Kudunthail Jeena R, Sharma Kartik, Bhirud Deepak Prakash, Singh Mahendra, Choudhary Gautam Ram, Navriya Shiv Charan, Sandhu Arjun Singh
Department of Urology, All India Institute of Medical Sciences, Jodhpur, Rajasthan, India.
Indian J Urol. 2025 Apr-Jun;41(2):104-110. doi: 10.4103/iju.iju_304_24. Epub 2025 Jan 29.
Natural orifice specimen extraction surgery (NOSES), particularly transvaginal NOSES, is an innovative approach in laparoscopic urological surgery. This study aims to assess the feasibility, safety, and outcomes of transvaginal NOSES in women undergoing laparoscopic simple nephrectomy in an Indian cohort.
A prospective observational study was conducted from September 2022 to May 2024 in the department of urology, including 15 women with prior vaginal deliveries undergoing simple nephrectomy. Exclusion criteria were vaginal scarring, previous pelvic surgeries, active intravaginal infections, cervical neoplasia, unresolved pelvic inflammation, and patient refusal. Parameters assessed included operative time, specimen extraction time, blood loss, postoperative recovery metrics, Female Sexual Function Index, and Pelvic Floor Impact Questionnaire scores at the baseline and at 3 months.
The mean age of the patients was 45.73 years. The average operative time, including the specimen extraction was 127.8 min and the average extraction time was 30.13 min. None required conversion to open surgery, and the average blood loss was 68.0 mL with no intraoperative transfusions. The postoperative recovery was rapid, with milestones achieved within 1 day, and the average hospital stay was 2.2 days. Pain scores were low (Visual Analog Scale: 2.87 at 24 h and 1.47 at 48 h). The complication rate was 6.67%, with one case of vaginal bleeding which was managed conservatively. Postoperative pelvic floor and sexual functions were preserved without significant adverse effects.
Transvaginal NOSES is a feasible and safe technique for nephrectomy, offering reduced postoperative pain, minimal blood loss, and rapid recovery, enhancing surgical outcomes and patient satisfaction.
自然腔道标本取出手术（NOSES），尤其是经阴道NOSES，是腹腔镜泌尿外科手术中的一种创新方法。本研究旨在评估在印度队列中，经阴道NOSES应用于接受腹腔镜单纯肾切除术女性患者的可行性、安全性及手术效果。
2022年9月至2024年5月在泌尿外科进行了一项前瞻性观察研究，纳入15例有经阴道分娩史且接受单纯肾切除术的女性患者。排除标准包括阴道瘢痕形成、既往盆腔手术史、活动性阴道感染、宫颈肿瘤、未治愈的盆腔炎症以及患者拒绝。评估的参数包括手术时间、标本取出时间、失血量、术后恢复指标、女性性功能指数以及基线和术后3个月时的盆底影响问卷评分。
患者的平均年龄为45.73岁。包括标本取出在内的平均手术时间为127.8分钟，平均取出时间为30.13分钟。无一例需要转为开放手术，平均失血量为68.0毫升，术中无输血情况。术后恢复迅速，术后1天内达到各关键节点，平均住院时间为2.2天。疼痛评分较低（视觉模拟评分：术后24小时为2.87，术后48小时为1.47）。并发症发生率为6.67%，其中1例阴道出血经保守治疗。术后盆底功能和性功能得以保留，无明显不良影响。
经阴道NOSES是一种可行且安全的肾切除技术，具有术后疼痛减轻、失血量少、恢复快的特点，可改善手术效果并提高患者满意度。
