Vacca Lorenzo, Rosato Eleonora, Lombardo Riccardo, Geretto Paolo, Albisinni Simone, Campi Riccardo, De Cillis Sabrina, Pelizzari Laura, Gallo Maria Lucia, Sampogna Gianluca, Lombisani Andrea, Campagna Giuseppe, Giammo Alessandro, Li Marzi Vincenzo, De Nunzio Cosimo
Gynecological Surgery Unit, Dipartimento Centro di Eccellenza Donna e Bambino Nascente, Ospedale Isola Tiberina-Gemelli Isola, 00136 Rome, Italy.
Unit of Urology, Department of Surgical Sciences, Tor Vergata University Hospital, Tor Vergata University of Rome, 00133 Rome, Italy.
J Clin Med. 2024 Sep 25;13(19):5707. doi: 10.3390/jcm13195707.
Minimally invasive surgery could improve cosmetic outcomes and reduce the risks of surgical injury with less postoperative pain and a quicker patient's discharge. Recently, transvaginal natural orifice transluminal endoscopic surgery (vNOTES) has been introduced in urogynecology with exciting results. After PROSPERO registration (n°CRD42023406815), we performed a comprehensive literature search on Pubmed, Embase, and Cochrane CENTRAL, including peer-reviewed studies evaluating transvaginal natural orifice transluminal endoscopic surgery. No limits on time or type of study were applied. Overall, 12 manuscripts were included in the analysis. Seven studies evaluated uterosacral ligament suspension, four studies evaluated sacral colpopexy, three evaluated sacrospinous ligament suspension, and one study evaluated lateral suspension. Overall success rates were high (>90%); however, definitions of success were heterogeneous. In terms of complication, most of the studies reported low-grade complications (Clavien-Dindo I and II); only two patients needed mesh removal because of mesh exposure. The risk of bias of the trials was rated in the medium to high-risk category. The present review highlights important initial results for vNOTES. Future randomized clinical trials are needed to better define its role in the management of urogynecological procedures.
微创手术可以改善美容效果，降低手术损伤风险，减少术后疼痛，并使患者更快出院。最近，经阴道自然腔道内镜手术（vNOTES）已被引入妇科泌尿学领域，并取得了令人兴奋的成果。在进行PROSPERO注册（编号CRD42023406815）后，我们在PubMed、Embase和Cochrane CENTRAL上进行了全面的文献检索，包括评估经阴道自然腔道内镜手术的同行评审研究。对研究的时间或类型没有限制。总体而言，分析纳入了12篇手稿。七项研究评估了子宫骶骨韧带悬吊术，四项研究评估了骶骨阴道固定术，三项评估了骶棘韧带悬吊术，一项研究评估了侧方悬吊术。总体成功率较高（>90%）；然而，成功的定义并不统一。在并发症方面，大多数研究报告的是低级别并发症（Clavien-Dindo I和II级）；只有两名患者因网片暴露需要取出网片。试验的偏倚风险被评为中到高风险类别。本综述强调了vNOTES的重要初步结果。未来需要进行随机临床试验，以更好地确定其在妇科泌尿手术管理中的作用。
