■经阴道自然腔道内镜手术(vNOTES)是一种新兴的微创方法,越来越多地应用于执行许多妇科手术。尽管证据仍然有限,与传统腹腔镜相比,vNOTES似乎与减少失血有关,手术时间更短,术后疼痛减少,住院时间短,更好的美容效果和降低术后发病率。尽管越来越多的证据支持vNOTES用于选择性附件手术的有效性,关于其在紧急情况下的可行性和安全性的知识仍然有限。在本研究中,我们报告了我们在妇科紧急情况下执行vNOTES的经验。
■我们前瞻性地收集并分析了2021年11月至2023年6月因妇科紧急情况而接受vNOTES的患者的数据。收集并分析人口统计学和围手术期特征。
■17名患者被纳入。怀疑异位妊娠者7例(41.2%),怀疑附件扭转7例(41.2%),子宫切除术后腹腔积血2例(11.8%),不可控子宫出血1例(5.9%)。急诊手术包括单侧输卵管切除术(35.3%),卵巢囊肿切除术(23.5%),卵巢囊肿切开术(17.6%),附件扭曲(11.8%),腹腔引流(11.8%),子宫切除术(5.9%),阑尾切除术(5.9%)。总的中位手术时间为38[18-72]分钟。术中出血量中位数为30[5-150]mL,术中无并发症发生。从不需要转换为常规腹腔镜或剖腹手术。患者在干预后住院的中位时间为30[4-144]小时。术后疼痛评估的视觉模拟评分中值在术后12、24和48小时为2[0-5]。没有发生与手术相关的并发症。
这项研究证明了执行vNOTES程序来管理输卵管异位妊娠等妇科紧急情况的可行性,附件扭转,痛苦的卵巢病变,子宫切除术后腹膜积血,无法控制的子宫出血。与现有文献中报告的数据相关,我们的结果提示vNOTES治疗妇科急症的潜在益处优于传统腹腔镜.然而,需要更大规模研究的更强有力的证据来证实这一点。
UNASSIGNED: Transvaginal natural orifice transluminal endoscopic surgery (vNOTES) is an emerging minimally invasive approach increasingly applied to perform many gynecological procedures. Despite a still limited level of evidence, compared to conventional laparoscopy, vNOTES seems to be associated with reduced blood loss, shorter operative time, less postoperative pain, shorter hospitalization time, better cosmetic results and decreased postoperative morbidity. Although growing evidence supports the effectiveness of vNOTES for elective adnexal surgeries, there is still limited knowledge regarding its feasibility and safety in emergency settings. In the present study, we report our experience performing vNOTES in gynecological emergency cases.
UNASSIGNED: We prospectively collected and analyzed data from patients who underwent vNOTES for gynecological emergencies between November 2021 and June 2023. Demographic and perioperative characteristics were collected and analyzed.
UNASSIGNED: Seventeen patients were included. Interventions were realized for suspicion of ectopic pregnancy in 7 cases (41.2%), for suspicion of adnexal torsion in 7 cases (41.2%), for post-hysterectomy hemoperitoneum in 2 cases (11.8%), and for uncontrollable uterine bleeding in 1 case (5.9%). Emergency procedures included unilateral salpingectomy (35.3%), ovarian cystectomy (23.5%), ovarian cystotomy (17.6%), adnexal detorsion (11.8%), hemoperitoneum drainage (11.8%), hysterectomy (5.9%), and appendectomy (5.9%). The overall median operative time was 38 [18-72] minutes. The median estimated intraoperative blood loss was 30 [5-150] mL, and no intraoperative complications occurred. Conversion to conventional laparoscopy or laparotomy was never needed. Patients stayed hospitalized for a median time of 30 [4-144] hours after the intervention. The median visual analog scale value for postoperative pain evaluation was 2 [0-5] at 12, 24, and 48 postoperative hours. No complications associated with the procedure occurred.
UNASSIGNED: This study demonstrated the feasibility of performing vNOTES procedures for managing gynecological emergencies such as tubal ectopic pregnancy, adnexal torsion, painful ovarian lesions, post-hysterectomy hemoperitoneum, and uncontrollable uterine bleeding. Associated with data reported in the available literature, our results suggest potential benefits in treating gynecological emergencies by vNOTES over conventional laparoscopy. However, stronger evidence from larger studies is needed to confirm it.