Jose F Noguera, MD, PhD1, Cristobal Zaragoza1, Jose Munoz2, Antonio Melero1, Gonzalo Martin3, Jorge Elorza1. 1Hospital General Universitario de Valencia, 2Hospital Son Llatzer, 3Hospital Universitario Son Espases
The aim of the study is to know the results after a long-term follow up of a clinical series of patients undergoing surgery for several procedures with transvaginal approach using rigid and flexible endoscopy.
Minimally invasive surgery is constantly evolving in recent years. The use of transvaginal route is not new but it takes special interest with the emergence of natural orifice endoscopic surgery NOTES. Since 2007 there have been many uses of the transvaginal route, whether to perform complete surgery, as an additional entryport or as additional route to extract the specimen. There are very few studies that can show results of long-term follow up after non-gynecological transvaginal intraperitoneal surgery.
METHODS AND PROCEDURES:
Clinical series of 73 female patients with transvaginal approach with rigid instruments and flexible endoscopy for several intraperitoneal procedures (cholecystectomy, colectomy and others). Laparoscopic transparietal access was as minimal as possible, with 3-5 mm instruments and a 2-3 throcar technique, even for the colorectal resections. The average hospital stay, intraoperative and postoperative complications, hernias, dyspareunia, previous pregnancy and postoperative pregnancy were analyzed.
73 female patients were operated with transvaginal approach and minilaparoscopy. The procerures were: 56 cholecystectomies (77.8%), 8 colorectal resections (11.1%), 4 appendectomies (5.6%), 1 adhesiolysis (1.4%), 2 ventral hernias (2.8%), 1 partial nephrectomy (1.4%), and 1 limited liver resection (1.4%). The flexible endoscope was used in 54 cases (75%) and the rigid endoscope in 17 cases (23.6%). The median follow up is more than 3 years (37 months, range 6-84 months). We had a total of 10 adverse events (15%): 2 cystic artery bleeding that were controlled successfully, 2 colonic anastomotic dehiscence with a reintervention in one case, 1 case of late incisional hernia and 1 case of dyspareunia (1.4%). In 55.6% of patients a previous pregnancy was achieved and the rest of them were nulliparous. Most patients were between 1 and 2 children before being treated. During follow-up 8.3% of patients had postoperative pregnancies and in some cases with more than 2 pregnancies. There was an abortion without pelvic concomitant pathology. Patients were ASA I and II in 98.6% and only one patient was ASA III. 11.1% were discharged the same day of the intervention, 58.3% remained admitted one day and only 3 patients needed more than 5 days to be discharged
Transvaginal approach has been shown to be safe after application in several laparoscopic procedures as cholecystectomy or colorectal surgery. Complications appeared are similar to those of conventional laparoscopic surgery, highlighting the low incidence of complications of vaginal wall or abdominal access per se and the very low incidence of dyspareunia or fertility problems.