Department of Obstetrics and Gynecology (Kar and Polat), Basaksehir Cam and Sakura City Hospital, Istanbul, Turkey.
Department of Gynecology (Philip), Beaumont Hospital, Dublin, Ireland.
J Minim Invasive Gynecol. 2024 Jul;31(7):574-583.e1. doi: 10.1016/j.jmig.2024.04.017. Epub 2024 Apr 26.
This study focuses on evaluating the effectiveness, safety and efficacy of 2 surgical tissue extraction methods for treating bowel endometriosis: natural orifice specimen extraction (NOSE) and minilaparotomy.
A systematic search was conducted in MedLine, Embase, and Cochrane Library databases in October 2023, without date restrictions.
This study included studies that directly compared NOSE and minilaparotomy in colectomy patients due to endometriosis. Primary outcomes were defined as operation duration, length of hospital stay, intraoperative blood loss, and major postoperative complication rates. The Clavien-Dindo classification was used to categorize complications. Statistical analysis was performed using Review Manager Software by Cochrane, with a DerSimonian and Laird random-effects model to account for anticipated high heterogeneity. Subgroup analysis was conducted for patients undergoing full laparoscopic (L/S) resection.
TABULATION, INTEGRATION AND RESULTS: Out of 1236 identified studies, 6 met the inclusion criteria, comprising 372 patients. One study was a randomized controlled trial, and 5 were observational. Operation duration did not significantly differ between NOSE and minilaparotomy (MD: -10.85 min; 95% CI: [-23.33, 1.63]; p = .09). NOSE was associated with a significantly reduced length of hospital stay (MD: -0.76 day; 95% CI: [-1.21, -0.31]; p = .008). The major postoperative complication rates were 3.77% for NOSE and 5.55% for minilaparotomy, with no significant difference (OR: 0.84; 95% CI: [0.27, 2.60]; p = .76). Subgroup analysis revealed that Full L/S had significantly shorter operation duration (MD: -26.06 min; 95% CI: [-45.85, -6.27]; p = .01), reduced length of stay (MD: -0.75 day; 95% CI: [-1.25, -0.25]; p = .003), and lower blood loss (MD: -15.01 mL; 95% CI: [-29.64, -0.37]; p = .04).
NOSE emerged as a potentially safer alternative to minilaparotomy for tissue extraction in colectomy for bowel endometriosis. However, standardization of the procedure and additional randomized controlled trials are needed to validate these findings.
本研究旨在评估两种用于治疗肠子宫内膜异位症的手术组织提取方法的有效性、安全性和疗效：自然腔道标本提取（NOSE）和小开腹术。
2023 年 10 月，在 MedLine、Embase 和 Cochrane Library 数据库中进行了系统检索，无时间限制。
本研究纳入了直接比较 NOSE 和小开腹术治疗因子宫内膜异位症而行结肠切除术患者的研究。主要结局定义为手术持续时间、住院时间、术中失血量和主要术后并发症发生率。采用 Clavien-Dindo 分类对并发症进行分类。使用 Cochrane 的 Review Manager 软件进行统计学分析，采用 DerSimonian 和 Laird 随机效应模型，以考虑预期的高度异质性。对行全腹腔镜（L/S）切除术的患者进行亚组分析。
列表、整合和结果：在 1236 项确定的研究中，有 6 项符合纳入标准，共纳入 372 例患者。其中 1 项为随机对照试验，5 项为观察性研究。NOSE 与小开腹术的手术持续时间无显著差异（MD：-10.85 分钟；95%CI：[-23.33，1.63]；p=.09）。NOSE 与住院时间显著缩短相关（MD：-0.76 天；95%CI：[-1.21，-0.31]；p=.008）。NOSE 的主要术后并发症发生率为 3.77%，小开腹术为 5.55%，差异无统计学意义（OR：0.84；95%CI：[0.27，2.60]；p=.76）。亚组分析显示，全腹腔镜下手术时间明显缩短（MD：-26.06 分钟；95%CI：[-45.85，-6.27]；p=.01），住院时间缩短（MD：-0.75 天；95%CI：[-1.25，-0.25]；p=.003），失血量减少（MD：-15.01 毫升；95%CI：[-29.64，-0.37]；p=.04）。
NOSE 作为一种用于肠子宫内膜异位症结肠切除术组织提取的潜在更安全的替代方法，优于小开腹术。然而，需要标准化该手术程序并开展更多的随机对照试验，以验证这些发现。
