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Balgobin S, Balk EM, Porter AE, Misal M, Grisales T, Meriwether KV, Jeppson PC, Doyle PJ, Aschkenazi SO, Miranne JM, Hobson DT, Howard DL, Mama S, Gupta A, Antosh DD. Enabling Technologies for Gynecologic Vaginal Surgery: A Systematic Review. Obstet Gynecol 2024; 143:524-537. [PMID: 38301255 DOI: 10.1097/aog.0000000000005522] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/24/2023] [Accepted: 12/07/2023] [Indexed: 02/03/2024]
Abstract
OBJECTIVE To systematically review the literature to evaluate clinical and surgical outcomes for technologies that facilitate vaginal surgical procedures. DATA SOURCES We systematically searched MEDLINE, EMBASE, and ClinicalTrials.gov from January 1990 to May 2022. METHODS OF STUDY SELECTION Comparative and single-arm studies with data on contemporary tools or technologies facilitating intraoperative performance of vaginal gynecologic surgical procedures for benign indications were included. Citations were independently double screened, and eligible full-text articles were extracted by two reviewers. Data collected included study characteristics, technology, patient demographics, and intraoperative and postoperative outcomes. Risk of bias for comparative studies was assessed using established methods, and restricted maximum likelihood model meta-analyses were conducted as indicated. TABULATION, INTEGRATION, AND RESULTS The search yielded 8,658 abstracts, with 116 eligible studies that evaluated pedicle sealing devices (n=32), nonrobotic and robotic vaginal natural orifice transluminal endoscopic surgery (n=64), suture capture devices (n=17), loop ligatures (n=2), and table-mounted telescopic cameras (n=1). Based on 19 comparative studies, pedicle sealing devices lowered vaginal hysterectomy operative time by 15.9 minutes (95% CI, -23.3 to -85), blood loss by 36.9 mL (95% CI, -56.9 to -17.0), hospital stay by 0.2 days (95% CI, -0.4 to -0.1), and visual analog scale pain scores by 1.4 points on a subjective 10-point scale (95% CI, -1.7 to -1.1). Three nonrandomized comparative studies and 53 single-arm studies supported the feasibility of nonrobotic vaginal natural orifice transluminal endoscopic surgery for hysterectomy, adnexal surgery, pelvic reconstruction, and myomectomy. Data were limited for robotic vaginal natural orifice transluminal endoscopic surgery, suture capture devices, loop ligatures, and table-mounted cameras due to few studies or study heterogeneity. CONCLUSION Pedicle sealing devices lower operative time and blood loss for vaginal hysterectomy, with modest reductions in hospital stay and pain scores. Although other technologies identified in the literature may have potential to facilitate vaginal surgical procedures and improve outcomes, additional comparative effectiveness research is needed. SYSTEMATIC REVIEW REGISTRATION PROSPERO, CRD42022327490.
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Affiliation(s)
- Sunil Balgobin
- Division of Urogynecology, Department of Obstetrics and Gynecology, University of Texas Southwestern Medical Center, Dallas, the Department of Obstetrics and Gynecology, University of Texas Health Science Center at San Antonio, San Antonio, and the Division of Urogynecology, Department of Obstetrics and Gynecology, Houston Methodist Hospital, Houston, Texas; the Center for Evidence Synthesis in Health, Brown University School of Public Health, Providence, Rhode Island; the Department of Obstetrics and Gynecology, The Ohio State University Wexner Medical Center, Columbus, Ohio; the Department of Obstetrics and Gynecology, University of California, Los Angeles, Los Angeles, California; the Division of Urogynecology, Department of Obstetrics and Gynecology, University of New Mexico, Albuquerque, New Mexico; the Woman's Center for Advanced Pelvic Surgery, Phoenix, Arizona; the Departments of Obstetrics and Gynecology and Urology, School of Medicine & Dentistry, University of Rochester, Rochester, New York; the Department of Obstetrics and Gynecology, Medical College of Wisconsin, Waukesha, Wisconsin; the Division of Urogynecology, Brigham and Women's Hospital, Harvard Medical School, Boston, Massachusetts; the Department of Obstetrics and Gynecology, Wayne State University School of Medicine, Detroit, Michigan; the Department of Obstetrics, Gynecology, and Reproductive Health, Rutgers New Jersey Medical School, Newark, and the Department of Obstetrics and Gynecology, Cooper Medical School of Rowan University, Camden, New Jersey; and the Division of Female Pelvic Medicine & Reconstructive Surgery, University of Louisville Health, Louisville, Kentucky
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Gamal A, Moschovas MC, Jaber AR, Saikali S, Perera R, Headley C, Patel E, Rogers T, Roche MW, Leveillee RJ, Albala D, Patel V. Clinical applications of robotic surgery platforms: a comprehensive review. J Robot Surg 2024; 18:29. [PMID: 38231279 DOI: 10.1007/s11701-023-01815-4] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/23/2023] [Accepted: 12/27/2023] [Indexed: 01/18/2024]
Abstract
Robotic surgery has expanded globally across various medical specialties since its inception more than 20 years ago. Accompanying this expansion were significant technological improvements, providing tremendous benefits to patients and allowing the surgeon to perform with more precision and accuracy. This review lists some of the different types of platforms available for use in various clinical applications. We performed a literature review of PubMed and Web of Science databases in May 2023, searching for all available articles describing surgical robotic platforms from January 2000 (the year of the first approved surgical robot, da Vinci® System, by Intuitive Surgical) until May 1st, 2023. All retrieved robotic platforms were then divided according to their clinical application into four distinct groups: soft tissue robotic platforms, orthopedic robotic platforms, neurosurgery and spine platforms, and endoluminal robotic platforms. Robotic surgical technology has undergone a rapid expansion over the last few years. Currently, multiple robotic platforms with specialty-specific applications are entering the market. Many of the fields of surgery are now embracing robotic surgical technology. We review some of the most important systems in clinical practice at this time.
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Affiliation(s)
- Ahmed Gamal
- Adventhealth Global Robotics Institute, 380 Celebration Place, Orlando, FL, 34747, USA.
| | - Marcio Covas Moschovas
- Adventhealth Global Robotics Institute, 380 Celebration Place, Orlando, FL, 34747, USA
- University of Central Florida (UCF), Orlando, FL, USA
| | - Abdel Rahman Jaber
- Adventhealth Global Robotics Institute, 380 Celebration Place, Orlando, FL, 34747, USA
| | - Shady Saikali
- Adventhealth Global Robotics Institute, 380 Celebration Place, Orlando, FL, 34747, USA
| | - Roshane Perera
- Adventhealth Global Robotics Institute, 380 Celebration Place, Orlando, FL, 34747, USA
| | - Chris Headley
- Adventhealth Global Robotics Institute, 380 Celebration Place, Orlando, FL, 34747, USA
| | - Ela Patel
- Stanford University, Palo Alto, CA, USA
| | - Travis Rogers
- Adventhealth Global Robotics Institute, 380 Celebration Place, Orlando, FL, 34747, USA
| | - Martin W Roche
- Department of Arthroplasty, Hospital for Special Surgery Florida, West Palm Beach, FL, USA
| | | | - David Albala
- Associated Medical Professionals, Urology, Syracuse, NY, USA
| | - Vipul Patel
- Adventhealth Global Robotics Institute, 380 Celebration Place, Orlando, FL, 34747, USA
- University of Central Florida (UCF), Orlando, FL, USA
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Lerner VT, May G, Iglesia CB. Vaginal Natural Orifice Transluminal Endoscopic Surgery Revolution: The Next Frontier in Gynecologic Minimally Invasive Surgery. JSLS 2023; 27:JSLS.2022.00082. [PMID: 36818766 PMCID: PMC9913063 DOI: 10.4293/jsls.2022.00082] [Citation(s) in RCA: 8] [Impact Index Per Article: 8.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/18/2023] Open
Abstract
Despite guidelines that assert that the vaginal route for benign hysterectomy is preferred as the most minimally invasive approach, rates of vaginal hysterectomy remain very low in the United States. Vaginal natural orifice transluminal endoscopic surgery (vNOTES) might reverse the trend. Potential advantages of vNOTES compared to traditional laparoscopic and robotic approaches include the potential for less pain, decreased operative time, improved cosmesis, and decreased risks. Importantly, vNOTES might allow for the conversion of laparoscopic and robotic routes back to vaginal due to surgeon factors.
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Affiliation(s)
- Veronica T. Lerner
- Department of Obstetrics & Gynecology, Lenox Hill Hospital, Northwell Health, New York, NY
| | - Grover May
- Department of OB/GYN, ETSU College of Medicine, Department of OBGYN, Johnson City, TN
| | - Cheryl B. Iglesia
- Departments of Obstetrics and Gynecology and Urology, Georgetown University, Washington, DC
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Integration of a Robotic Platform for Sacrocolpopexy in Transvaginal Natural Orifice Transluminal Endoscopic Surgery: A Novel Surgical Technique. Urology 2021; 154:109-114. [PMID: 33775785 DOI: 10.1016/j.urology.2021.03.015] [Citation(s) in RCA: 10] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/18/2021] [Revised: 03/15/2021] [Accepted: 03/16/2021] [Indexed: 12/29/2022]
Abstract
OBJECTIVE To demonstrate the feasibility and the simplified surgical techniques of intraabdominal suturing and knot-tying in robotic transvaginal natural orifice transluminal endoscopic surgery (RV-NOTES) sacrocolpopexy. MATERIALS AND METHODS We report on two patients with symptomatic stage II apical pelvic organ prolapse who underwent a new technique of RV-NOTES sacrocolpopexy. Case one: A 69-year-old G2P2002 with a history of two prior vaginal deliveries presented with a vaginal bulge and pressure symptoms. She was initially fitted for a pessary but was unsatisfied and elected to proceed with surgical intervention. Case two: A 50-year-old G2P0011 female with a history of one prior vacuum-assisted vaginal delivery presented with symptoms of vaginal mass and bleeding due to an endometrial polyp. She was noted to have stage 2 apical prolapse and opted for transvaginal sacrocolpopexy. RESULTS Both patients were observed overnight and discharged home twelve hours after surgery on postoperative day 1, after completing a voiding trial. For both patients, the postoperative course was unremarkable, and they only required one day of pain medications. At the three-week follow-up visit, they endorsed no postoperative pain or complications, and the POP-Q stage was noted to be 0. Patients had telemedicine visits at eight weeks postoperatively, at which time they had returned to their regular activities and denied symptoms of vaginal bulge or pressure. CONCLUSION Robotic assisted transvaginal NOTES sacrocolpopexy is a feasible and an alternative to traditional laparoscopic NOTES sacrocolpopexy.
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Evangelisti G, Barra F, Centurioni MG, D'Alessandro G, Alessandri F, Ferrero S. Vaginal Natural Orifice Transluminal Endoscopic Surgery (NOTES) for Treating Benign Adnexal Diseases: Past Results and Future Developments. J INVEST SURG 2020; 35:409-410. [PMID: 33289584 DOI: 10.1080/08941939.2020.1843205] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/22/2022]
Affiliation(s)
- Giulio Evangelisti
- Academic Unit of Obstetrics and Gynecology, IRCCS Ospedale Policlinico San Martino, Genova, Italy.,Department of Neurosciences, Rehabilitation, Ophthalmology, Genetics, Maternal and Child Health (DiNOGMI), University of Genoa, Genova, Italy
| | - Fabio Barra
- Academic Unit of Obstetrics and Gynecology, IRCCS Ospedale Policlinico San Martino, Genova, Italy.,Department of Neurosciences, Rehabilitation, Ophthalmology, Genetics, Maternal and Child Health (DiNOGMI), University of Genoa, Genova, Italy
| | | | - Gloria D'Alessandro
- Academic Unit of Obstetrics and Gynecology, IRCCS Ospedale Policlinico San Martino, Genova, Italy.,Department of Neurosciences, Rehabilitation, Ophthalmology, Genetics, Maternal and Child Health (DiNOGMI), University of Genoa, Genova, Italy
| | - Franco Alessandri
- Unit of Obstetrics and Gynecology, IRCCS Ospedale Policlinico San Martino, Genova, Italy
| | - Simone Ferrero
- Academic Unit of Obstetrics and Gynecology, IRCCS Ospedale Policlinico San Martino, Genova, Italy.,Department of Neurosciences, Rehabilitation, Ophthalmology, Genetics, Maternal and Child Health (DiNOGMI), University of Genoa, Genova, Italy
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Lowenstein L, Mor O, Matanes E, Lauterbach R, Boulus S, Weiner Z, Baekelandt J. Robotic Vaginal Natural Orifice Transluminal Endoscopic Hysterectomy for Benign Indications. J Minim Invasive Gynecol 2020; 28:1101-1106. [PMID: 33144242 DOI: 10.1016/j.jmig.2020.10.021] [Citation(s) in RCA: 9] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/11/2020] [Revised: 10/07/2020] [Accepted: 10/24/2020] [Indexed: 02/07/2023]
Abstract
STUDY OBJECTIVE The Hominis surgical system is a novel robot-assisted system, designed specifically for robotic vaginal natural orifice transluminal endoscopic surgery (RvNOTES). We presented our experience of the first 30 RvNOTES hysterectomies assessing the feasibility and safety of this technology. DESIGN A two-center prospective study. SETTING Academic tertiary referral centers. The ethics committees approved the study in both centers. PATIENTS Thirty women with benign indication for hysterectomy. INTERVENTION RvNOTES hysterectomy performed by the Hominis surgical system. MEASUREMENTS AND MAIN RESULTS The primary outcome of the study was the rate of conversion to open or conventional laparoscopic approaches. Secondary outcomes included intra- and postoperative adverse events, operative time, estimated blood loss, length of hospital stay, and 6-week follow-up assessment. A total of 15 women were enrolled at each site. The median age was 59 years (range: 37-79) and the median body mass index was 25.4 kg/m2 (range: 17.6-40.0). Twenty-four women (80%) had comorbidities. All the procedures were completed successfully without conversion to open abdominal, traditional vaginal, or conventional laparoscopic surgery. No intraoperative complications were observed. Median blood loss and procedure duration were 50 mL (range: 20-400) and 57 minutes (range: 24-88), respectively. Postoperative pain was minimal, with a median visual analog scale of 3 (range: 1-5) for the first 24 hours following surgery. The median hospital stay was 3 days (range: 2-8). According to the treating physicians' evaluations, the vaginal cuff was fully healed in all patients at the 6-week postoperative follow-up visit. CONCLUSIONS This is the first publication of robot-assisted vaginal hysterectomy using the Hominis surgical system. The positive results of this study show this new technology to be a safe and effective tool for vaginal natural orifice transluminal endoscopic surgery, enabling surgeons to operate vaginally with the known advantages of robotic modality.
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Affiliation(s)
- Lior Lowenstein
- Department of Obstetrics and Gynecology, Rambam Health Care Campus, and Ruth and Bruce Rappaport Faculty of Medicine, Technion Israel Institute of Technology, Haifa, Israel (Drs. Lowenstein, Mor, Matanes, Lauterbach, Boulus, Weiner).
| | - Omer Mor
- Department of Obstetrics and Gynecology, Rambam Health Care Campus, and Ruth and Bruce Rappaport Faculty of Medicine, Technion Israel Institute of Technology, Haifa, Israel (Drs. Lowenstein, Mor, Matanes, Lauterbach, Boulus, Weiner)
| | - Emad Matanes
- Department of Obstetrics and Gynecology, Rambam Health Care Campus, and Ruth and Bruce Rappaport Faculty of Medicine, Technion Israel Institute of Technology, Haifa, Israel (Drs. Lowenstein, Mor, Matanes, Lauterbach, Boulus, Weiner)
| | - Roy Lauterbach
- Department of Obstetrics and Gynecology, Rambam Health Care Campus, and Ruth and Bruce Rappaport Faculty of Medicine, Technion Israel Institute of Technology, Haifa, Israel (Drs. Lowenstein, Mor, Matanes, Lauterbach, Boulus, Weiner)
| | - Sari Boulus
- Department of Obstetrics and Gynecology, Rambam Health Care Campus, and Ruth and Bruce Rappaport Faculty of Medicine, Technion Israel Institute of Technology, Haifa, Israel (Drs. Lowenstein, Mor, Matanes, Lauterbach, Boulus, Weiner)
| | - Zeev Weiner
- Department of Obstetrics and Gynecology, Rambam Health Care Campus, and Ruth and Bruce Rappaport Faculty of Medicine, Technion Israel Institute of Technology, Haifa, Israel (Drs. Lowenstein, Mor, Matanes, Lauterbach, Boulus, Weiner)
| | - Jan Baekelandt
- Department of Gynecological Oncology and Endoscopy, Imelda Hospital, Bonheiden, Antwerpen, Belgium (Dr. Baekelandt)
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