Objective:To investigate the feasibility and safety of transvaginal natural orific transluminal endoscopic surgery(vNOTES)in elderly women with adnexectomy.Methods:Using a prospective randomized controlled study method, 90 patients with benign ovarian tumors who met the study inclusion criteria and were treated in the Department of Gynecology of Beijing Hospital from January 2019 to December 2021 were randomly assigned to the experimental group(vNOTES group)according to 1∶1.The conventional laparoscopy group(CL group)and the control group underwent ovarian cystectomy.Preoperative baseline conditions, surgical success rate, operation time, intraoperative blood loss, postoperative complications, visual analogue scale(VAS)within 24 hours and one week after operation, postoperative scar score, and postoperative sexual function score were compared between the two groups.and other related data.Results:The operation of 90 patients was successfully completed, and there was no intraoperative and postoperative complications.There were no significant differences in preoperative general condition, operation time, intraoperative blood loss, health status score and sexual function evaluation between the two groups( P>0.05).The peak airway pressure of mechanical ventilation(21.9±1.8)cmH 2O(1 cmH 2O=0.098 kPa), end-expiratory CO 2 partial pressure(36.6±1.4)mmHg(1 mmHg=0.133 kPa), postoperative exhaust time(8.8±1.7)h, and VAS pain score within 24 hours after surgery(1.3±1.2 points)and scar scores at 1 month, 3 months and 6 months after surgery(1.7±1.1、0.4±0.3、0.0±0.0)were all lower than the control group(29.7±2.6)cmH 2O; (39.9±2.0)mmHg; (21.9±2.7)h; 4.6±2.8、6.5±2.0、4.0±1.6、2.5±1.0), ( P<0.01). 6 months after the operation, the health condition score of the experimental group(124.8±10.6)was higher than that of the TL group.(119.9±10.7)points( P<0.05). Conclusions:For elderly women, transvaginal laparoscopic adnexectomy is safe and feasible, with unique advantages such as less impact on cardiopulmonary function, less pain, less scarring, and faster physical recovery.It is a more minimally invasive method of surgery.It can be used as a surgical modality for adnexectomy in older women.

Objective:To investigate the factors influencing the occurrence of poor surgical incision healing after gynecologic open surgery in elderly patients, and to construct a risk prediction model.Methods:A retrospective cohort study was conducted to collect perioperative data from 255 elderly patients(age ≥60 years at the time of surgery)who underwent gynecologic open abdominal surgery in Beijing Hospital from September 2021 to September 2023, and the patients were divided into 204 cases of the well-healed group and 51 cases of the poorly healed group according to the healing of their abdominal incision conditions, and all the included samples were randomly split into the training set of 179 cases and the validation set of 76 cases according to a ratio of 7∶3.Risk factors for poor incision healing were screened using univariate analysis and multifactorial Logistic regression analysis, and a column-line diagram model was constructed.The predictive value of the model was examined using the receiver operating characteristic(ROC)curve, the internal validation of the model was performed using the Bootstrap method, the clinical application value of the model was evaluated by plotting the calibration curve, and the predictive performance of the model was compared by calculating the net reclassification index(NRI)and the integrated discriminant improvement index(IDI).Results:The results of univariate analysis showed that age, body mass index(BMI), preoperative abdominal wall thickness, intraoperative bleeding, preoperative albumin, postoperative minimum albumin, ascites, nature of the disease, and perioperative albumin supplementation were correlated with abdominal incision healing(all P<0.05).Multifactorial Logistic regression analysis showed that perioperative albumin supplementation( OR=0.07, 95% CI: 0.01-0.44, P=0.008), age( OR=1.28, 95% CI: 1.12-1.52, P<0.001), preoperative abdominal wall thickness( OR=5.75, 95% CI: 2.81-15.74, P<0.001), and postoperative minimum albumin( OR=0.82, 95% CI: 0.69-0.97, P=0.017)were the influencing factors of abdominal incision healing.Plotting the ROC curves of the column-line graphical model showed that the area under the curve(AUC)for the training set and the internal validation set were 0.982(95% CI: 0.967-0.997)and 0.961(95% CI: 0.906-1.000), respectively.The model was validated using the Bootstrap self-sampling method, and the calibration curve showed that the model predicted well with good calibration, and NRI and IDI indicated that the predictive value of the four combined was higher than that of a single index for poor incision healing. Conclusions:The prediction model established in this study(including 4 indicators of age, preoperative abdominal wall thickness, perioperative albumin supplementation, and postoperative minimum albumin)has been statistically tested and internally validated to predict the risk of poorly healed abdominal incisions in elderly women in the perioperative period, facilitating timely clinical adjustment of treatment for high-risk patients.