Chen Yan, Zhou Youjun, Tan Liping, Chen Shihui, Wu Chunhua, Liang Yanling, Sun Nannan, Liu Juan
Department of Obstetrics and Gynecology, Guangdong Provincial Key Laboratory of Major Obstetric Diseases, The Third Affiliated Hospital of Guangzhou Medical University, Guangzhou Medical University, Guangzhou, 510150, China.
Heliyon. 2023 Sep 3;9(9):e19698. doi: 10.1016/j.heliyon.2023.e19698. eCollection 2023 Sep.
To compare the safety, feasibility, and effectiveness of transvaginal natural orifice transluminal endoscopic sacrocolpopexy (vNOTES-SC) and laparoendoscopic single-site sacrocolpopexy (LESS-SC) for pelvic organ prolapse (POP).
Ninety-four patients with POP who underwent vNOTES-SC or LESS-SC from October 2016 to November 2018 were included. The propensity score matching method was used for 1:1 matching between the two surgery groups. After matching, the general perioperative indicators, surgical complications, and the subjective and objective therapeutic effects of the two groups 3 years post-surgery were analyzed.
After matching, 36 patients in each group were included, exhibiting balanced and comparable baseline data and an average follow-up of 48.6 ± 7.44 months. The operation time and postoperative hospitalization days were significantly reduced in the vNOTES-SC group (P < 0.05). However, perioperative complication incidence was not significantly different between the two groups (P > 0.05). Additionally, no significant differences were detected in de novo stress urinary incontinence (16.7% vs. 13.9%), de novo overactive bladder (de novo OAB, 8.3% vs. 0.0%), urination disorder (2.8% vs. 0.0%), defecation disorder (0.0% vs. 2.8%), lumbosacral pain (0.0% vs. 2.8%), or mesh complication (2.8% vs. 5.6%) incidences between the vNOTES-SC and LESS-SC groups (P > 0.05). Prolapse recurrence was not reported in either group. The quantitative description of pelvic organ position (POP-Q), Pelvic Floor Impact Questionnaire-7 (PFIQ-7), and Patient Global Impression of Improvement scale (PGI-I) scores showed improvement after the operation, but no significant differences were observed between the two groups (P > 0.05).
The 3-year follow-up revealed that vNOTES-SC and LESS-SC had similar complications and efficacy rates. Compared with LESS-SC, vNOTES-SC resulted in shorter operation time and fewer postoperative hospitalization days (corresponding to the enhanced recovery after surgery [ERAS] concept), along with better cosmetic results without a scar. Therefore, our study findings suggest that clinicians should choose the surgery method based on the specific situation, and we recommend choosing vNOTES-SC when both surgeries are suitable.
比较经阴道自然腔道内镜下骶骨阴道固定术（vNOTES-SC）和腹腔镜单孔骶骨阴道固定术（LESS-SC）治疗盆腔器官脱垂（POP）的安全性、可行性和有效性。
纳入2016年10月至2018年11月期间接受vNOTES-SC或LESS-SC治疗的94例POP患者。采用倾向评分匹配法对两组手术患者进行1:1匹配。匹配后，分析两组患者围手术期一般指标、手术并发症以及术后3年的主观和客观治疗效果。
匹配后，每组纳入36例患者，基线数据均衡可比，平均随访时间为48.6±7.44个月。vNOTES-SC组的手术时间和术后住院天数显著缩短（P<0.05）。然而，两组围手术期并发症发生率无显著差异（P>0.05）。此外，vNOTES-SC组和LESS-SC组在新发压力性尿失禁（16.7%对13.9%）、新发膀胱过度活动症（新发OAB，8.3%对0.0%）、排尿障碍（2.8%对0.0%）、排便障碍（0.0%对2.8%）、腰骶部疼痛（0.0%对2.8%）或网片并发症（2.8%对5.6%）发生率方面均未检测到显著差异（P>0.05）。两组均未报告脱垂复发情况。盆腔器官位置的定量描述（POP-Q）、盆底影响问卷-7（PFIQ-7）和患者整体改善印象量表（PGI-I）评分显示术后有所改善，但两组间未观察到显著差异（P>0.05）。
3年随访结果显示，vNOTES-SC和LESS-SC的并发症和有效率相似。与LESS-SC相比，vNOTES-SC手术时间更短，术后住院天数更少（符合加速康复外科[ERAS]理念），且美容效果更好，无疤痕。因此，我们的研究结果表明临床医生应根据具体情况选择手术方式，在两种手术均适用时，我们建议选择vNOTES-SC。
