Clinical NOTES appendectomy study: comparison of transvaginal NOTES appendectomy in hybrid technique with laparoscopic appendectomy

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• 作者：Joern Bernhardt ; Holger Steffen…
• 关键词：Natural orifice translumenal endoscopic surgery ; Natural orifice translumenal endoscopic appendectomy ; Minimal invasive techniques ; Clinical applications
• 刊名：International Journal of Colorectal Disease
• 出版年：2015
• 出版时间：February 2015
• 年：2015
• 卷：30
• 期：2
• 页码：259-267
• 全文大小：428 KB
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• 刊物类别：Medicine
• 刊物主题：Medicine & Public Health
  Surgery
  Internal Medicine
  Gastroenterology
  Hepatology
  Proctology
  
• 出版者：Springer Berlin / Heidelberg
• ISSN：1432-1262

文摘

Purpose The proposed advantages of NOTES are aimed to assess the comparison with standard procedures. Complications are a major focus of its evaluation. We initiated a prospective comparison between transvaginal hybrid appendectomy versus laparoscopic appendectomy. Patients and methods For each, NOTES and laparoscopic appendectomy, 10 consecutive female patients participated in the study with follow-up documentation for 35?days and after 1?year. Transvaginal appendectomy was considered a non-standard medical procedure and required individual patient’s consent. Pre- and postoperative gynecological examinations were performed. Questionnaire-based evaluation included issues related to quality of life in addition to objective clinical findings. The study is approved by the ethics committee of the University of Rostock. Results All women returned questionnaires for evaluation. Age and BMI are comparable. Overall procedure time was significantly shorter in laparoscopy. The only postoperative complication consisted of an intra-abdominal abscess after laparoscopic appendectomy. One patient of the NOTES group suffered from new abdominal pain 3?weeks postoperatively; a mini-laparoscopy showed a normal situation. Significant differences (p--.05) of the questionnaire-based comparison with advantages for the NOTES group were found in following items: reduced activity at day 1-4, postoperative pain at day 1, general health conditions at day 1- and quality of life at day 3. NOTES patients wished significantly earlier to be discharged and started significantly earlier with activities, but no differences existed after 4?weeks. Conclusions Transvaginal flexible appendectomy appears to be a safe procedure performed in hybrid technique. Data from the study point to shortened recovery intervals and improved quality of life.