荷兰阴道辅助 NOTES 子宫切除术;前瞻性队列研究

IF 1.5 Q3 OBSTETRICS & GYNECOLOGY
Ilse P.W. Bekkers , Rebecca Henschen , Nicol A.C. Smeets , Huib A.A.M. van Vliet , Anne Damoiseaux , Martine M.L.H. Wassen
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引用次数: 0

摘要

目的阴道辅助自然腔道经内镜手术(NOTES)结合了阴道手术和内镜手术的优点。本研究介绍了荷兰首例阴道辅助 NOTES 子宫切除术(VANH)的结果。研究设计在荷兰两家非学术性教学医院开展了一项前瞻性队列研究。数据收集自2019年8月至2023年4月期间因良性适应症接受VANH手术的患者。研究记录并分析了基线特征、术中和术后手术结果数据。结果 共有200名患者接受了VANH手术。手术指征包括功能失调性月经出血(61%;n = 122)、宫颈细胞学异常(15.5%;n = 31)、腹痛(11.5%;n = 23)、消融/灭菌后疼痛综合征(3.5 %;n = 7)、子宫肌瘤(5.0 %;n = 10)、非典型子宫内膜增生(2.5 %;n = 5)和林奇或 BRCA 基因突变携带者(1.0 %,n = 2)。平均手术时间为 61.4 分钟(± 22.8 分钟),平均失血量为 88 毫升(± 89 毫升),平均子宫重量为 150 克(± 112 克)。2.0%的病例(n = 4)需要进行转换。在计划日间护理的患者中,80.2%(n = 105)的患者可以当天出院(SDD)。2.0%的病例(4例)发生了术中并发症,9.0%的病例(18例)发生了术后并发症。该研究强调了外科医生在首次实施 vNOTES 手术时,必须认识到实施新手术技术初期固有的挑战。还需要更多的随机临床试验来证明vNOTES与传统手术相比的优越性。
本文章由计算机程序翻译,如有差异,请以英文原文为准。
Vaginal assisted NOTES hysterectomy in The Netherlands; A prospective cohort study

Objectives

Vaginal assisted Natural Orifice Transluminal Endoscopic Surgery (NOTES) combines the benefits of vaginal and endoscopic surgery. This study presents the results of the first vaginal assisted NOTES hysterectomies (VANH) in The Netherlands.

Study design

A prospective cohort study was performed in two non-academic teaching hospitals in The Netherlands. Data was collected from patients who underwent a VANH for benign indications between August 2019 and April 2023. Baseline characteristics and data of intra- and postoperative surgical outcomes were recorded and analysed. The VANHs were performed by four experienced vaginal and endoscopic gynaecological surgeons.

Results

A total of 200 patients underwent a VANH. Indications were dysfunctional menstrual bleeding (61 %; n = 122), abnormal cervical cytology (15.5 %; n = 31), abdominal pain (11.5 %; n = 23), post ablation/sterilization pain syndrome (3.5 %; n = 7), uterine fibroids (5.0 %; n = 10), atypical endometrial hyperplasia (2.5 %; n = 5) and Lynch or BRCA gene mutation carriers (1.0 %, n = 2). The mean surgical time was 61.4 min ( ± 22.8 min) with a mean blood loss of 88 mL ( ± 89 mL) and a mean uterine weight of 150 g ( ± 112 g). In 2.0 % (n = 4) of the cases a conversion was necessary. Same day discharge (SDD) was feasible in 80.2 % (n = 105) of the patients planned in day-care. In 2.0 % (n = 4) an intra-operative complication and in 9.0 % (n = 18) a post-operative complication occurred.

Conclusion

This study shows vNOTES to be a safe and feasible surgical technique and can be safely implemented with appropriate patient selection and skilled surgeons. It highlights the importance of surgeon awareness of the challenges inherent in the initial stages of the implementation of a new surgical technique when performing their first vNOTES procedures. Additional randomized clinical trials are needed to show superiority of vNOTES compared to traditional surgery.

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来源期刊
CiteScore
2.20
自引率
0.00%
发文量
31
审稿时长
58 days
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