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| Natural orifice transluminal endoscopic surgery in urology: The Chinese experience |
Xiaofeng Zoua,*( ),Guoxi Zhanga,Tianpeng Xiea,Yuanhu Yuana,Rihai Xiaoa,Gengqing Wua,Xiaoning Wanga,Hui Xua,Folin Liua,Yuting Wua,Yunfeng Liaoa,Quanliang Liua,Yinghao Sunb,Bo Yangb,Linhui Wangb,Chuanliang Xub,Xiaofeng Gaob
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a Department of Urology, First Affiliated Hospital of Gannan Medical University, Research Center of Jiangxi Province for Engineering Technology of Calculus Prevention and Control, Ganzhou, China
b Department of Urology, Changhai Hospital, Second Military Medical University, Shanghai, China |
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Abstract Objective: To describe the Chinese experience of natural orifice transluminal endoscopic surgery (NOTES) in urology. Methods: From December 2008 to May 2017, 35 animal experiments and 305 clinical surgeries of NOTES or natural orifices specimen extractions (NOSE) were performed in China. The animal experiments included five kidney biopsies, 24 nephrectomies and six partial nephrectomies. The clinical surgeries included 12 transvaginal NOSE (TV-NOSE), 266 hybrid transvaginal NOTES (TV-NOTES) and 27 pure TV-NOTES. The TV-NOSE procedure was performed in five transumbilical laparoendoscopic single-site (U-LESS) nephrectomies, four suprapubic-assisted laparoendoscopic single-site surgery (SA-LESS) nephroureterectomies, and three laparoscopic radical cystectomies. The hybrid TV-NOTES procedure included 210 nephrectomies, 31 adrenalectomies, eight nephroureterectomies, 13 partial nephrectomies, and four heminephrectomies. The pure TV-NOTES procedure included five renal cyst decortications and 22 nephrectomies. Results: A total of 29 animal experiments were successfully performed. One partial nephrectomy was converted to standard laparoscopic surgery. Two kidney biopsies and two nephrectomies were unsuccessful. A total of 297 clinical surgeries were successfully performed. Six patients who underwent hybrid TV-NOTES were converted to open surgery. Two patients who underwent pure TV-NOTES were converted to SA-LESS. There were 22 major complications, 16 occurred intraoperatively and six postoperatively. The mean visual analog score (VAS) of 48 h after the operation was 2.5 points in TV-NOSE, 2.3 points in hybrid TV-NOTES and 1.7 points in pure TV-NOTES. The mean follow-up of 50.6 (3.0-87.0) months showed that all patients were in good condition. The umbilicus scars were nearly invisible in TV-NOSE and hybrid TV-NOTES. The vaginal incision healed well. Conclusions: TV-NOSE and TV-NOTES are feasible, safe, and effective with little injury, low pain, fast recovery, and good cosmetic outcomes in properly selected patients. They are worth consideration for urological clinical practice.
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Received: 02 May 2018
Available online: 06 July 2019
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Corresponding Authors:
Xiaofeng Zou
E-mail: gyfyurology@126.com
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| Characteristics | Value | | Age, mean, range, year | 39.5 (23-76) | | BMI, mean, range, kg/m2 | 21.5 (15.4-29.6) | | Classification of diseases, n | | Adrenal tumors | 31 | | Renal tumors | 49 | | Non-functional kidneys | 194 | | Renal tuberculosis | 7 | | Renal cysts | 5 | | Duplex kidneys | 4 | | Renal pelvis and ureteral tumors | 12 | | Bladder tumors | 3 | | Tumor size, mean, range, cm | 5.0 (3.2-6.8) | | Previous operation history, n | | Pelvic operation | 22 | | Abdominal operation | 12 | | ASA score, mean, range | 2 (1-3) |
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Baseline characteristics of all 305 patients.
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| Surgical procedures | Cases, n | Successful cases, n | Mean operative time (range), min | Mean estimated blood loss (range), mL | Patients receiving transfusion, n (%) | Intraoperative major complications, n (%) | Postoperative major complications, n (%) | Postoperative hospital stay, mean (range), day | | TV-NOSE | 12 | 12 | | | | | | | | Nephrectomy | 5 | 5 | 136 (110-160) | 66 (40-100) | 0 | 0 | 0 | 4.8 (4-6) | | Nephroureterectomy | 4 | 4 | 150 (120-210) | 180 (80-350) | 0 | 0 | 0 | 8.2 (7-9) | | Radical cystectomy | 3 | 3 | 232 (210-255) | 383 (300-500) | 0 | 0 | 0 | 9.3 (7-12) | | Hybrid TV-NOTES | 266 | 260 | | | | | | | | Adrenalectomy | 31 | 30 | 65 (45-310) | 110 (20-800) | 1 (3.2%) | 1 (3.2%) | 0 | 6.5 (4-13) | | Nephrectomy | 210 | 205 | 96 (70-280) | 72 (30-800) | 6 (2.9%) | 12 (5.7%) | 3 (1.4%) | 7.0 (4-10) | | Partial nephrectomy | 13 | 13 | 115 (110-190) | 130 (50-450) | 1 (7.7%) | 1 (7.7%) | 1 (7.7%) | 7.4 (4-10) | | Heminephroureterectomy | 4 | 4 | 98 (87-110) | 225 (160-300) | 0 | 0 | 0 | 7.0 (6-8) | | Nephroureterectomy | 8 | 8 | 180 (160-245) | 183 (100-500) | 1 (12.5%) | 1 (12.5%) | 0 | 8.3 (7-9) | | Pure TV-NOTES | 27 | 25 | | | | | | | | Nephrectomy | 22 | 20 | 190 (160-320) | 170 (100-500) | 1 (4.5%) | 1 (4.5%) | 2 (9.1%) | 5.8 (4-10) | | Renal cyst excision | 5 | 5 | 80 (60-90) | 25 (20-50) | 0 | 0 | 0 | 3.8 (3-4) |
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Perioperative data for the 305 patients.
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| Surgical procedures | Cases, n | Postoperative 48 h VAS, mean (range) | PSAQ score, mean (range) | FSFI score, mean (range) | SF-36 score, mean (range) | p-Value | | 1 week preoperatively | 3 months postoperatively | 1 week preoperatively | 3 months postoperatively | FSFI | SF-36 | | TV-NOSE | 12 | 2.5 (2-4) | 37.3 (32-48) | 26.2 (25.3-29.5) | 25.6 (25.1-28.7) | 39.8 (33.1-44.9) | 50.2 (43.7-62.6) | 0.502 | 0.041 | | Hybrid TV-NOTES | 266 | 2.3 (1-4) | 38.2 (31-58) | 27.2 (22.7-30.8) | 26.2 (22.5-30.6) | 39.2 (32.2-45.8) | 53.2 (41.6-65.8) | 0.430 | 0.037 | | Pure TV-NOTES | 27 | 1.7 (1-3) | None | 31.2 (26.5-32.6) | 30.7 (26.5-32.2) | 38.3 (32.7-44.6) | 52.9 (42.8-66.3) | 0.388 | 0.033 | | Total | 305 | 2.2 (1-4) | 38.1 (31-58) | 28.5 (22.7-32.6) | 28.2 (22.5-32.2) | 38.6 (32.2-45.8) | 53.1 (41.6-66.3) | 0.403 | 0.036 |
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The score of VAS, PSAQ, FSFI and SF-36.
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