Evaluation of clinical efficacy of three different laparoscopic approaches for large hysterectomy

doi:10.3877/cma.j.issn.1674-6899.2023.06.003

Abstract

Abstract:

Objective

To compare the clinical effects of transvaginal natural endoscopic surgery (vNOTES), transumbilical single-site laparoscopic surgery (TU-LESS) and traditional laparoscopic surgery (MPLS) in large hysterectomy.

Methods

A total of 138 patients with large uterus who underwent total uterine + salpinx ± oophorectomy in The First Affiliated Hospital of Shandong First Medical University &Shandong Provincial Qianfoshan Hospital from Jan. 2018 to Dec. 2020 were selected and divided into MPLS group (n=40), TU-LESS group (n=37) and vNOTES group (n=61) according to different surgical approaches, and the clinical application effects of the three groups were compared and analyzed.

Results

All operations in the three groups were successfully completed without transferring to other surgical methods. vNOTES group had the shortest operation time, the shortest time of first postoperative anal exhaust, the lowest score of 0 h and 24 h VAS, the lowest score of BIS and the highest score of CS. There was no significant difference in postoperative hospital stay among the three groups (P>0.05). There were no significant differences in the amount of intraoperative blood loss, total hospitalization cost, postoperative hospital stay, surgical complications and postoperative follow-up, the healing of the broken end of the vagina and the satisfaction of the operation among the three groups (P>0.05).

Conclusions

vNOTES, TU-LESS and MPLS can successfully complete large hysterectomy plus tubal ± ovariectomy. Compared with TU-LESS and MPLS, vNOTES has the advantages of shorter operation time, faster recovery of gastrointestinal function after surgery, less postoperative pain, and no scar in the abdomen during large hysterectomy.

Key words: Vaginal natural orifice transluminal endoscopic surgery, vNOTES, Transumbilical laparoendoscopic single-site surgery, TU-LESS, Large hysterectomy

Xiaoying Yang, Ge Zhang, Xiaomeng Xu, Yaxin Sun, Yueyuan Miao, Yingchun Ma. Evaluation of clinical efficacy of three different laparoscopic approaches for large hysterectomy[J]. Chinese Journal of Laparoscopic Surgery(Electronic Edition), 2023, 16(06): 331-337.

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References 25

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	MPLS组(n＝40)	TU-LESS组(n＝37)	vNOTES组(n＝61)	P值
年龄(岁)	49.83±4.41	52.16±4.26	50.70±4.23	0.058
BMI(kg/m²)	25.91±3.09	25.61±3.22	25.24±2.60	0.526
孕次(次)	2.80±1.45	3.14±1.49	3.03±1.17	0.527
产次(次)	1(1，2)	1(1，2)	2(1，2)	0.097
绝经[n(%)]	4(10)	3(8.11)	6(9.83)	0.950^a
盆腹腔手术史[n(%)]	20(50.00)	10(27.03)	24(39.34)	0.119^a
子宫大小(孕周)[n(%)]				0.102^a
12～16周	19(47.50)	18(48.65)	38(62.30)
16～20周	18(45.00)	11(29.73)	14(37.84)
≥20周	3(7.50)	8(21.62)	9(14.75)
同时行附件手术[n(%)]				0.401^a
双侧输卵管	36(90.00)	35(94.59)	57(93.44)
一侧附件＋单侧输卵管	3(7.50)	2(5.41)	1(1.64)
双侧附件	1(2.50)	0	3(4.92)
手术诊断[n(%)]				0.582^a
子宫平滑肌瘤	22(55.00)	23(89.19)	43(70.49)
子宫腺肌症	5(12.50)	4(10.81)	7(11.48)
肌瘤合并腺肌病	13(32.52)	9(24.32)	10(16.39)
子宫内膜病变	0	1(2.70)	1(1.64)

	MPLS组(n＝40)	TU-LESS组(n＝37)	vNOTES组(n＝61)	P值
年龄(岁)	49.83±4.41	52.16±4.26	50.70±4.23	0.058
BMI(kg/m²)	25.91±3.09	25.61±3.22	25.24±2.60	0.526
孕次(次)	2.80±1.45	3.14±1.49	3.03±1.17	0.527
产次(次)	1(1，2)	1(1，2)	2(1，2)	0.097
绝经[n(%)]	4(10)	3(8.11)	6(9.83)	0.950^a
盆腹腔手术史[n(%)]	20(50.00)	10(27.03)	24(39.34)	0.119^a
子宫大小(孕周)[n(%)]				0.102^a
12～16周	19(47.50)	18(48.65)	38(62.30)
16～20周	18(45.00)	11(29.73)	14(37.84)
≥20周	3(7.50)	8(21.62)	9(14.75)
同时行附件手术[n(%)]				0.401^a
双侧输卵管	36(90.00)	35(94.59)	57(93.44)
一侧附件＋单侧输卵管	3(7.50)	2(5.41)	1(1.64)
双侧附件	1(2.50)	0	3(4.92)
手术诊断[n(%)]				0.582^a
子宫平滑肌瘤	22(55.00)	23(89.19)	43(70.49)
子宫腺肌症	5(12.50)	4(10.81)	7(11.48)
肌瘤合并腺肌病	13(32.52)	9(24.32)	10(16.39)
子宫内膜病变	0	1(2.70)	1(1.64)

	MPLS组(n＝40)	TU-LESS组(n＝37)	vNOTES组(n＝61)	P值
手术时间(min)	146.50(122.50～178.75)	180.00(154.00～212.00)	136.00(112.50～156.50)	<0.01
术中出血量(ml)	50.00(50.00～137.50)	50.00(50.00～125.00)	50.00(50.00～100.00)	0.945
术中输血[n(%)]				0.075^a
未输血	34(85.00)	35(94.60)	59(96.72)
输血	6(15.00)	2(5.41)	2(3.2)

	MPLS组(n＝40)	TU-LESS组(n＝37)	vNOTES组(n＝61)	P值
手术时间(min)	146.50(122.50～178.75)	180.00(154.00～212.00)	136.00(112.50～156.50)	<0.01
术中出血量(ml)	50.00(50.00～137.50)	50.00(50.00～125.00)	50.00(50.00～100.00)	0.945
术中输血[n(%)]				0.075^a
未输血	34(85.00)	35(94.60)	59(96.72)
输血	6(15.00)	2(5.41)	2(3.2)

	MPLS组(n＝40)	TU-LESS组(n＝37)	vNOTES组(n＝61)	P值
肛门排气时间(d)	1.63±0.54	1.65±0.59	1.34±0.48	0.006
VAS 0 h	3.08±0.27	3.14±0.35	2.93±0.25	0.002
VAS 24 h	2.10±0.30	2.14±0.35	1.92±0.28	<0.01
住院总花费(元)	21 910.07±3797.75	23 545.82±3800.66	23 291.56±3950.25	0.124
术后住院时间(d)	3.93±1.72	4.57±0.99	4.00±1.54	0.106
手术并发症[n(%)]				0.971^a
有	1(2.50)	1(2.70)	2(3.28)
无	39(97.50)	36(97.30)	59(96.72)

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