采用阴道辅助自然腔道内窥镜手术进行子宫切除术:一家三级医院的经验。

IF 1.4 4区 医学 Q3 OBSTETRICS & GYNECOLOGY Australian & New Zealand Journal of Obstetrics & Gynaecology Pub Date : 2024-07-15 DOI:10.1111/ajo.13862
Supuni Kapurubandara, Jan Baekelandt, Patrick Laws, Jenny King
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引用次数: 0

摘要

背景:与腹腔镜子宫切除术(LH)相比,阴道子宫切除术(VH)可缩短手术时间和住院时间,被认为是子宫切除术的最佳微创选择,但阴道子宫切除术的比例却在下降。阴道辅助自然腔道内镜子宫切除术(VANH)结合了阴道和内镜手术方法的优点。目的:报告澳大利亚一家三级医院由一名外科医生采用 VANH 的可行性和早期经验:前瞻性回顾前20例VANH病例,回顾性收集完整数据集,包括患者人口统计学、手术指征和围手术期结果:前 20 例患者的中位年龄为 51.5 岁(47-57 岁),中位体重指数为 33.5 kg/m2(27.8-38.3 kg/m2)。主要适应症为复杂增生伴不典型增生(12/20,60%)。中位胎次为2(1-3),其中4名患者为无子宫。中位失血量为 125 毫升(100-200 毫升),手术时间为 149 分钟(138-198 分钟),标本中位重量为 181.5 克(66.5-219 克)。平均住院时间为 1.4 天(1-2 天)。5例患者转为腹腔镜手术,大多数(80%)发生在前10例中:结论:VANH是可行的,但要掌握这项技术需要一个学习曲线,这就要求在采用该技术的早期阶段进行充分培训,并谨慎选择病例。在获得更多可靠数据以确定 VANH 的临床益处和安全性之前,应仔细咨询患者,并根据个体情况决定子宫切除方式。
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Adoption of vaginally assisted natural orifice transluminal endoscopic surgery for hysterectomy: A single tertiary experience.

Background: Vaginal hysterectomy (VH) rate is declining despite being considered as the optimal minimally invasive option for hysterectomy with reduced operative time and length of stay compared with laparoscopic hysterectomy (LH). Vaginal assisted natural orifice transluminal endoscopic surgery hysterectomy (VANH) combines the advantages of both vaginal and endoscopic approach to surgery.

Aims: To report feasibility and early experience of a single surgeon adopting VANH at a tertiary Australian hospital.

Materials and methods: Prospective review of the first 20 VANH cases with complete data set collected retrospectively including patient demographics, indication for surgery and perioperative outcomes.

Results: The median age of the first 20 participants was 51.5 years (47-57 years of age) and the median body mass index was 33.5 kg/m2 (27.8-38.3 kg/m2). The predominant indication was complex hyperplasia with atypia (12/20, 60%). The median parity was two (1-3) where four patients were nulliparous. The median blood loss was 125 mL (100-200 mL) with an operative time of 149 min (138-198 min) and median weight of the specimen of 181.5 g (66.5-219 g). The mean length of stay was 1.4 days (1-2 days). Five cases had conversion to laparoscopy and the majority (80%) occurred within the first ten cases.

Conclusions: VANH is feasible but there is a learning curve to achieve competence in this technique, which requires adequate training in the early stages of adoption with careful case selection. Until further robust data is available to determine the clinical benefit and safety profile of VANH, patients should be carefully counselled and the decision on mode of hysterectomy be individualised.

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来源期刊
CiteScore
3.40
自引率
11.80%
发文量
165
审稿时长
4-8 weeks
期刊介绍: The Australian and New Zealand Journal of Obstetrics and Gynaecology (ANZJOG) is an editorially independent publication owned by the Royal Australian and New Zealand College of Obstetricians and Gynaecologists (RANZCOG) and the RANZCOG Research foundation. ANZJOG aims to provide a medium for the publication of original contributions to clinical practice and/or research in all fields of obstetrics and gynaecology and related disciplines. Articles are peer reviewed by clinicians or researchers expert in the field of the submitted work. From time to time the journal will also publish printed abstracts from the RANZCOG Annual Scientific Meeting and meetings of relevant special interest groups, where the accepted abstracts have undergone the journals peer review acceptance process.
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