Bekkers Ilse P W, Henschen Rebecca, Smeets Nicol A C, van Vliet Huib A A M, Damoiseaux Anne, Wassen Martine M L H
Department of Obstetrics & Gynecology, Zuyderland Medical Centre Heerlen, Henri Dunantstraat 5, 6419 PC Heerlen, Limburg, the Netherlands.
GROW School for Oncology and Reproduction, Maastricht University Medical Centre, Maastricht, the Netherlands.
Eur J Obstet Gynecol Reprod Biol X. 2024 Jul 2;23:100323. doi: 10.1016/j.eurox.2024.100323. eCollection 2024 Sep.
Vaginal assisted Natural Orifice Transluminal Endoscopic Surgery (NOTES) combines the benefits of vaginal and endoscopic surgery. This study presents the results of the first vaginal assisted NOTES hysterectomies (VANH) in The Netherlands.
A prospective cohort study was performed in two non-academic teaching hospitals in The Netherlands. Data was collected from patients who underwent a VANH for benign indications between August 2019 and April 2023. Baseline characteristics and data of intra- and postoperative surgical outcomes were recorded and analysed. The VANHs were performed by four experienced vaginal and endoscopic gynaecological surgeons.
A total of 200 patients underwent a VANH. Indications were dysfunctional menstrual bleeding (61 %; n = 122), abnormal cervical cytology (15.5 %; n = 31), abdominal pain (11.5 %; n = 23), post ablation/sterilization pain syndrome (3.5 %; n = 7), uterine fibroids (5.0 %; n = 10), atypical endometrial hyperplasia (2.5 %; n = 5) and Lynch or BRCA gene mutation carriers (1.0 %, n = 2). The mean surgical time was 61.4 min ( ± 22.8 min) with a mean blood loss of 88 mL ( ± 89 mL) and a mean uterine weight of 150 g ( ± 112 g). In 2.0 % (n = 4) of the cases a conversion was necessary. Same day discharge (SDD) was feasible in 80.2 % (n = 105) of the patients planned in day-care. In 2.0 % (n = 4) an intra-operative complication and in 9.0 % (n = 18) a post-operative complication occurred.
This study shows vNOTES to be a safe and feasible surgical technique and can be safely implemented with appropriate patient selection and skilled surgeons. It highlights the importance of surgeon awareness of the challenges inherent in the initial stages of the implementation of a new surgical technique when performing their first vNOTES procedures. Additional randomized clinical trials are needed to show superiority of vNOTES compared to traditional surgery.
经阴道自然腔道内镜手术（NOTES）结合了经阴道手术和内镜手术的优势。本研究展示了荷兰首例经阴道辅助NOTES子宫切除术（VANH）的结果。
在荷兰的两家非学术性教学医院进行了一项前瞻性队列研究。收集了2019年8月至2023年4月期间因良性指征接受VANH手术患者的数据。记录并分析了患者的基线特征以及手术中及术后的手术结果数据。VANH手术由四位经验丰富的阴道和内镜妇科外科医生实施。
共有200例患者接受了VANH手术。手术指征包括功能失调性子宫出血（61%；n = 122）、宫颈细胞学异常（15.5%；n = 31）、腹痛（11.5%；n = 23）、消融/绝育后疼痛综合征（3.5%；n = 7）、子宫肌瘤（5.0%；n = 10）、非典型子宫内膜增生（2.5%；n = 5）以及林奇或BRCA基因突变携带者（1.0%，n = 2）。平均手术时间为61.4分钟（±22.8分钟），平均失血量为88毫升（±89毫升），平均子宫重量为150克（±112克）。2.0%（n = 4）的病例需要中转手术。计划日间手术的患者中，80.2%（n = 105）实现了当日出院（SDD）。术中并发症发生率为2.0%（n = 4），术后并发症发生率为9.0%（n = 18）。
本研究表明经阴道NOTES是一种安全可行的手术技术，在进行适当的患者选择和由技术熟练的外科医生操作时可以安全实施。它强调了外科医生在首次进行经阴道NOTES手术时，意识到实施新手术技术初始阶段所固有的挑战的重要性。需要更多的随机临床试验来证明经阴道NOTES相对于传统手术的优越性。
