Liu Ying, Li Xin, Liu Tianjiao, Xie Aijie, Wu Xian, Jia Yujian, Liao Xiaoyan, Cheng Wei, Wang Hui, Zhong Fangyuan, Xu Lijuan, Huang Juan, Xiu Siqin, Li Zhongzhi, Li Yalan, Xiao Xue, Lin Yonghong, Gan Xiaoqin
Department of Gynecology and Obstetrics, Chengdu Women's and Children's Central Hospital, School of Medicine, University of Electronic Science and Technology of China, Chengdu, 611731, China.
Department of Gynecology and Obstetrics, Chongqing University Fuling Hospital, Chongqing, 408099, China.
Heliyon. 2024 Jan 20;10(2):e24945. doi: 10.1016/j.heliyon.2024.e24945. eCollection 2024 Jan 30.
We aimed to determine the safety of Vaginal natural orifice transluminal endoscopic surgery (vNOTES) in terms of the Enhanced Recovery after Surgery (ERAS) concept for tubal pregnancy surgery and provide a detailed process of vNOTES for tubal pregnancy surgery, including experience and key points for surgeons performing this procedure.
The Longitudinal Vaginal Natural Orifice Transluminal Endoscopic Surgery Study (LovNOTESS), which was conducted in Chengdu, China. A total of 219 patients who underwent tubal ectopic pregnancy surgery between September 2021 and March 2022. The patients underwent salpingectomy or salpingostomy using transumbilical laparoendoscopic single-site surgery (LESS) or vNOTES, according to their preferences. This study prospectively collected perioperative and one-year follow-up data on tubal pregnancy outcomes after vNOTES and compared them with those after LESS.
The vNOTES group showed a shorter surgical duration, hospitalization duration, and postoperative exhaust time and a lower analgesic medication usage rate, but it showed a higher surgical conversion rate. The vNOTES approach reduced the postoperative exhaust time by approximately 9 h (95% confidence interval [CI]: -11.93, -5.57 h, p < .001) and the risk of postoperative analgesic drug use by 77% (odds ratio, 0.23; 95% CI: 0.10, 0.61, p = .023).
vNOTES can shorten the exhaust time and duration of hospitalization, reduce postoperative pain, and avoid surface surgical scars in tubal pregnancy surgeries, consistent with the ERAS concept. However, more comprehensive preoperative evaluation of patients who choose vNOTES is required to reduce the occurrence of intraoperative conversion.: ChiCTR2100053483.
我们旨在根据手术加速康复（ERAS）理念，确定经阴道自然腔道内镜手术（vNOTES）用于输卵管妊娠手术的安全性，并提供vNOTES输卵管妊娠手术的详细流程，包括外科医生进行该手术的经验和要点。
在中国成都进行的纵向经阴道自然腔道内镜手术研究（LovNOTESS）。2021年9月至2022年3月期间，共有219例接受输卵管异位妊娠手术的患者。患者根据自身意愿，采用经脐单孔腹腔镜手术（LESS）或vNOTES进行输卵管切除术或输卵管造口术。本研究前瞻性收集了vNOTES术后围手术期及一年随访期的输卵管妊娠结局数据，并与LESS术后的数据进行比较。
vNOTES组手术时间、住院时间和术后排气时间较短，镇痛药物使用率较低，但手术转化率较高。vNOTES方法使术后排气时间缩短约9小时（95%置信区间[CI]：-11.93，-5.57小时，p <.001），术后使用镇痛药物的风险降低77%（优势比，0.23；95%CI：0.10，0.61，p =.023）。
vNOTES可缩短输卵管妊娠手术的排气时间和住院时间，减轻术后疼痛，避免体表手术瘢痕，符合ERAS理念。然而，需要对选择vNOTES的患者进行更全面的术前评估，以减少术中中转的发生。试验注册号：ChiCTR2100053483
