RESUMO
Background: Transvaginal natural orifice transluminal endoscopic surgery (V-NOTES) is an emerging surgical technique in the evolution of minimally invasive surgery. This technique allows different types of surgical procedures to be performed by vaginal access with endoscopic control. The combination of vaginal surgery and laparoscopy brings many advantages, especially the absence of incisions in the abdominal wall and better visualization of the abdominal cavity. Objectives: In this retrospective study we report our initial experience of V-NOTES in benign gynaecologic surgery by describing our first consecutive 32 surgeries. Materials and Methods: From June 2020 to January 2022, 32 gynaecological procedures were performed by V-NOTES by the same surgeon in a university hospital. Perioperative outcomes were evaluated retrospectively. Main outcome measures: Conversion to laparoscopy or laparotomy and peri-operative and post-operative complications. Results: None of the 32 V-NOTES procedures required conversion to conventional laparoscopy or laparotomy. We observed 2 intraoperative complications managed by V-NOTES and 2 post-operative complications (Clavien-Dindo Grade 2). Conclusion: Our results are similar to studies previously published about this subject and are promising concerning the techniques efficacy and safety. We do believe that a short training allows to reach benefits safely. However, further prospective multicentre randomized trials comparing V-NOTES to totally laparoscopic hysterectomy and to vaginal hysterectomy are needed to strengthen the validity of this new approach. What's new?: V-NOTES widens the indications of vaginal hysterectomies by removing limitations such as large uterus, absence of prolapse, and history of caesarean. Moreover, this technique allows adnexal surgery to be performed by vaginal access.
RESUMO
A case of simple urinary lithiasis resulting in several severe complications is reported to illustrate the problem of iatrogeny in medical practice. It demonstrates the iatrogenic risk related to any medical treatment, including simple procedures. It is critical to identify the kind of iatrogenic events and their severity to reduce their medical, economical or medico-legal impact for the patient, the physicians and the health care system.
Un cas clinique de lithiase urinaire pourtant banal évoluant vers des complications en cascade est décrit pour illustrer l'importance du risque iatrogène dans la pratique médicale courante. Cet exemple, parmi tant d'autres, démontre le risque inhérent à la prise en charge des pathologies et aux actes médicaux, même lorsque ceux-ci semblent anodins. Il est essentiel d'identifier la nature et la sévérité des événements iatrogènes de façon à réduire l'impact clinique, financier ou médico-légal pour le patient, le clinicien et le système de santé publique.
