Transvaginal minimally invasive approach: An update on safety from an anatomical, anatomopathological and clinical point of view - 21/10/20
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Highlights |
• | Transvaginal surgery is a promising approach, with ongoing randomized trials. |
• | Anatomical and histological analysis proved the safety of the transvaginal approach. |
• | Our experience and the review of the literature do not show impaired sexual function. |
• | TVA requires a systematic and strict preoperative evaluation. |
Abstract |
Introduction |
The aim of this work was to analyze the transvaginal approach in minimally invasive surgery in terms of anatomical, histopathological and functional characteristics, to show the safety of this surgical approach.
Methods |
Anatomical study was first conducted by dissection on fresh cadavers of adult women in order to measure the distance between the vaginal incision and the ureters, rectum and hypogastric nerves. In parallel, an anatomopathological study detailed and compared the macroscopic and histological characteristics of the anterior and posterior surfaces of vaginal samples obtained from cadavers and patients in the context of a hysterectomy for benign pathology. Finally, patients who underwent a transvaginal approach nephrectomy or transplantation were retrospectively enrolled for a clinical examination and an evaluation of their sexuality.
Results |
The anatomical study conducted on seventeen cadavers showed that the posterior vaginal fornix was remote from the major structures of the pelvis such as rectum, ureters, hypogastric plexus, which allowed a safe incision. Mechanical tests further demonstrated that the posterior vaginal fornix was more extensible than the anterior and histological features showed no major vascular or nervous structures. Ten patients were included in the retrospective clinical study. Long-term follow up showed no negative impact on the texture of the vagina or satisfaction from sexual intercourse.
Conclusions |
Anatomical, histological and functional data supported that transvaginal approach by posterior vagina fornix incision is a minimally invasive surgery that can be performed safely and effectively by a skilled surgeon in cases with a specific surgical indication for this approach.
Le texte complet de cet article est disponible en PDF.Abbreviations : NOTES, TVA
Keywords : Minimally invasive surgery, Transvaginal approach, Natural orifice transluminal endoscopic surgery, Anatomy and histology, Kidney transplantation
Plan
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