| Part I Systematic review and meta analysis of transvaginal natural orifice transluminal endoscopic surgery and transumbilical laparoendscopy single site surgery in benign gynecologic adnexal diseasesObjective: By querying the database and systematic evaluation,the meta analysis was performed to evaluate the feasibility and safety of transvaginal natural orifice transluminal endoscopic surgery and transumbilical laparoendoscopic single site surgery in benign adnexal diseases.Methods: We followed PRISMA guidelines for systematicevaluation.We searched English databases(Pub Med,EMBASE,the Cochrane Library,Web of Science)and Chinese databases(CNKI,CBM,Wanfang,VIP),and searched for randomized control studies,cohort studies,and case-control studies in which v-NOTES and TU-LESS were compared for benign adnexal diseases.Results: Through careful reading,we included a total of 8 articles that met the criteria.The summary analysis results of the two groups showed that there was no significant difference between the two groups in operation time(MD=-0.87,95%CI [-4.33,2.58],P=0.62),intraoperative bleeding(MD=-4.51,95%CI [-10.40,1.37],P=0.13),postoperative hospital stay(MD=-0.16,95%CI [-0.50,0.17],P=0.34),surgical complication(OR=0.83,95%CI [0.38,1.84],P=0.65).There was significant difference in postoperative exhaust time(MD=-3.54,95%CI [-4.61,-2.48],P< 0.00001),pain score(MD=-1.31,95%CI [-1.47,-1.14],P< 0.00001)and cosmetic score(MD =2.11,95%CI [1.31,2.91],P< 0.00001).Conclusions: The summary results show that among the individuals who meet the inclusion criteria,v-NOTES is as effective as transumbilical laparoendoscopic single site surgery in the treatment of benign adnexal diseases.But v-NOTES has a faster postoperative anal exhaust time,less postoperative pain,and a higher cosmetic score.Part II Clinical study of transvaginal natural orifice endoscopic surgery in benign gynecologic adnexal diseasesObjective:By comparing the differences between transvaginal natural orifice endoscopic surgery(v-NOTES)and transumbilical laparoendoscopic single site surgery(TU-LESS)in the treatment of the benign gynecological adnexal diseases,we explored the practicality and safety of transvaginal natural orifice endoscopic surgery in gynecological benign adnexal diseases.By comparing the intraoperative,postoperative and complicated effects of the two surgery groups,the clinical value of v-NOTES in benign gynecological adnexal diseases was preliminarily analyzed.Methods: A total of 30 patients who underwent v-NOTES surgery in Guangxi Zhuang Autonomous Region People’s Hospital from August 2018 to December 2021 were collected as experimental group and 30 patients with transumbilical laparoendoscopic single site surgery as control group.The operation time and intraoperative bleeding with different procedures in the experimental group and the control group were compared.Compared the postoperative exhaust time,postoperative hospital stay(except the day of surgery),visual analogue scale(VAS)of pain at 12 and 24 hours and hospitalization.Results:During the operation,the operation time of the experimental group was(100.83±29.82)min,and intraoperative bleeding was(39.50±34.25)ml;The operation time of the control group was(84.80±32.15)min,and intraoperative bleeding was(24.50±18.40)ml.After statistical processing,there was no statistically significant difference in the operation time between the two groups of patients(P=0.05),and the intraoperative bleeding between the two groups was statistically significant(P<0.05).The statistics showed that the postoperative exhaust time was(1.20±0.41)day in the experimental group,which was shorter than that in the control group(1.63±0.61)day.The postoperative hospital stay was(3.63±0.81)day and(3.57±0.62)day in the experimental group and the control group,respectively.Visual analogue scale(VAS)of pain at 12 and 24 hours in the experimental group was(2.17±0.45)and(1.35±0.31)points,respectively.And the visual analogue scale(VAS)of pain at 12 and24 hours in the control group was(2.89±0.53)and(1.41±0.29)points,respectively.The experimental group was significantly lower than that of the control group(P<0.05)in the visual analogue scale(VAS)of pain at 12 hours.There were no significant differences in postoperative hospital stay,and visual analogue scale(VAS)of pain at 24 hours between the two groups(P>0.05).The hospitalization of the experimental group was(13447.00 ± 377.78)yuan,and the control group were(13296.00 ± 346.91)yuan.There was no statistically significant difference in the hospitalization expenses between the two groups(P>0.05).Whether in the experimental group or the control group,the patients successfully completed the operation,and there was no blood transfusion treatment and other organ damage.There was no intermediate laparotomy or traditional laparoscopic surgery in the middle of the operation,and there were no surgery-related complications such as hematoma,fever,infection,etc.During and after the operation,the rapid pathology and postoperative pathological paraffin sections in the patient’s book showed benign adnexal lesions.And after discharge,all patients were followed up and re-examined without incision infection,no bleeding or hematoma,no fever,incision dehiscence,incision hernia,etc.And the wound healed well.Conclusions: The postoperative exhaust time of patients in the experimental group was shorter and the visual analogue scale(VAS)of pain at 12 hours after the transvaginal natural orifice endoscopic surgery than that of the transumbilicallaparoendoscopysingle site surgery.Transvaginal natural orifice endoscopic surgery is a effective way in the treatment of benign gynecologic adnexal diseases and worthy of promotion. |
