Clinical Outcomes of Vaginal Natural Orifice Transluminal Endoscopic Surgery (vNOTES) in Gynecology: A Comprehensive Systematic Review and Meta-analysis.
Giorgia Dinoi, Sara Mastrovito, Vincenzo Tarantino, Camilla Riccetti, Davide Arrigo, Giancarlo Paradisi, Antonella Carcagni, Diana Giannarelli, Anna Fagotti, Francesco Fanfani, Giovanni Panico
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引用次数: 0
Abstract
Objective: To evaluate the clinical outcomes of vaginal natural orifice transluminal endoscopic surgery (vNOTES) compared with conventional minimally invasive surgery (MIS), including multiport laparoscopy and laparoendoscopic single-site surgery (LESS), in benign gynecologic procedures.
Data sources: A systematic search of PubMed, Web of Science, and Scopus was conducted from database inception through January 2025. Search terms included "vNOTES" and "laparoscopy." The review was prospectively registered in PROSPERO (CRD42025639454). Only English-language studies were included.
Methods of study selection: Randomized controlled trials, prospective, and retrospective comparative studies evaluating vNOTES versus MIS in adult women undergoing hysterectomy, adnexal surgery, or myomectomy for benign indications were included. Studies were required to report at least one perioperative outcome. A total of 33 studies involving more than 4000 patients met inclusion criteria.
Tabulation, integration, and results: Two reviewers independently performed study selection, data extraction, and quality assessment using the Cochrane Risk of Bias 2 tool and Newcastle-Ottawa Scale. Random-effects models were applied. Compared with conventional MIS, vNOTES was associated with significantly shorter operative time (mean difference -25.8 minutes, 95% CI -33.6 to -18.0), lower postoperative pain (mean difference -0.59, 95% CI -1.02 to -0.15), fewer postoperative complications (risk ratio 0.60, 95% CI 0.41-0.87), and shorter hospital stay (mean difference -0.59 days, 95% CI -1.03 to -0.15). No significant differences were observed in intraoperative complications, conversion rates, or estimated blood loss. Prespecified subgroup analyses and meta-regression found no evidence that surgical procedure type modified these associations.
Conclusion: vNOTES appears to be an effective alternative to conventional MIS for benign gynecologic surgery, offering improved operative efficiency and reduced postoperative morbidity with no statistically significant differences in intraoperative safety. These findings support its integration into minimally invasive gynecologic practice, while further prospective studies are needed to refine indications and patient selection.
目的：评价阴道自然口腔内内镜手术（vNOTES）与常规微创手术（MIS）（包括多口腹腔镜和腹腔镜单部位手术（LESS））在妇科良性手术中的临床效果。数据来源：从数据库建立到2025年1月，对PubMed、Web of Science和Scopus进行了系统搜索。搜索词包括“vNOTES”和“腹腔镜检查”。该综述已在PROSPERO前瞻性注册（CRD42025639454）。仅包括英语研究。研究选择方法：纳入随机对照试验、前瞻性和回顾性比较研究，评估vNOTES与MIS在因良性适应症接受子宫切除术、附件手术或子宫肌瘤切除术的成年女性中的应用。研究需要报告至少一个围手术期结果。共有33项研究涉及4000多名患者符合纳入标准。制表、整合和结果：两位审稿人使用Cochrane风险偏倚2工具和Newcastle-Ottawa量表独立进行研究选择、数据提取和质量评估。采用随机效应模型。与传统MIS相比，vNOTES显著缩短手术时间（平均差值-25.8分钟，95% CI -33.6 ~ -18.0），降低术后疼痛（平均差值-0.59,95% CI -1.02 ~ -0.15），减少术后并发症（风险比0.60,95% CI 0.41 ~ 0.87），缩短住院时间（平均差值-0.59天，95% CI -1.03 ~ -0.15）。术中并发症、转换率或估计失血量均无显著差异。预先指定的亚组分析和meta回归没有发现手术类型改变这些关联的证据。结论：vNOTES是妇科良性手术替代传统MIS的有效选择，可提高手术效率，降低术后发病率，术中安全性差异无统计学意义。这些发现支持将其纳入微创妇科实践，但需要进一步的前瞻性研究来完善适应症和患者选择。
期刊介绍：
The Journal of Minimally Invasive Gynecology, formerly titled The Journal of the American Association of Gynecologic Laparoscopists, is an international clinical forum for the exchange and dissemination of ideas, findings and techniques relevant to gynecologic endoscopy and other minimally invasive procedures. The Journal, which presents research, clinical opinions and case reports from the brightest minds in gynecologic surgery, is an authoritative source informing practicing physicians of the latest, cutting-edge developments occurring in this emerging field.
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