単一術者によるvNOTES127例の検討

抄録

Objective: We present a retrospective analysis of 127 consecutive vNOTES （transvaginal natural orifice transluminal endoscopic surgery） cases, including hysterectomy and adnexal surgery, performed by a single surgeon between April 2021 to December 2022.

Results: One-hundred and five vaginally assisted NOTES hysterectomy (VANH) cases were performed using GelPOINT V-Path (9.5 cm). Four early cases were hybrid-VANH, which were performed via adding a 5 mm umbilical port to determine pelvic condition before vaginal approach. Among the other 101 VANH cases, one case was converted to hybrid-VANH. A 5 mm camera from the umbilical port was used to determine pelvic adhesion during the vaginal procedure and VANH was performed with supporting umbilical view. The remaining 100 cases were performed without any conversion to abdominal, laparoscopic, and vaginal surgery. Mean surgical time and uterine weight were 86 min and 160 g, respectively. There were no intraoperative complications but two cases had vaginal bleeding after discharge, requiring vaginal suturing.

　Twenty-two vNOTES adnexal surgery cases were performed using GelPOINT V-Path (7 cm). One case was converted to hybrid-vNOTES to determine pelvic condition from umbilical camera access, during the vaginal procedure. The other 21 cases were performed without any conversion to abdominal, laparoscopic, and vaginal surgery. Mean surgical time and extracted tumor weight were 63 min and 29 g, respectively. There were no intraoperative or postoperative complications.

Conclusion: vNOTES hysterectomy and adnexal surgery can be safely introduced using GelPOINT V-Path with appropriate patient selection.