Sarikaya Serkan, Taskin Mine Islimye, Bozhuyuk Sahin Tuba, Guney Gurhan, Kececioglu Mehmet, Afsar Selim, Guney Sergul Selvi
Department of Obstetrics and Gynecology, Balikesir University, Faculty of Medicine, Balikesir, Turkey.
Department of Obstetrics and Gynecology, Balikesir Atatürk City Hospital, Balikesir, Turkey.
J Invest Surg. 2025 Dec;38(1):2488131. doi: 10.1080/08941939.2025.2488131. Epub 2025 May 1.
This retrospective study compared the perioperative outcomes of vaginal natural orifice transluminal endoscopic surgery (V-NOTES) and total laparoscopic hysterectomy (TLH).
This analysis included 62 patients: 32 underwent V-NOTES and 30 underwent TLH. Patients with a body mass index (BMI) >30, a history of endometriosis, multiple cesarean sections, or a uterine size >12 week were excluded. Perioperative data-including visual analog scale (VAS) scores, analgesia use, mobilization time, hospitalization duration, and hemoglobin deficit-were compared using independent sample tests and Mann-Whitney tests.
There were no significant differences in BMI, number of pregnancies, or operative time ( > 0.05). VAS scores at 6 and 24 h were significantly lower in the V-NOTES group ( < 0.001). Patients in the V-NOTES group required less analgesia, had shorter mobilization and hospitalization periods, and returned to daily activities sooner ( < 0.001). However, the hemoglobin deficit was higher in the V-NOTES group (1.85 g/dl vs. 0.7 g/dl, < 0.001). The neutrophil-to-lymphocyte ratio (NLR) was lower in the V-NOTES group ( = 0.013), whereas the platelet-to-lymphocyte ratio (PLR) and mean platelet volume (MPV) did not differ significantly between the two groups.
V-NOTES offers advantages such as reduced postoperative pain and faster recovery compared to TLH. The higher hemoglobin deficit observed with V-NOTES may be related to the surgeon's experience. Further randomized studies are warranted to validate these findings and define appropriate patient selection criteria.
本回顾性研究比较了经阴道自然腔道内镜手术（V-NOTES）与全腹腔镜子宫切除术（TLH）的围手术期结局。
本分析纳入62例患者，其中32例行V-NOTES，30例行TLH。排除体重指数（BMI）>30、有子宫内膜异位症病史、多次剖宫产史或子宫大小>12周的患者。采用独立样本t检验和Mann-Whitney U检验比较围手术期数据，包括视觉模拟评分（VAS）、镇痛药物使用情况、活动时间、住院时间和血红蛋白降低量。
两组患者在BMI、妊娠次数或手术时间方面无显著差异（P>0.05）。V-NOTES组术后6小时和24小时的VAS评分显著更低（P<0.001）。V-NOTES组患者所需镇痛药物更少，活动和住院时间更短，且更快恢复日常活动（P<0.001）。然而，V-NOTES组的血红蛋白降低量更高（1.85 g/dl vs. 0.7 g/dl，P<0.001）。V-NOTES组的中性粒细胞与淋巴细胞比值（NLR）更低（P=0.013），而两组之间的血小板与淋巴细胞比值（PLR）和平均血小板体积（MPV）无显著差异。
与TLH相比，V-NOTES具有术后疼痛减轻和恢复更快等优势。V-NOTES观察到的更高血红蛋白降低量可能与外科医生的经验有关。有必要进行进一步的随机研究以验证这些发现并确定合适的患者选择标准。
