Abstract：
OBJECTIVE: Vaginal natural orifice transluminal endoscopic surgery (vNOTES) is widely recognized for its potential benefits, including reducing post-surgical pain and leaving no discernible scarring. However, the anatomical specificity of the vNOTES approach may elevate the risk of nearby organ damage, such as the rectum and bladder. Thus, this study aims to demonstrate the safety and relative merits of vNOTES over transumbilical laparoendoscopic single-site surgery (LESS).
METHODS: The Longitudinal Vaginal Natural Orifice Transluminal Endoscopic Surgery Study (LovNOTESS), which was conducted in Chengdu, China. A total of 110 patients who underwent myomectomy in vNOTES or LESS from January 2021 to December 2022. This study prospectively collected and compared perioperative and follow-up data of the two groups.
RESULTS: In the vNOTES group, patients had shorter postoperative anal exhaust time, lower pain medications use rate, shorter hospital stay but higher intraoperative conversion rate, and higher postoperative fever rate. vNOTES decreased the anal exhaust time by approximately 8.7 h (95 %CI: -16.182, -1.262, p = 0.007). Moreover, vNOTES reduces pain medication use risk by 73.1 % (OR: 0.269, 95 %CI: 0.172, 0.318, p = 0.016).
CONCLUSIONS: Relative to LESS, vNOTES can make patients mitigate postoperative discomfort, accelerate the recovery of gastrointestinal function, curtail hospitalization duration, and enable a more rapid return to daily activities in myomectomy. However, vNOTES has a higher risk of surgical conversion and adjacent organ injury. Therefore, larger scale prospective studies are needed to prove its security and promote the widespread application of vNOTES in myomectomy.
METHODS: The Longitudinal Vaginal Natural Orifice Transluminal Endoscopic Surgery Study (LovNOTESS), which was conducted in Chengdu, China. A total of 110 patients who underwent myomectomy in vNOTES or LESS from January 2021 to December 2022. This study prospectively collected and compared perioperative and follow-up data of the two groups.
RESULTS: In the vNOTES group, patients had shorter postoperative anal exhaust time, lower pain medications use rate, shorter hospital stay but higher intraoperative conversion rate, and higher postoperative fever rate. vNOTES decreased the anal exhaust time by approximately 8.7 h (95 %CI: -16.182, -1.262, p = 0.007). Moreover, vNOTES reduces pain medication use risk by 73.1 % (OR: 0.269, 95 %CI: 0.172, 0.318, p = 0.016).
CONCLUSIONS: Relative to LESS, vNOTES can make patients mitigate postoperative discomfort, accelerate the recovery of gastrointestinal function, curtail hospitalization duration, and enable a more rapid return to daily activities in myomectomy. However, vNOTES has a higher risk of surgical conversion and adjacent organ injury. Therefore, larger scale prospective studies are needed to prove its security and promote the widespread application of vNOTES in myomectomy.
摘要：
目的：经阴道自然腔道内镜手术（vNOTES）因其潜在的益处而被广泛认可，包括减少手术后的疼痛和留下明显的疤痕。然而,vNOTES方法的解剖学特异性可能会增加附近器官损伤的风险，如直肠和膀胱。因此，本研究旨在证明vNOTES优于经脐腹腔镜单部位手术(LESS)的安全性和相对优势.
方法：纵向阴道自然口内镜手术研究（LovNOTESS），这是在成都进行的，中国。从2021年1月至2022年12月，共有110例患者在vNOTES或以下接受了子宫肌瘤切除术。本研究前瞻性收集并比较两组患者围手术期及随访资料。
结果：在vNOTES组中，患者术后肛门排气时间较短，降低止痛药的使用率，住院时间短，术中转换率高，术后发热率较高。vNOTES使肛门排气时间减少约8.7h（95CI：-16.182，-1.262，p=0.007）。此外，vNOTES将止痛药使用风险降低73.1%(OR:0.269,95CI:0.172,0.318,p=0.016)。
结论：相对于较少，vNOTES可以使患者减轻术后不适，加速胃肠功能的恢复，缩短住院时间，并使子宫肌瘤切除术更快速地恢复日常活动。然而,vNOTES具有较高的手术转换和邻近器官损伤的风险。因此,需要更大规模的前瞻性研究来证明其安全性，并促进vNOTES在子宫肌瘤切除术中的广泛应用。
方法：纵向阴道自然口内镜手术研究（LovNOTESS），这是在成都进行的，中国。从2021年1月至2022年12月，共有110例患者在vNOTES或以下接受了子宫肌瘤切除术。本研究前瞻性收集并比较两组患者围手术期及随访资料。
结果：在vNOTES组中，患者术后肛门排气时间较短，降低止痛药的使用率，住院时间短，术中转换率高，术后发热率较高。vNOTES使肛门排气时间减少约8.7h（95CI：-16.182，-1.262，p=0.007）。此外，vNOTES将止痛药使用风险降低73.1%(OR:0.269,95CI:0.172,0.318,p=0.016)。
结论：相对于较少，vNOTES可以使患者减轻术后不适，加速胃肠功能的恢复，缩短住院时间，并使子宫肌瘤切除术更快速地恢复日常活动。然而,vNOTES具有较高的手术转换和邻近器官损伤的风险。因此,需要更大规模的前瞻性研究来证明其安全性，并促进vNOTES在子宫肌瘤切除术中的广泛应用。
