Chengdu Women's and Children's Central Hospital, School of Medicine (X. Li, Liu, Hou, Zeng, Xiong, Yang, Lin, and He), University of Electronic Science and Technology of China, Chengdu, China.
Department of Gynaecology and Obstetrics (Z. Li), Chongqing University Fuling Hospital, Chongqing, China.
J Minim Invasive Gynecol. 2024 Sep;31(9):795-802. doi: 10.1016/j.jmig.2024.04.021. Epub 2024 Apr 30.
Vaginal natural orifice transluminal endoscopic surgery (vNOTES) is considered to have the advantages of completely scarless, less postoperative pain, earlier flatus, and faster postoperative recovery. However, posterior myoma are relatively difficult to operate through vNOTES in the conventional lithotomy position. Thus, we innovated the application of prone position in the removal of posterior myoma in vNOTES. The aim of this study is the comparison of myomectomy outcomes of patient for single posterior myoma in prone and lithotomy position.
A single-center, prospective study.
A university teaching hospital.
A total of 81 patients with posterior myoma who underwent myomectomy in vNOTES from January 2021 to December 2022.
The patients underwent myomectomy in vNOTES in prone or lithotomy position.
Among the patients who underwent vNOTES myomectomy, 29 (35.8%) were in the lithotomy position group, and 52 (64.2%) in the prone position group. Of note, 4 (4.9%) patients underwent a conversion to LESS during the operation-3 in the lithotomy and 1 in the prone position group. And a patient in the lithotomy position group underwent resurgery for hemostasis due to postoperative pelvic bleeding. Compared with the lithotomy position, prone position significantly shortens the operation time (12.3, 95% CI: 6.811, 17.761. p = .009) without increasing the complications and postoperative discomfort of patients.
Compared to the lithotomy position, the prone position provides greater convenience for operation and exhibits a lower rate of surgical conversion during the removal of single posterior myomas via vNOTES. Further, for patients selecting vNOTES, surgeons need to conduct sufficient preoperative evaluation, timely hemostasis during surgery, and timely surgical conversion if necessary to ensure patient safety.
阴道自然腔道内镜手术（vNOTES）被认为具有完全无痕、术后疼痛少、排气早、术后恢复快等优点。然而，在后位肌瘤的情况下，传统截石位下通过 vNOTES 进行手术相对困难。因此，我们创新地应用了俯卧位在 vNOTES 下切除后位肌瘤。本研究旨在比较俯卧位与截石位在 vNOTES 下切除单发后位肌瘤的手术效果。
单中心前瞻性研究。
一所大学教学医院。
2021 年 1 月至 2022 年 12 月期间，共有 81 例后位肌瘤患者在 vNOTES 下接受肌瘤切除术。
患者在 vNOTES 下接受仰卧位或俯卧位肌瘤切除术。
在接受 vNOTES 子宫肌瘤切除术的患者中，29 例（35.8%）在截石位组，52 例（64.2%）在俯卧位组。值得注意的是，有 4 例（4.9%）患者在手术中转为LESS-3 例在截石位组，1 例在俯卧位组。此外，1 例截石位组患者因术后盆腔出血行二次手术止血。与截石位相比，俯卧位显著缩短了手术时间（12.3，95%置信区间：6.811，17.761，p =.009），但不会增加患者的并发症和术后不适。
与截石位相比，在通过 vNOTES 切除单发后位肌瘤时，俯卧位为手术提供了更大的便利，且手术中转率更低。对于选择 vNOTES 的患者，外科医生需要进行充分的术前评估，及时进行术中止血，如果必要，及时进行手术转换，以确保患者安全。
