Patients who underwent panhysterectomy due to hysteromyoma were selected for the study. As hysteromyoma is a common clinical disease, its prevalence rate is on the rise and tends to be found among younger patients [13, 14], making it easier for clinical data collection. The existing hysteromyoma treatment options include drug therapy and surgical therapy, and surgery is the most effective and direct mode of treatment. If the patient has no fertility requirements, panhysterectomy can be adopted to avoid recurrence and effectively achieve radical treatment [15]. Panhysterectomy includes laparotomy, transvaginal panhysterectomy, traditional laparoscopic panhysterectomy, and transvaginal single-port laparoscopic panhysterectomy. Currently, traditional laparotomy is gradually being replaced by more advanced minimally invasive surgical techniques due to the former's disadvantages of large trauma, slow recovery, and many complications [16]. This article discusses the feasibility and safety of transvaginal natural orifice transluminal endoscopic surgery panhysterectomy through a comparative analysis of patients' clinical data.
Our team's study showed that, in the treatment of panhysterectomy patients, both groups achieved satisfactory efficacy and prognosis, with advantages and disadvantages. Specifically, the V-NOTES group had significant advantages of a lower treatment cost, less pain, and more beautiful wound. In addition, its postoperative pain score was lower than that of laparoscopic surgery in various periods, with a lower incidence rate of complications as well. Studies [17, 18] have shown that laparoscopic surgery can cause damage to nerves, blood vessels, ligaments, and other tissues to varying degrees, which may lead to abnormal secretion of postoperative hormones, and ultimately adversely affect libido and sexual life quality. V-NOTES, however, has smaller damage to the body and plays a certain comforting role in pain reduction, wound beauty, and other aspects of patients, to improve patients' subjective feelings, avoid mood disorders, and ultimately improve the sexual life quality. It can also effectively reduce the risk of postoperative complications. In this study, the incidence of postoperative bladder injury, vaginal wall hematoma, vaginal stump bleeding, and other related complications in the observation group was significantly lower than that in the control group, with statistically significant differences, which was in good agreement with the research results of scholars such as Rakotomahenina H [18].
Combined with the results of this study, the author summarized the advantages and disadvantages of V-NOTES in clinical application as follows: (1) The vaginal incision has relatively good expansibility, without a need to crush the specimens with a morcellator, which is more conducive to the removal of large specimens such as the uterus, expanding its application. (2) V-NOTES achieves "no scar" on the body surface in the real sense, which meets the pursuit of beauty by female patients in the new era. (3) The vaginal fornix is innervated by visceral nerves, so the incision pain is less, and the complications of abdominal wall incision infection and hernia can be avoided, compared with traditional laparoscopy. (4) V-NOTES has less effect on the gastrointestinal tract and can effectively promote better and faster recovery of gastrointestinal motility, shortening the exsufflation time and facilitating rapid postoperative recovery. (5) The anesthesia depth required for this procedure is shallow, which reduces the anesthesia risk. Combined with the advantages of V-NOTES in less pain, patients can get out of bed earlier, indirectly reducing the incidence of postoperative pulmonary atelectasis and lung infection and shortening the postoperative hospital stay and recovery time [19]. However, our study also showed that the shortcomings of V-NOTES surgery largely lay in the longer operation duration, the larger HB decline, etc. The main consideration was that V-NOTES, contrary to the traditional field of view of MPLS, adopts a bottom-up perspective of the uterus and the two appendages, increasing the difficulty of operation. Although the vagina had good ductility, it was relatively narrow, making it difficult to place V-NOTES dedicated port, especially for physicians who are not that experienced in this operating procedure. Therefore, it may take longer to establish the pelvic approach and suture the incision on the vaginal wall after the operation. Besides, intraoperative suture and hemostatic operations are relatively slow, increasing the total operation duration and a sharper HB decline. Therefore, surgeons need more time to get familiar with and adapt to V-NOTES, which is one of the reasons for the relatively slow promotion of V-Notes [20].
Vaginal surgery is also a common procedure for gynecological panhysterectomy. But compared with it, V-NOTES also has significant advantages. Although vaginal panhysterectomy has no laparotomy, less injury, and rapid recovery, it also has limitations, such as a small field of vision, which increases the difficulty of exposure. Moreover, especially in patients with vaginal stricture, pelvic adhesion, obesity, and other conditions, the failure rate of transvaginal surgery is high, and the patient may need to be converted to laparotomy. On the other hand, v-NOTES enables direct vision to show the whole pelvic cavity clearly, facilitating the operation. Moreover, the microscopic energy platform reduces the risk of postoperative bleeding and is more conducive to postoperative recovery [21]. Therefore, V-NOTES expands the indication of vaginal surgery to some extent, which marks an improvement and innovation in vaginal surgery [22, 23].
With the continuous innovation and progress of medical device research and development in China, the minimally invasive concept can be popularized among gynecologists. However, its development is also restricted by many factors, such as equipment, instruments, and technology. Therefore, it is also the common responsibility of domestic enterprises and gynecological endoscopists to improve the existing laparoscopic equipment and instruments to better serve most female patients. Developing and promoting a new technology cannot go without stepped training. V-NOTES training also requires a series of procedures such as a pelvic simulator, animal model, surgical observation, and tutor guidance. This new technology can only be applied after it completes a learning curve with more practice of various operations under the microscope, with the mastery of instruments and knowledge about female pelvic anatomy [22].
This study proved that, compared with MPLS, V-NOTES surgery has significant advantages, including fewer complications, higher safety, less pain, and faster recovery. However, the number of cases is small at present, and the effects of this technology on postoperative sex life and vaginal delivery of patients, especially the potential long-term effects, still require more evidence to determine the extent of its benefits for patients. Therefore, we should pay attention to medical ethics, accurately grasp the application indications, and inform patients of the advantages of this method, such as beauty without a scar, while explaining its potential risks in detail. Due to time limitations and other factors, this study failed to conduct long-term follow-ups on patients to evaluate the improvement of patients' sexual life quality after the surgery. It is expected that a bigger sample size can be realized in future studies, with a longer follow-up period of patients to enable more comprehensive and in-depth evidence-based research.