Kellerhals Gaétan, Nef James, Hurni Yannick, Huber Daniela
Faculty of Medicine, University of Geneva, Geneva, Switzerland.
Department of Gynecology and Obstetrics, Sion Hospital, Sion, Switzerland.
Front Surg. 2025 Feb 19;12:1542486. doi: 10.3389/fsurg.2025.1542486. eCollection 2025.
Surgery is the cornerstone of ovarian cancer treatment. Transvaginal natural orifice transluminal endoscopic surgery (vNOTES) is a novel, minimally invasive technique that is gaining interest in gynecological oncology. However, its use in ovarian cancer is still limited, with only a few cases reported. This study aimed to evaluate the feasibility of vNOTES for the surgical staging of borderline and early-stage ovarian cancer.
We retrospectively reviewed all cases of borderline ovarian tumors (BOTs) and early-stage ovarian cancer surgically staged by vNOTES at our institution between October 2021 and August 2024.
Eleven patients were included, seven with early-stage ovarian or tubal cancer and 4 with BOTs. The median age was 47 (27-81) years, and the median body mass index was 28.1 (22.4-39.2) kg/m. Complete vNOTES staging was achieved in all cases, including peritoneal washing, unilateral/bilateral salpingo-oophorectomy, abdominal cavity inspection, peritoneal biopsies, infracolic omentectomy, and total hysterectomy when required. The median operating time was 70 (35-138) min, with a median blood loss of 50 (10-100) ml. No intraoperative complications occurred except for one case of minor ovarian spillage. No conversions to conventional laparoscopy or laparotomy were needed. Postoperative complications included one surgical site infection (9.1%) and 2 cases of postoperative cystitis (18.2%). No severe complications graded ≥3 on the Clavien-Dindo classification were observed.
vNOTES appears to be a feasible approach for the surgical staging of highly selected patients with early-stage adnexal malignancies. Further studies are needed to validate its long-term safety and oncological outcomes.
手术是卵巢癌治疗的基石。经阴道自然腔道内镜手术（vNOTES）是一种新型的微创技术，在妇科肿瘤学领域正逐渐受到关注。然而，其在卵巢癌中的应用仍然有限，仅有少数病例报道。本研究旨在评估vNOTES用于交界性和早期卵巢癌手术分期的可行性。
我们回顾性分析了2021年10月至2024年8月在本机构接受vNOTES手术分期的所有交界性卵巢肿瘤（BOTs）和早期卵巢癌病例。
纳入11例患者，其中7例为早期卵巢或输卵管癌，4例为BOTs。中位年龄为47（27 - 81）岁，中位体重指数为28.1（22.4 - 39.2）kg/m²。所有病例均成功完成vNOTES分期，包括腹腔冲洗、单侧/双侧输卵管卵巢切除术、腹腔检查、腹膜活检、结肠下网膜切除术以及必要时的全子宫切除术。中位手术时间为70（35 - 138）分钟，中位失血量为50（10 - 100）毫升。除1例轻微卵巢内容物溢出外，未发生术中并发症。无需转为传统腹腔镜手术或开腹手术。术后并发症包括1例手术部位感染（9.1%）和2例术后膀胱炎（18.2%）。未观察到Clavien-Dindo分类中≥3级的严重并发症。
vNOTES似乎是高度选择的早期附件恶性肿瘤患者手术分期的一种可行方法。需要进一步研究以验证其长期安全性和肿瘤学结局。
