发症和肿瘤学结果。
25 例患者均成功完成手术，无一例中转开放手术。总手术时间平均为 294.1±48.80 分钟。NOSES 时间平均为 12±6.48 分钟。术后中位住院时间为 10.5 天（6-27 天）。术后第 1、2、3 天的中位视觉模拟疼痛评分分别为 2、2、1。30 天内有 13 例患者发生并发症（3 例为 Clavien Ⅰ级，11 例为 Clavien Ⅱ级）。3 个月时盆腔功能困扰量表-短表 20 项（PFDI-20）为 9.8±1.9（与术前 PFDI-20 相比，P=0.06），6 个月时为 9.3±1.2（与术前 PFDI-20 相比，P=0.15）。在平均 24.7±12.05 个月（11-60 个月）的随访中，1 例（4%）患者复发，2 例（8%）患者转移，1 例（4%）患者死亡。
3D LRC 联合经阴道 NOSES 安全可行。了解女性阴道解剖结构并掌握相关技术有利于避免切口相关并发症。NOSES 具有微创优势，美容效果好，手术并发症少，不影响盆底功能。
