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Objective To describe our experience with the transvaginal natural orifice transluminal endoscopic surgery (NOTES) in female patients,and to evaluate its clinical value.Methods Between May 2010 and April 2017,a total of 289 female patients underwent transvaginal NOTES in our center,including 31cases of adrenal tumors,46 cases of renal tumors,188 cases of non-functional kidneys,5 cases of renal cysts,4 cases of duplex kidney,7 cases of renal tuberculosis and 8 cases of renal pelvis tumors.Among them,146 cases were on the left side,142 cases on the right side,and 1 case on both sides (renal cysts).The median age was 39.4 (range 23 to 76) years,and the median body mass index was 21.8(range 15.4 to 32.6) kg/m2.After general anesthesia,the patients were positioned in lithotomy with ipsilateral lumbar at 30°-60° angle to the floor.Hybrid and pure transvaginal NOTES were performed.The specimen was removed through an extended incision at the posterior vaginal fornix.Results Transvaginal NOTES was successfully completed in 281 patients.Two patients required conversion to suprapubic-assisted laparoendoscopic single-site surgery because of the rectal injury in pure transvaginal NOTES nephrectomy.Six patients underwent open conversion.The various transvaginal hybrid NOTES procedures included adrenalectomy (31 cases),nephrectomy (206 cases;simple 174 cases,radical 32 cases),partial nephrectomy (13 cases),heminephroureterctomy for duplex kidney (4 cases) and hybrid endoscopy for nephroureterectomy (7 cases).The mean operative time was 105 min (45-310 min),the mean estimated blood loss was 87 ml (20-800 ml),the mean visual analogue score (VAS) of 48 hours after operation was 2.5 (1-4) points and the mean hospitalization was 7.3 d (4-13 d) for transvaginal hybrid NOTES.The various pure transvaginal NOTES procedures included nephrectomy (22 cases;simple 21,radical 1),renal cyst excision (5 cases).The mean operative time was 170 min (60-320 min),the mean estimated blood loss was 140 ml (20-500 ml),the mean VAS of 48 hours after operation was 1.7 (1-3) points and the mean hospitalization was 5.5 d (3-10 d) for transvaginal pure NOTES.Complications occurred in 56 cases (19.38％),including 20 cases (6.92％) of severe complications,and no death occurred.After a mean follow-up of 51 (range 3 to 86) months,umbilicus scar was hidden.The incision in the vagina healed well.No infection in the abdominal or pelvic cavity or celiocele occurred.The umbilicus scar is not obvious after surgery,and 3 months after surgery.The median Patient Scar Assessment Questionnaire (PSAQ) score was 38 (31-58) and the median Female Sexual Function Index (FSFI) score was 28.2 (22.5-32.2),and the quality of life index was significantly higher than that of preoperation.Condusions Transvaginal NOTES could treat variousprimary diseases,and improve the postoperative quality of life.It does not increase the incidence of related complications,or cause negative effect on the female sexual function,pregnancy or fertility.It can lead to good cosmetic outcome and less pain,which is worth applying in clinical practice.
ABSTRACT
Objective To describe our experience with the transvaginal natural orifice transluminal endoscopic surgery (NOTES) in female patients,and to evaluate its clinical value.Methods Between May 2010 and April 2017,a total of 289 female patients underwent transvaginal NOTES in our center,including 31cases of adrenal tumors,46 cases of renal tumors,188 cases of non-functional kidneys,5 cases of renal cysts,4 cases of duplex kidney,7 cases of renal tuberculosis and 8 cases of renal pelvis tumors.Among them,146 cases were on the left side,142 cases on the right side,and 1 case on both sides (renal cysts).The median age was 39.4 (range 23 to 76) years,and the median body mass index was 21.8(range 15.4 to 32.6) kg/m2.After general anesthesia,the patients were positioned in lithotomy with ipsilateral lumbar at 30°-60° angle to the floor.Hybrid and pure transvaginal NOTES were performed.The specimen was removed through an extended incision at the posterior vaginal fornix.Results Transvaginal NOTES was successfully completed in 281 patients.Two patients required conversion to suprapubic-assisted laparoendoscopic single-site surgery because of the rectal injury in pure transvaginal NOTES nephrectomy.Six patients underwent open conversion.The various transvaginal hybrid NOTES procedures included adrenalectomy (31 cases),nephrectomy (206 cases;simple 174 cases,radical 32 cases),partial nephrectomy (13 cases),heminephroureterctomy for duplex kidney (4 cases) and hybrid endoscopy for nephroureterectomy (7 cases).The mean operative time was 105 min (45-310 min),the mean estimated blood loss was 87 ml (20-800 ml),the mean visual analogue score (VAS) of 48 hours after operation was 2.5 (1-4) points and the mean hospitalization was 7.3 d (4-13 d) for transvaginal hybrid NOTES.The various pure transvaginal NOTES procedures included nephrectomy (22 cases;simple 21,radical 1),renal cyst excision (5 cases).The mean operative time was 170 min (60-320 min),the mean estimated blood loss was 140 ml (20-500 ml),the mean VAS of 48 hours after operation was 1.7 (1-3) points and the mean hospitalization was 5.5 d (3-10 d) for transvaginal pure NOTES.Complications occurred in 56 cases (19.38％),including 20 cases (6.92％) of severe complications,and no death occurred.After a mean follow-up of 51 (range 3 to 86) months,umbilicus scar was hidden.The incision in the vagina healed well.No infection in the abdominal or pelvic cavity or celiocele occurred.The umbilicus scar is not obvious after surgery,and 3 months after surgery.The median Patient Scar Assessment Questionnaire (PSAQ) score was 38 (31-58) and the median Female Sexual Function Index (FSFI) score was 28.2 (22.5-32.2),and the quality of life index was significantly higher than that of preoperation.Condusions Transvaginal NOTES could treat variousprimary diseases,and improve the postoperative quality of life.It does not increase the incidence of related complications,or cause negative effect on the female sexual function,pregnancy or fertility.It can lead to good cosmetic outcome and less pain,which is worth applying in clinical practice.
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Objective To analyze the complications of transvaginal natural orifice transluminal endoscopic surgery( TV-NOTES) nephrectomy, and to explore effective measures to prevent and manage those complication.Methods From May 2010 to January 2015, a total of 178 females who had been married and given birth underwent TV-NOTES nephrectomy in our center.The average age was 47 ( ranging 23 to 71 ) years and the average BMI was 23.6 ( ranging 14.7 to 31.9 ) kg/m2.Pathological diagnosis included 142 cases of non-functional kidneys, 29 cases of renal tumors ( T1 N0-1 M0 25 cases, T2 N0-1 M0 4 cases) , and 7 cases of renal tuberculosis.One hundred and sixty hybrid TV-NOTES nephrectomy procedures (simple in 132, radical in 28) and 18 pure TV-NOTES nephrectomy procedures (simple in 17, radical in 1) were performed.Intraoperative and postoperative complications were graded according to Satava and Clavien-Dindo grade classifications.The major complications and relative treatments were analyzed.Results Among the 178 TV-NOTES nephrectomy procedures, there were 40 ( 22.5%) complications occurred, including 13 (7.3%) major complications, in which there were 11 cases of intraoperative complications (6.2%),2 cases of postoperative complications (1.1%).All the complications were successfully managed using organ repair or resection, embolectomy, hemostasis, and so on.No intraoperative and postoperative deaths occurred.There was no significant difference in major complications between hybrid TV-NOTES and pure TV-NOTES nephrectomy (6.9%vs.11.1%, P=0.620).The intraoperative major complications in the early developmental stage of TV-NOTES nephrectomy were more than that of the late stage (20.0%vs.3.4%, P=0.004).There was no significant difference in postoperative complications between the early and late developmental stage of TV-NOTES nephrectomy (13.3%vs.10.8%, P=0.751).Conclusions TV-NOTES nephrectomy is safe and feasible, but there are some major complications worthy of attention.Personal prevent and treatment strategy should be considered.
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Objective To investigate the impact of transvaginal natural orifice transluminal endo-scopic surgery(NOTES)-assisted laparoscopic nephrectomy on female sexual function and quality of life . Methods This was a prospective study on the change of female sexual function and quality of life of female patients who underwent transvaginal NOTES-assisted laparoscopic nephrectomy from May .2011 to Nov. 2012.A total of 42 cases were included in this study (28 of them with severe hydronephrosis , non-functio-ning kidney , 11 with pyelonephrosis , 1 with renal tuberculosis , 1 with duplex kidney complicated with hy-dronephrosis, and 1 with renal angiomyolipoma ).The mean age was 36.9±5.3 (26-45) years, and the mean body mass index was 21.7±2.6 (14.7 to 27.1) kg/m2.Twenty-four cases were operated on the left side, 18 cases on the right .The female sexual function and quality of life were assessed before and 4 months, 7 months and 1 year after surgery using the Female Sexual Function Index (FSFI) questionnaire and the MOS 36-item Short-Form Health Survey (SF-36), respectively. Results The mean FSFI of 42 cases preoperatively and 4 months, 7 months and 1 yr postoperatively were 27.74 ±4.34, 27.19 ±4.49, 28.54±4.23, and 28.68 ±4.19, respectively.There was no statistically significant difference among them (F=1.111, P=0.346).Compared with that of preoperation , the physical function, vitality, metal health, body pain, and general health of the patients were improved , but the role-physical, role-emotion and social function were not improved at postoperative month 4 and month 7 (P<0.05).Each item of SF-36 was im-proved after postoperative 1 year ( P<0.05) . Conclusions Transvaginal NOTES-assisted laparoscopic ne-phrectomy does not cause negative effect on the female sexual function .The quality of life can be improved after operation .The physical function is improved at early stage , and the psychological function as well .
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Objective To study the clinic features and the mechanism of skin damage induced by high-dose methotrexate(HD-MTX).Method Children treated with HD-MTX were enrolled in a retrospective study in which the incidence and presentations of skin damage were concluded.Mechanism of the damage was studied base on skin pathology of an animal model.Result Skin damage presented in 3～9(median 5) days after HD-MTX and usually followed by bullation and exfoliation.Twelve cases,more severe than the others,accompanied with fever and symptoms of other organs especially the respiratory tract and the intestine.Skin damage was reduced when large dose rehydration used before,during and after HD-MTX.Conclusion HD-MTX may cause scald-like skin damage directly by its prolonged toxic effect on epidermal cells.Besides extended tetrahydrofolic acid rescue and supportive treatments,anti infection is the most important in dealing this condition.