Transvaginal endoscopic appendectomy in humans: a unique approach to NOTES - world's first report
Transvaginal endoscopic appendectomy in humans: a unique approach to NOTES - world's first report
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DOI：
10.1007/s00464-008-9811-5
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发表时间：
2008-05-01
影响因子：
3.1
通讯作者：
Prasad, Mohan
中科院分区：
文献类型：
--
作者：
Palanivelu, Chinnusamy;Rajan, Pidigu Seshiyer;Prasad, Mohan
背景自然开口经肾小球腔内窥镜手术(NOTES)是近年来在外科领域出现的最新技术。文献中描述了几种技术；然而，目前还没有标准化。我们描述了经阴道行经阴道内窥镜阑尾切除术的方法，这可能是世界上第一个报道。材料和方法气腹是通过脐部的Veress针实现的。常规12 mm内窥镜和常规器械。结果6例患者中，1例在内窥镜下完成经阴道阑尾切除术。其余5例患者均改行常规腹腔镜手术或辅助手术。患者平均年龄29.5岁。平均手术时间103.5分钟。住院天数1~2天。随访时间分别为7天、30天、90天和6个月。妇科医生检查了阴道伤口，发现在第一次和第二次随访中完全愈合。到目前为止，在人类中已经报道了经胃阑尾切除术和胆囊切除术，以及经阴道胆囊切除术。经阴道内窥镜阑尾切除术在人类中尚未见报道。经阴道入路提供了目标器官的正常图像，而不同于经胃入路的倒置图像，这是由于无法操纵口腔外的范围而导致的。手术的技术简便性和早期结果似乎令人满意，尽管需要比较研究来证实这一点。
Background Natural orifice translumenal endoscopic surgery (NOTES) is the newest technique emerging in the field of surgery. There are several techniques described in the literature; however there is no standardization yet. We describe the transvaginal approach for endoscopic appendectomy in humans, probably the world's first report.Materials and methods Pneumoperitoneum was achieved via a Veress needle in the umbilicus. Routine 12-mm endoscope and routine instruments were used. Peritoneal access was gained via a transvaginal approach through the posterior fornix.Results Out of a total of six patients, a totally endoscopic transvaginal appendectomy was successfully performed for one patient. The other five patients were either converted to conventional laparoscopy or aided by a laparoscope. The average age of the patients was 29.5 years. The mean operating time was 103.5 min. Hospital stay was 1-2 days. The follow-ups were scheduled at 7 days, 30 days, 90 days, and 6 months. The vaginal wound was examined by the gynecologist and found to have completely healed during the first and second follow-up.Discussion So far in humans, transgastric appendectomy and cholecystectomy, and transvaginal cholecystectomy have been reported. A transvaginal endoscopic appendectomy in humans has not been reported yet. The transvaginal approach provided a normal image of the target organ, unlike the inverted image of a transgastric approach caused by the inability to manipulate the scope outside the mouth. The technical ease of the procedure and early outcome seem satisfactory, although comparative studies are needed to confirm this.