Department of Gynecologic Oncology, Imelda Hospital and Department of Development and Regeneration, University of Leuven (Dr. Baekelandt), Belgium.
J Minim Invasive Gynecol. 2024 Sep;31(9):723. doi: 10.1016/j.jmig.2024.04.009. Epub 2024 Apr 19.
To demonstrate how a radical hysterectomy with sentinel node resection for cervical cancer can be performed via vaginal Natural Orifice Transluminal Endoscopic Surgery (vNOTES).
Demonstration of the technique in 10 steps. making use of narrated original video footage SETTING: The surgical treatment of cervical cancer is traditionally performed via one of the following techniques: Wertheim radical hysterectomy via laparotomy, Schauta radical hysterectomy vaginally, laparoscopic radical hysterectomy or robotic radical hysterectomy. The results of the LACC trial showed that minimally invasive radical hysterectomy was associated with lower rates of disease-free survival and overall survival than open radical hysterectomy among women with early-stage cervical Cancer [1]. For endometrial cancer, a vNOTES retroperitoneal approach to sentinel node resection was first published in 2019 [2]. Based on the experience with this approach and with Schauta-Stoeckel radical hysterectomy for cervical cancer [3], a new approach was developed to perform a radical hysterectomy via vNOTES whereby most of the procedure is performed retroperitoneally [4]. This video article demonstrates in 10 steps how a radical hysterectomy via vNOTES is performed.
Radical hysterectomy via vNOTES demonstrated making use of original video footage of a 57-year-old woman operated on for cervical adenocarcinoma 7 weeks after a LEEP cone. The steps of the procedure are: 1. Vaginal cuff creation, 2. Development of lateral retroperitoneal space and sentinel node resection, 3. Uterine artery and vein transection, 4. Hypogastric nerve dissection, 5. Development of central retroperitoneal space and rectum dissection, 6. Posterior colpotomy, 7. Parametrium dissection, 8. Bladder pillar dissection, 9. Anterior colpotomy, 10. Salpingo-oophorectomy or salpingectomy. 3 Patients were so far treated by this new technique that allowed for good hemostatic control.
vNOTES enables a potentially less invasive approach to radical hysterectomy performed largely retroperitoneally and completely transvaginally, leaving no visible scars. The endoscopic approach offers excellent visualization of the retroperitoneal and parametrial anatomy. This is a new approach that requires further validation and should only be performed in a research setting, taking into account the current reservations about endoscopic surgery for cervical cancer resulting from the LACC trial. VIDEO ABSTRACT.
展示如何通过阴道自然腔道内镜手术（vNOTES）进行宫颈癌根治性子宫切除术和前哨淋巴结切除术。
分 10 步演示技术，使用旁白原始视频片段。
宫颈癌的传统手术治疗方法如下：经剖腹术的 Wertheim 根治性子宫切除术、经阴道的 Schauta 根治性子宫切除术、腹腔镜根治性子宫切除术或机器人根治性子宫切除术。LACC 试验的结果表明，与开腹根治性子宫切除术相比，微创根治性子宫切除术与早期宫颈癌女性的无病生存率和总生存率降低有关[1]。对于子宫内膜癌，vNOTES 后腹膜前入路的前哨淋巴结切除术于 2019 年首次发表[2]。基于这种方法以及宫颈癌 Schauta-Stoeckel 根治性子宫切除术的经验[3]，开发了一种新的通过 vNOTES 进行根治性子宫切除术的方法，其中大部分手术在腹膜后进行[4]。本文通过 10 个步骤演示了如何通过 vNOTES 进行根治性子宫切除术。
通过 vNOTES 进行根治性子宫切除术，使用一名 57 岁妇女的原始视频进行演示，该妇女在 LEEP 锥切术后 7 周因宫颈腺癌接受手术。手术步骤如下：1.阴道残端的创建；2.侧腹膜后空间的发展和前哨淋巴结切除术；3.子宫动脉和静脉的切断；4.下腹神经的解剖；5.中央腹膜后空间的发展和直肠的解剖；6.后阴道切开术；7.子宫旁组织的解剖；8.膀胱柱的解剖；9.前阴道切开术；10.输卵管卵巢切除术或输卵管切除术。到目前为止，已经有 3 名患者接受了这种新技术的治疗，这种新技术能够实现良好的止血控制。
vNOTES 能够通过阴道完全实现前哨淋巴结切除术和大部分腹膜后根治性子宫切除术，实现潜在的微创方法，没有可见的疤痕。内镜方法提供了腹膜后和子宫旁解剖结构的出色可视化。这是一种新的方法，需要进一步验证，并且只能在研究环境中进行，考虑到 LACC 试验导致对宫颈癌内镜手术的当前保留意见。视频摘要。
