Chengdu Women's and Children's Central Hospital, School of Medicine, University of Electronic Science and Technology of China, 1617 Riyue Avenue, Qingyang District, Chengdu, 610036, Sichuan, China.
Sci Rep. 2024 Sep 30;14(1):22657. doi: 10.1038/s41598-024-70337-2.
This study aims to objectively assess the effect of three surgical approaches for posterior uterine fibroid resection: transumbilical laparoendoscopic single-site surgery (LESS), vaginal natural orifice transluminal endoscopic surgery (vNOTES) in prone position (vNOTES-P), and vNOTES in the lithotomy position (vNOTES-L). A retrospective analysis was conducted on data pertaining to all patients who underwent vNOTES and LESS for single posterior fibroids at our institution from January 2023 to July 2023. Patients were categorized into three groups based on the surgical approach: vNOTES-P group (n = 30), vNOTES-L group (n = 17), and LESS group (n = 32). Comparative analysis was performed on the demographic characteristics and perioperative outcomes among the three groups of patients. All 79 patients underwent surgery without the need for conversion to laparotomy. There were no statistically significant differences among the LESS group, vNOTES-P group, and vNOTES-L group in terms of operative time, intraoperative blood loss, and perioperative complication rates. In the vNOTES-L group, two patients required conversion to LESS during surgery. Patients had faster return of bowel function (less time to flatus) in the vNOTES group compared to the LESS group (P < 0.05). However, three cases of postoperative infection occurred in the vNOTES group, while none were reported in the LESS group. Compared to LESS, vNOTES demonstrates significant advantages in alleviating postoperative pain, shortening time to passage of flatus, speeding recovery and enhancing cosmetic outcomes. Particularly, vNOTES-P for posterior uterine fibroid resection, as an emerging surgical approach, offers certain advantages in facilitating surgical maneuverability and reducing operative time, rendering it more suitable for posterior uterine fibroid resection.
本研究旨在客观评估三种经阴道入路（经脐单孔腹腔镜手术、经阴道自然腔道内镜手术、截石位经阴道NOTES）治疗后位子宫肌瘤的手术效果。对 2023 年 1 月至 7 月在我院接受经阴道NOTES 和经脐单孔腹腔镜手术治疗单发后位子宫肌瘤的患者进行回顾性分析。根据手术方式将患者分为三组：经阴道NOTES-仰卧位组（vNOTES-P 组，n=30）、经阴道NOTES-截石位组（vNOTES-L 组，n=17）和经脐单孔腹腔镜组（LESS 组，n=32）。比较三组患者的一般资料和围手术期结果。79 例患者均顺利完成手术，无中转开腹。LESS 组、vNOTES-P 组和 vNOTES-L 组在手术时间、术中出血量和围手术期并发症发生率方面无统计学差异。vNOTES-L 组有 2 例患者术中改行经脐单孔腹腔镜手术。vNOTES 组患者术后排气时间（肛门恢复排气时间）短于 LESS 组（P<0.05），但 vNOTES 组有 3 例发生术后感染，而 LESS 组无术后感染发生。与 LESS 相比，vNOTES 在缓解术后疼痛、缩短肛门排气时间、促进康复和改善美容效果方面具有显著优势。特别是经阴道NOTES 治疗后位子宫肌瘤，作为一种新兴的手术方式，在手术操作灵活性和缩短手术时间方面具有一定优势，更适合治疗后位子宫肌瘤。
