Application Of Transvaginal Natural Orifice Transluminal Endoscopic Surgery In Benign Gynecological Diseases

Objective To evaluate the reliability,effectiveness and advantages of transvaginal natural orifice transluminal endoscopic surgery（v-NOTES）in the surgical treatment of gynecological benign diseases such as hysterectomy,fibroid and ovarian cysts.Methods The clinical data of patients hospitalized in the Reproductive Gynecology Department of the First People’s Hospital of Yunnan Province from September 2019 to February 2022 were retrospectively analyzed.By total hysterectomy,34 cases were performed by v-NOTES,the Laparoendoscopic Single-site Surgery group and the traditional laparoscopic group had 40 cases each.By uterine fibroid removal,the v-NOTES group had 23 cases,the Laparoendoscopic Single-site Surgery group and the traditional laparoscopy group,had 30 cases each.There were 25 cases undergoing v-NOTES ovarian cyst removal,30 cases receiving the Laparoendoscopic Single-site Surgery ovarian cyst removal and 30 cases having the conventional laparoscopic ovarian cyst removal.The indicators included in the statistical analysis contain:1.the general patient characteristics data;2.intraoperative conditions,such as the duration of operation,the volume of bleeding during surgery;3.postoperative observation indicators,such as hemoglobin difference before and after surgery,the length of hospitalization stay（except the day of surgery）,Visual Analogue Scale（VAS）of pain at 12 and 24 hours postoperative,the postoperative peak temperature,hospitalization costs,intraoperative or postoperative complications and so on.Results1.Comparison of preoperative general data Comparing the general characteristics of patients who underwent total hysterectomy,uterine fibroid removal and ovarian cyst removal by three different approaches,the age difference among ovarian cyst removal patients was statistically significant（p<0.05）.The other comparison differences were not statistically significant（p>0.05）.2.Intraoperative analysis of the three groups The operative time of total hysterectomy and uterine fibroid removal by three different approaches was significantly different（p< 0.05）.There was no statistically significant difference in the comparison of intraoperative blood loss among patients undergoing total hysterectomy,uterine fibroid removal and ovarian cyst removal by three different approaches（p >0.05）.3.Comparison of postoperative conditions Among the total hysterectomy,uterine fibroid removal and ovarian cyst removal surgery groups,hemoglobin difference,postoperative hospital stay,postoperative drainage time,postoperative peak body temperature,12 h and24 h VAS and hospitalization costs were not statistically significant（p >0.05）.There were statistically significant differences in the postoperative anal exhaust time and the first time of bed after total hysterectomy and ovarian cyst stripping（p<0.05）.4.Surgical results of patients in the three groups All included patients successfully completed surgery,and no surgical route was transferred.There were no intraoperative or postoperative complications,blood transfusion or other organ injuries occurred in all patients.All of patients were diagnosed with benign gynecological diseases and healed well.Conclusion1.The results show that v-NOTES is safe and feasible in the surgical treatment of benign gynecological benign diseases.2.The surgical effect of v-NOTES is comparable to that of Laparoendoscopic Single-site Surgery and traditional laparoscopic surgery,v-NOTES,without scar or obvious pain,has more advantages in cosmetic effect and postoperative rehabilitation.3.v-NOTES is a less invasive endoscopic technique,and will be the trend for future development of gynecological surgery.