Background and Aims

Natural orifice transluminal endoscopic surgery (NOTES) has been established in animal models and human studies, but few clinical studies have investigated transvaginal NOTES in the diagnosis of unexplained refractory ascites. We aimed to assess the feasibility, efficacy, and safety of transvaginal NOTES for the diagnosis of unexplained ascites in female patients.

Methods

A prospective study was done involving 3 female patients with unexplained ascites. After general anesthesia and disinfection, a 1.0-cm incision was made in the posterior fornix of the vagina. A gastroscope was inserted into the abdominal cavity through the transvaginal incision and an artificial pneumoperitoneum was created; NOTES peritoneoscopy was performed to scrutinize the pathologic changes. Endoscopic biopsy specimens were obtained for pathologic examination. The transvaginal incision was closed by direct suturing.

Results

Transvaginal NOTES for diagnostic peritoneoscopy was successfully performed in 3 patients. The mean operative time was 61 minutes. The estimated blood loss was 5 to 10 mL. The pathologic diagnoses were tuberculosis for all patients, and the symptoms and ascites disappeared after antituberculosis therapy. During the 4-year follow-up, no clinically significant adverse events occurred in any patient after NOTES. No patient experienced an annex inflammation, vaginitis, dyspareunia, or sexual dysfunction. All patients were comfortable and satisfied with the nonscarring surgical procedure.

Conclusions

Transvaginal NOTES for the diagnosis of unexplained ascites is feasible, effective, and safe. This method had no long-term effect on female sexual function and is particularly suitable for women who have special aesthetic requirements. (Clinical trial registration number: ChiCTR-TRC-10001053.)

中文翻译：

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经阴道自然孔腔内镜手术诊断来源不明的腹水

背景和目标

在动物模型和人体研究中已建立了自然孔腔内镜手术（NOTES），但很少有临床研究在诊断无法解释的难治性腹水中研究经阴道NOTES。我们旨在评估经阴道NOTES诊断女性患者无法解释的腹水的可行性，有效性和安全性。

方法

进行了一项前瞻性研究，涉及3名原因不明的腹水女性患者。全身麻醉和消毒后，在阴道后穹a切一个1.0厘米的切口。通过经阴道切口将胃镜插入腹腔，并产生人工气腹。注意进行腹膜镜检查以检查病理变化。获得内窥镜活检标本进行病理检查。通过直接缝合闭合经阴道切口。

结果

3例患者成功进行了经阴道NOTES诊断性腹膜镜检查。平均手术时间为61分钟。估计失血量为5到10毫升。所有患者的病理诊断均为肺结核，抗结核治疗后症状和腹水消失。在4年的随访期间，NOTES后任何患者均未发生临床上明显的不良事件。没有患者经历过附件发炎，阴道炎，性交困难或性功能障碍。所有患者对无疤手术方法均感到舒适和满意。

结论

经阴道注意事项用于诊断无法解释的腹水是可行，有效和安全的。这种方法对女性的性功能没有长期影响，特别适合具有特殊审美要求的女性。（临床试验注册号：ChiCTR-TRC-10001053。）