单孔腹腔镜技术在妇科应用中的若干问题

Issues in application of laparoendoscopic single-site surgery and natural orifice transluminal endoscopic surgery in gynecology

单孔腹腔镜手术从广义上可分为经脐单孔腹腔镜手术(laparoendoscopic single-site surgery,LESS)和经自然腔道的内镜手术(natural orifice transluminal endo-scopic surgery,NOTES)。前者是指通过肚脐进行手术操作,后者是指通过口腔、肛门、阴道或内脏造口进入腹腔完成手术。从多孔腹腔镜到经脐单孔腹腔镜,再到NOTES,其微创理念逐渐升级,其美容优势更加突出,但其手术难度也在提高。

Compared with the conventional multiport laparoscopy,laparoendoscopic single-site surgery(LESS)and natural orifice transluminal endoscopic surgery(NOTES)have shown their advantages in the postoperative cosmetic effect,which promotes the rapid development of these technologies in gynecology in recent years.LESS and transvaginal NOTES(vNOTES)are more difficult to operate and both have longer learning curves than multiport laparoscopy.A comprehensive understanding of the operative techniques in LESS may facilitate its wider application.Currently LESS and vNOTES are used mostly for treatment of benign gynecological diseases,and their application in treatment of malignancies remains challenging and controversial.Some robotic platforms overcome the limitation of human hands,and may represent the future direction of gynecological surgeries.