Güngördük Kemal, Şahin Uyar Berican, Gülseren Varol
Division of Gynecologic Oncology, Department of Obstetrics and Gynecology, Faculty of Medicine, Muğla Sıtkı Koçman University, Muğla, Turkey.
Department of Obstetrics and Gynecology, Faculty of Medicine, Muğla Sıtkı Koçman University, Muğla, Turkey.
Minim Invasive Ther Allied Technol. 2025 Aug;34(4):318-323. doi: 10.1080/13645706.2025.2490080. Epub 2025 Apr 18.
This study compared two minimally invasive hysterectomy techniques-single-port umbilical laparoscopy (SPLS) and vaginal natural orifice transluminal endoscopic surgery (vNOTES)-in terms of operating time, blood loss, postoperative pain, and hospitalization duration.
We retrospectively analyzed patients who underwent hysterectomy SPLS or vNOTES. Inclusion criteria were patients who had a hysterectomy with bilateral salpingectomy, with additional procedures such as salpingo-oophorectomy or sentinel lymph node dissection as indicated.
Among the 121 patients studied, 63 underwent SPLS and 58 underwent vNOTES. The mean operative time was 67.3 ± 15.9 min for vNOTES and 75.7 ± 12.1 min for SPLS. Six patients (9.5%) in the SPLS group and four (6.9%) in the vNOTES group underwent sentinel lymph node biopsies for endometrial cancer. Pain assessment at six, 12, and 24 h after surgery indicated lower visual analog scale (VAS) scores in the vNOTES group. Notably, patients in that group reported reduced shoulder and umbilical pain at 24 h postoperatively. Those patients also showed improved sexual function index scores and reduced dyspareunia, although the differences were not statistically significant.
The vNOTES approach to hysterectomy is a viable alternative, characterized by shorter operative times and decreased postoperative pain without increasing complication rates.
本研究比较了两种微创子宫切除术技术——单孔脐部腹腔镜手术（SPLS）和经阴道自然腔道内镜手术（vNOTES）在手术时间、失血量、术后疼痛及住院时间方面的差异。
我们回顾性分析了接受SPLS或vNOTES子宫切除术的患者。纳入标准为接受子宫切除术并双侧输卵管切除术的患者，必要时可进行输卵管卵巢切除术或前哨淋巴结清扫等额外手术。
在121例研究患者中，63例行SPLS，58例行vNOTES。vNOTES组的平均手术时间为67.3±15.9分钟，SPLS组为75.7±12.1分钟。SPLS组有6例（9.5%）患者和vNOTES组有4例（6.9%）患者因子宫内膜癌接受了前哨淋巴结活检。术后6、12和24小时的疼痛评估显示，vNOTES组的视觉模拟评分（VAS）较低。值得注意的是，该组患者术后24小时肩部和脐部疼痛减轻。这些患者的性功能指数评分也有所改善，性交困难减少，尽管差异无统计学意义。
vNOTES子宫切除术是一种可行的替代方法，其特点是手术时间较短，术后疼痛减轻，且不增加并发症发生率。
