Jinekolojide Doğal Orifis Transluminal Endoskopik Cerrahi Tekniği (V NOTES)
Özet
vNOTES (Doğal Orifis Transluminal Endoskopik Cerrahi), jinekolojide laparoskopik ve vajinal cerrahinin avantajlarını birleştiren minimal invaziv bir yöntemdir. Bu teknik; kistektomi, ektopik gebelik, myomektomi ve histerektomi gibi benign jinekolojik hastalıkların tedavisinde güvenle tercih edilmektedir. vNOTES, standart laparoskopik aletlerin kullanımına izin verirken görünür bir iz bırakmaması, daha az postoperatif ağrı, kısa hastanede kalış ve hızlı iyileşme süresi gibi belirgin avantajlar sunar. Buna karşın, derinlik algısının azalması nedeniyle cerrahi tecrübe ve uzun bir öğrenme süreci gerektirir. Rektovajinal endometriozis, şiddetli pelvik enfeksiyon, radyoterapi öyküsü ve birden fazla sezaryen geçmişi olan hastalarda uygulanması tavsiye edilmez. Ayrıca vNOTES, son yıllarda erken evre endometrial kanserlerde lenfadenektomi ve pelvik organ prolapsusunda sakrokolpopeksi gibi karmaşık onkolojik ve ürojinekolojik prosedürlere de başarıyla genişletilmektedir.
vNOTES (Natural Orifice Transluminal Endoscopic Surgery) is a minimally invasive method in gynecology that combines the advantages of laparoscopic and vaginal surgery. This technique is safely preferred in the treatment of benign gynecological diseases such as cystectomy, ectopic pregnancy, myomectomy, and hysterectomy. While allowing the use of standard laparoscopic instruments, vNOTES offers distinct advantages such as leaving no visible scar, less postoperative pain, shorter hospital stays, and rapid recovery times. However, it requires surgical experience and a long learning curve due to reduced depth perception. Its application is not recommended in patients with rectovaginal endometriosis, severe pelvic inflammatory disease, a history of radiotherapy, or multiple cesarean sections. Furthermore, vNOTES has recently been successfully extended to complex oncological and urogynecological procedures, including lymphadenectomy in early-stage endometrial cancers and sacrocolpopexy for pelvic organ prolapse.
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