Abstract
BackgroundWith the development of minimally invasive technology, more and more people pay attention to aesthetics of the wound after operation. This study is aim to introduce a new surgical technique of transvaginal natural orifice specimen extraction surgery (NOSES) in 3D laparoscopic partial or radical nephrectomy and evaluate the safety, feasibility and clinical effect.MethodsEleven patients who underwent 3D laparoscopic partial nephrectomy (n = 7) or radical nephrectomy (n = 4) and NOSES were included in this study. The surgical procedures and techniques, especially the NOSES operation, are reported in detail. In addition, the basic clinical data, perioperative related data, perioperative complications were analyzed.ResultsAll 11 patients were performed successfully without conversion to open surgery. The mean total operative time was 133 (84, 150) min. NOSES time was 15 (13, 16) min, and the postoperative hospital stay was 5 (5, 5) d. The mean visual analogue score (VAS) was 3 (2, 4) point and 1 (0, 1) point at 24 h and 48 h after operation, respectively. No patient had recurrence, metastasis and death during the follow-up period of 3 to 17 months. The median Vancouver Scar Scale (VSS) was 1 (1, 1) point. The mean of Female Sexual Function Index (FSFI) was 21.60 (20.20, 21.60), 21.80 (19.80, 21.80) respectively between preoperative and postoperative 3 months, which has no statistical difference (P = 0.179). There was no statistical difference in the Pelvic Floor Distress Inventory-short form 20 (PFDI-20) score between preoperative and postoperative 3 months (P = 0.142).ConclusionsTransvaginal NOSES is safe and feasible in 3D laparoscopic partial or radical nephrectomy. Furthermore, it results in low incision-related pain without affecting the pelvic floor and sexual function.
Highlights
With the development of minimally invasive technology, more and more people pay attention to aesthetics of the wound after operation
There was no statistical difference in the Pelvic Floor Distress Inventory-short form 20 (PFDI-20) score between preoperative and postoperative 3 months (P = 0.142)
In a meta-analysis summarizing 665 patients who underwent surgery via natural orifice specimen extraction surgery (NOSES) versus 772 via conventional laparoscopy, patients showed no significant difference in terms of postoperative recurrence rate, postoperative pain, hospital stay, time to first flatus, aesthetic outcome of the wound, and wound infection compared with conventional laparoscopy [8]
Summary
With the development of minimally invasive technology, more and more people pay attention to aesthetics of the wound after operation. This study is aim to introduce a new surgical technique of transvaginal natural orifice specimen extraction surgery (NOSES) in 3D laparoscopic partial or radical nephrectomy and evaluate the safety, feasibility and clinical effect. With the development of laparoscopic technology, more and more patients are pursuing the aesthetic condition of the wound after operation. The traditional laparoscopic partial nephrectomy or radical nephrectomy are still using the median incision of the lower abdomen to remove specimens, which increase the pain feeling of patients after operation, and affect the wound healing and other related complications. Nowadays natural orifice specimen extraction surgery (NOSES) has attracted wide attention. There are relatively few studies on laparoscopic partial or radical nephrectomy plus transvaginal NOSES. Since July 2019, our center has performed partial nephrectomy or radical nephrectomy and transvaginal NOSES for 11 female patients and analyzed the relevant data of the patients preoperative and postoperative, and the report is as follows
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