Taylor Morganstein, Mihnea Gangal, Eric Belzile, Dorsa Sohaei, Jouhayna Bentaleb, Adi Reuveni-Salzman, Lisa Merovitz, Jens-Erik Walter, Maryse Larouche
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The relationships between variables were tested using Fisher's exact test or t test, including a sub-analysis comparing hysterectomy and hysteropexy outcomes within the groups. Logistic regression assessed the influence of baseline factors and operative factors on the primary and main secondary outcomes of interest.</p><p><strong>Results: </strong>This study comprised 47 vNOTES and 54 laparoscopic USLS cases (including 11 and 15 hysteropexies respectively). Baseline demographics in the two groups were similar. There were no differences in operative outcomes and no instances of ureteral injury. The vNOTES technique allowed for the use of significantly more sutures per side (2.0 [2.0-4.0] vs 1.0 [1.0-1.0], p = 0.001). Postoperative complications within 6 weeks demonstrated no significant differences. Both groups exhibited comparable rates of baseline subjective POP symptoms (100% vs 96.2%, p = 1.00) which improved significantly at 6 weeks (4.3% vs 11.1%, p = 0.282). At 6 weeks, anatomical success was achieved by significantly more patients with vNOTES (93.5% vs 78.6%, p = 0.042). Baseline and 6-week POP symptoms in the hysterectomy and hysteropexy subgroups were similar.</p><p><strong>Conclusion: </strong>Both vNOTES and laparoscopic USLS demonstrated comparable subjective success rates at 6 weeks postoperatively. The vNOTES approach demonstrated improved anatomical success at 6 weeks, but the difference was not significant after adjusting for operative factors.</p>","PeriodicalId":14355,"journal":{"name":"International Urogynecology Journal","volume":null,"pages":null},"PeriodicalIF":1.8000,"publicationDate":"2024-09-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":"0","resultStr":"{\"title\":\"vNOTES versus Laparoscopic Uterosacral Ligament Suspension for Apical Pelvic Organ Prolapse: Perioperative and Short-Term Outcomes.\",\"authors\":\"Taylor Morganstein, Mihnea Gangal, Eric Belzile, Dorsa Sohaei, Jouhayna Bentaleb, Adi Reuveni-Salzman, Lisa Merovitz, Jens-Erik Walter, Maryse Larouche\",\"doi\":\"10.1007/s00192-024-05907-z\",\"DOIUrl\":null,\"url\":null,\"abstract\":\"<p><strong>Introduction and hypothesis: </strong>Vaginal Natural Orifice Transluminal Endoscopic Surgery (vNOTES) is a novel approach in gynecological surgery. 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引用次数: 0
摘要
引言和假设：阴道自然腔道经内镜手术（vNOTES）是妇科手术中的一种新方法。本研究旨在比较vNOTES与腹腔镜子宫骶骨韧带悬吊术（USLS）治疗顶端盆腔器官脱垂的围手术期和术后短期疗效：一项回顾性队列研究纳入了2017年至2023年期间在两所大学附属中心接受vNOTES与腹腔镜USLS手术的所有女性。使用费雪精确检验或t检验对变量之间的关系进行了检验，包括比较组内子宫切除术和子宫整形术结果的子分析。逻辑回归评估了基线因素和手术因素对主要和主要次要结果的影响：这项研究包括47例vNOTES和54例腹腔镜USLS病例（分别包括11例和15例子宫切除术）。两组的基线人口统计学特征相似。手术结果无差异，也无输尿管损伤病例。vNOTES技术每侧使用的缝合线明显更多（2.0 [2.0-4.0] vs 1.0 [1.0-1.0]，p = 0.001）。术后 6 周内的并发症无明显差异。两组患者的 POP 主观症状基线发生率相当（100% vs 96.2%，p = 1.00），但在 6 周后均有明显改善（4.3% vs 11.1%，p = 0.282）。6周时，使用vNOTES的患者获得解剖学成功的比例明显更高（93.5% vs 78.6%，p = 0.042）。子宫切除术亚组和子宫肌瘤切除术亚组的基线和6周POP症状相似：结论：vNOTES和腹腔镜USLS术后6周的主观成功率相当。VNOTES方法在6周时的解剖成功率更高，但在调整手术因素后，差异并不显著。
vNOTES versus Laparoscopic Uterosacral Ligament Suspension for Apical Pelvic Organ Prolapse: Perioperative and Short-Term Outcomes.
Introduction and hypothesis: Vaginal Natural Orifice Transluminal Endoscopic Surgery (vNOTES) is a novel approach in gynecological surgery. This study was aimed at comparing perioperative and short-term postoperative outcomes of vNOTES versus laparoscopic approaches to uterosacral ligament suspension (USLS) for apical pelvic organ prolapse.
Methods: A retrospective cohort study included all women who underwent vNOTES versus laparoscopic USLS at two university-affiliated centers between 2017 and 2023. The relationships between variables were tested using Fisher's exact test or t test, including a sub-analysis comparing hysterectomy and hysteropexy outcomes within the groups. Logistic regression assessed the influence of baseline factors and operative factors on the primary and main secondary outcomes of interest.
Results: This study comprised 47 vNOTES and 54 laparoscopic USLS cases (including 11 and 15 hysteropexies respectively). Baseline demographics in the two groups were similar. There were no differences in operative outcomes and no instances of ureteral injury. The vNOTES technique allowed for the use of significantly more sutures per side (2.0 [2.0-4.0] vs 1.0 [1.0-1.0], p = 0.001). Postoperative complications within 6 weeks demonstrated no significant differences. Both groups exhibited comparable rates of baseline subjective POP symptoms (100% vs 96.2%, p = 1.00) which improved significantly at 6 weeks (4.3% vs 11.1%, p = 0.282). At 6 weeks, anatomical success was achieved by significantly more patients with vNOTES (93.5% vs 78.6%, p = 0.042). Baseline and 6-week POP symptoms in the hysterectomy and hysteropexy subgroups were similar.
Conclusion: Both vNOTES and laparoscopic USLS demonstrated comparable subjective success rates at 6 weeks postoperatively. The vNOTES approach demonstrated improved anatomical success at 6 weeks, but the difference was not significant after adjusting for operative factors.
期刊介绍：
The International Urogynecology Journal is the official journal of the International Urogynecological Association (IUGA).The International Urogynecology Journal has evolved in response to a perceived need amongst the clinicians, scientists, and researchers active in the field of urogynecology and pelvic floor disorders. Gynecologists, urologists, physiotherapists, nurses and basic scientists require regular means of communication within this field of pelvic floor dysfunction to express new ideas and research, and to review clinical practice in the diagnosis and treatment of women with disorders of the pelvic floor. This Journal has adopted the peer review process for all original contributions and will maintain high standards with regard to the research published therein. The clinical approach to urogynecology and pelvic floor disorders will be emphasized with each issue containing clinically relevant material that will be immediately applicable for clinical medicine. This publication covers all aspects of the field in an interdisciplinary fashion
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