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Guan X, Yang Q, Lovell DY. Assessing Feasibility and Outcomes of Robotic Single Port Transvaginal NOTES(RSP-vNOTES) Hysterectomy: A Case Series. J Minim Invasive Gynecol 2024:S1553-4650(24)00364-9. [PMID: 39222841 DOI: 10.1016/j.jmig.2024.08.018] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/28/2024] [Revised: 08/19/2024] [Accepted: 08/28/2024] [Indexed: 09/04/2024]
Abstract
OBJECTIVE To demonstrate the feasibility and short-term outcomes of Robot-Assisted Single Port vaginal NOTES (RSP-vNOTES) for total hysterectomy, with or without endometriosis resection for all stages. DESIGN Retrospective case series. SETTING Single academic tertiary care hospital in Houston, Texas, USA. PARTICIPANTS 28 adult women with chronic pelvic pain who underwent RSP-vNOTES hysterectomy, with or without endometriosis resection. INTERVENTIONS Hysterectomy with or without excision of endometriosis via single-port robot-assisted vNOTES platform (Intuitive Da Vinci SP Platform). MAIN RESULTS 28 patients with a mean age of 40.1 years (range 24.0-54.0 years), mean BMI 28.5 kg/m2 (range 19.5-48.4 kg/m2), underwent RSP-vNOTES from November 11, 2023 to May 7, 2024. Five (17.9%) patients underwent solely a hysterectomy, while 23 (82.1%) patients underwent additional endometriosis resection; 28.6% with stage I, 25.0% stage II, 7.1% stage III, and 21.4% with stage IV. Mean total operative time was 188.7 minutes (range 135.0-427.0 minutes), with robot dock time of 2.9 minutes (range 1.0-10.0 minutes), robot console time of 97.3 minutes (range 51.0-221.0 minutes), and hysterectomy time of 55.3 minutes (range 24.0-170.0 minutes). Estimated blood loss averaged 32.1 mL (range 25.0-50.0mL). One case required a mini-laparotomy as the irregularly-shaped 1668g fibroid uterus was unable to be removed vaginally. Complications included one case of vaginal cuff cellulitis and one case of urinary tract infection. CONCLUSION Our findings indicate that RSP-vNOTES, a novel single-port surgical approach, presents a promising alternative surgical platform in vaginal surgeries.
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Affiliation(s)
- Xiaoming Guan
- Division of Minimally Invasive Gynecologic surgery, Baylor College of Medicine, Houston, Texas, U.S.A..
| | - Qiannan Yang
- Department of Obstetrics & Gynecology, Baylor College of Medicine, Houston, Texas, U.S.A
| | - Daniel Y Lovell
- Division of Minimally Invasive Gynecologic surgery, Baylor College of Medicine, Houston, Texas, U.S.A
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Xu G, Lovell DY, Guan X. Robot-Assisted Vaginal Natural Orifice Transluminal Endoscopic Surgery (RvNOTES) With Total Hysterectomy for Management of Stage IV Endometriosis With/Without Complete Cul-de-Sac Obliteration: 23-Case Pilot Feasibility Study. J Minim Invasive Gynecol 2024; 31:496-503. [PMID: 38493829 DOI: 10.1016/j.jmig.2024.03.006] [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: 09/18/2023] [Revised: 03/05/2024] [Accepted: 03/11/2024] [Indexed: 03/19/2024]
Abstract
STUDY OBJECTIVE To show feasibility and short-term outcomes of robot-assisted vaginal NOTES (RvNOTES) for the treatment of stage IV endometriosis during total hysterectomy with/without complete cul-de-sac obliteration. DESIGN Retrospective case series. SETTING Single academic tertiary care hospital in Houston, Texas, USA. PATIENTS Twenty-three adult women with stage IV endometriosis. INTERVENTIONS RvNOTES with total hysterectomy for excision of severe endometriosis. MEASUREMENTS AND MAIN RESULTS Patients were assessed for various metrics including total operative time, robot dock time, robot console time, hysterectomy time, estimated blood loss, perioperative pain using the Visual Analogue Scale (VAS), and complications. The mean total operative time was 224.3 minutes. The study also found that patients with complete cul-de-sac obliteration had significantly longer operative times and higher estimated blood loss compared to those with partial or no obliteration. Postoperative VAS pain scores showed a significant reduction over a 6-week period. Complications included one case of complete ureteral transection, pelvic hematoma with infection, vaginal abscess, urinary tract infection, and pneumonia. CONCLUSION Our findings suggest that RvNOTES may be a feasible surgical approach in expert hands for treating stage IV endometriosis, even in cases with complete obliteration of the cul-de-sac.
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Affiliation(s)
- Gufeng Xu
- Division of Minimally Invasive Gynecologic surgery, Baylor College of Medicine (Drs. Xu, Lovell, and Guan), Houston, Texas; Department of Ambulatory Surgery, Women's Hospital, Zhejiang University School of Medicine (Dr. Xu), Hangzhou, China
| | - Daniel Y Lovell
- Division of Minimally Invasive Gynecologic surgery, Baylor College of Medicine (Drs. Xu, Lovell, and Guan), Houston, Texas
| | - Xiaoming Guan
- Division of Minimally Invasive Gynecologic surgery, Baylor College of Medicine (Drs. Xu, Lovell, and Guan), Houston, Texas.
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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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Kim JC, Yim GW, Kim YT. Clinical relevance of vaginal natural orifice transluminal endoscopic surgery (vNOTES) in gynecology. Obstet Gynecol Sci 2024; 67:199-211. [PMID: 38225904 PMCID: PMC10948214 DOI: 10.5468/ogs.23205] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/16/2023] [Revised: 10/30/2023] [Accepted: 11/13/2023] [Indexed: 01/17/2024] Open
Abstract
This study reviews the progress and recent advances in vaginal natural orifice transluminal endoscopic surgery (vNOTES) as a minimally invasive gynecologic procedure. The proposed advantages of vaginal natural orifice transluminal surgery include enhanced cosmesis due to a scarless procedure, better exposure compared with the pure vaginal approach, tolerable pain scores, fewer perioperative complications, and a shorter hospital stay. Recent advances in surgical instrumentation and technology have improved the feasibility of vNOTES as an innovative treatment option for gynecological conditions. However, technical challenges and training issues must be overcome before its widespread use. As a promising surgical innovation, further randomized comparative studies are required to clarify the safety and effectiveness of vNOTES in gynecology.
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Affiliation(s)
- Jung Chul Kim
- Department of Obstetrics and Gynecology, Institute of Women’s Life Medical Science, Yonsei University College of Medicine, Seoul,
Korea
| | - Ga Won Yim
- Department of Obstetrics and Gynecology, Dongguk University College of Medicine, Goyang,
Korea
| | - Young Tae Kim
- Department of Obstetrics and Gynecology, Institute of Women’s Life Medical Science, Yonsei University College of Medicine, Seoul,
Korea
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Imai K, Suzuki Y, Hiiragi K, Hotta Y, Shigeta H. Comparison of quality of life after robotic-transvaginal natural orifice transluminal endoscopic surgery and robot-assisted laparoscopic hysterectomy. Eur J Obstet Gynecol Reprod Biol 2023; 288:211-215. [PMID: 37572450 DOI: 10.1016/j.ejogrb.2023.08.003] [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: 07/05/2023] [Revised: 08/04/2023] [Accepted: 08/06/2023] [Indexed: 08/14/2023]
Abstract
OBJECTIVES We investigated quality of life (QOL) of patients who underwent total hysterectomy for benign uterine diseases using two surgical approaches: robotic-transvaginal natural orifice transluminal endoscopic surgery (R-vNOTES) and robot-assisted laparoscopic hysterectomy (RALH). STUDY DESIGN This single-center retrospective study was conducted in a tertiary academic setting and included 65 patients who underwent robotic-assisted hysterectomy for benign uterine diseases. Total hysterectomy was performed using R-vNOTES or RALH by the same gynecologist between December 2021 and June 2022. The primary outcome was a comparison of QOL over time and complete QOL recovery (postoperative QOL score/preoperative QOL score ≥ 1) by postoperative day 28 (POD28) in the R-vNOTES and RALH groups. QOL was examined using EQ-5D-5L in this study. The secondary outcome was a comparison of the surgical outcomes in the R-vNOTES and RALH groups. RESULTS Complete QOL recovery was achieved by 62.7% in the R-vNOTES group and 7.3% in the RALH group at POD7 (p <.001) and by 100% in the R-vNOTES group and 56.1% in the RALH group at POD28 (p <.001). In a multivariable model, patients who underwent R-vNOTES achieved higher complete QOL recovery at POD 28 [adjusted hazard ratio: 4.03, 95% confidence interval: 2.03-8.04]. There was no significant difference between the R-vNOTES and RALH groups in terms of operating time (p =.07), intraoperative blood loss (p =.35), uterus weight (p =.76), or postoperative complications (p =.71). CONCLUSION The R-vNOTES approach for total hysterectomy for benign uterine diseases provided better complete QOL recovery by POD28 compared to the RALH approach. The surgical outcomes for R-vNOTES were equivalent to those for RALH, suggesting that R-vNOTES may provide a safe approach for robot-assisted hysterectomy.
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Affiliation(s)
- Kazuaki Imai
- Department Obstetrics and Gynecology, Yokohama Municipal Citizen's Hospital, Yokohama, Japan
| | - Yukio Suzuki
- Division of Gynecologic Oncology, Department of Obstetrics and Gynecology, Columbia University Vagelos College of Physicians and Surgeons, New York, NY, USA.
| | - Kazuya Hiiragi
- Department Obstetrics and Gynecology, Yokohama Municipal Citizen's Hospital, Yokohama, Japan
| | - Yuichiro Hotta
- Department Obstetrics and Gynecology, Yokohama Municipal Citizen's Hospital, Yokohama, Japan
| | - Hiroyuki Shigeta
- Department Obstetrics and Gynecology, Yokohama Municipal Citizen's Hospital, Yokohama, Japan
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Xu P, Zhao Z, Tian Y, Li Y, Liu Y, Ji M. A retrospective analysis of robot-assisted total hysterectomy by transvaginal natural orifice transluminal endoscopic surgery. Heliyon 2023; 9:e19207. [PMID: 37662750 PMCID: PMC10474405 DOI: 10.1016/j.heliyon.2023.e19207] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/03/2023] [Revised: 08/10/2023] [Accepted: 08/16/2023] [Indexed: 09/05/2023] Open
Abstract
Objective The present study aimed to explore the feasibility and safety of robot-assisted total hysterectomy by transvaginal natural orifice transluminal endoscopic surgery (vNOTES). Methods In this study, the clinical data of 37 patients who underwent da Vinci robot-assisted total hysterectomy by vNOTES between September 1, 2019 and March 31, 2022 at the Department of Gynecology, the First Affiliated Hospital of Zhengzhou University, China were retrospectively analyzed. Clinical characteristics, operative postoperative complications, surgical outcomes, and postoperative pain scores were collected and analyzed. Results The average age of the patients included in the study was 47.43 ± 4.44 years. The body mass index (BMI) was calculated using the formula BMI = body weight (kg)/height2 (m2). The average BMI was 23.16 ± 2.72 kg/m2. Among the 37 patients, 30 patients underwent total hysterectomy and bilateral salpingectomy, of which 11 patients underwent ovarian cystectomy simultaneously. Among these 11 patients, three had bilateral ovarian cysts and eight had unilateral ovarian cysts, with the largest cyst diameter measuring 8 cm. The remaining seven patients underwent total hysterectomy and bilateral salpingo-oophorectomy. The average operative time was 86.19 ± 17.83 min, and the estimated intraoperative blood loss was 24.46 ± 15.40 mL, with no intraoperative complications reported. The time to the first postoperative exhaust was 18.51 ± 6.63 h, and the average postoperative length of hospital stay was 3.81 ± 1.05 days. The postoperative visual analog scale (VAS) pain scores were 5.30 ± 0.91 at 24 h after surgery, 3.30 ± 0.70 at 36 h after surgery, and 1.14 ± 0.92 at 48 h after surgery. Only one patient experienced a fever exceeding 38.5 °C, which resolved after receiving antibiotic treatment. Conclusion The use of the da Vinci robot-assisted total hysterectomy by vNOTES demonstrated safety and offers several advantages. These include reduced surgical trauma, an aesthetic incision, decreased pain, and shorter duration of postoperative exhaust time and hospital stay. These benefits contribute to accelerated postoperative rehabilitation.
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Affiliation(s)
- Penglin Xu
- Department of Gynecology, The First Affiliated Hospital of Zhengzhou University, Zhengzhou, Henan, 450052, PR China
| | - Zhao Zhao
- Department of Gynecology, The First Affiliated Hospital of Zhengzhou University, Zhengzhou, Henan, 450052, PR China
| | - Yanpeng Tian
- Department of Gynecology, The First Affiliated Hospital of Zhengzhou University, Zhengzhou, Henan, 450052, PR China
| | - Yue Li
- Department of Gynecology, The First Affiliated Hospital of Zhengzhou University, Zhengzhou, Henan, 450052, PR China
| | - Yafen Liu
- Department of Gynecology, The First Affiliated Hospital of Zhengzhou University, Zhengzhou, Henan, 450052, PR China
| | - Mei Ji
- Department of Gynecology, The First Affiliated Hospital of Zhengzhou University, Zhengzhou, Henan, 450052, PR China
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Chopra H, Baig AA, Cavalu S, Singh I, Emran TB. Robotics in surgery: Current trends. Ann Med Surg (Lond) 2022; 81:104375. [PMID: 36051814 PMCID: PMC9424352 DOI: 10.1016/j.amsu.2022.104375] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/04/2022] [Accepted: 08/11/2022] [Indexed: 11/29/2022] Open
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Liu J, Tan L, Thigpen B, Koythong T, Zhou X, Liu Q, Wang Q, Guan X. Evaluation of the learning curve and safety outcomes in robotic assisted vaginal natural orifice transluminal endoscopic hysterectomy: A case series of 84 patients. Int J Med Robot 2022; 18:e2385. [PMID: 35236012 DOI: 10.1002/rcs.2385] [Citation(s) in RCA: 8] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/15/2021] [Revised: 02/26/2022] [Accepted: 02/28/2022] [Indexed: 12/27/2022]
Abstract
BACKGROUND To explore the learning curve and safety outcomes of robotic assisted transvaginal natural orifice transluminal endoscopic surgery (R-vNOTES) for hysterectomy in benign gynaecological diseases. METHODS A retrospective chart review of all patients undergoing R-vNOTES hysterectomy for benign gynaecological disease from 2019 to 2021. SETTING An academic tertiary care university hospital in Houston, TX, USA. RESULTS 84 patients were identified that met the study requirements. The mean hysterectomy time was 77.27 ± 2.89 min. The median additional operation time was 63 (8-206) min. There were two conversions to robotic assisted single incision laparoscopy. Thirteen (15.48%) patients had an associated complication. Analysis of the learning curve suggests plateauing of hysterectomy time at approximately 10 cases and time for robot docking and port placement after 10-20 cases. CONCLUSION R-vNOTES is a safe and effective route for hysterectomy. For a surgeon with experience in laparoscopic single site surgery and abdominal robotic surgery, they need to perform 10 cases of R-vNOTES hysterectomy and 10-20 cases in port placement and robotic docking to achieve proficiency.
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Affiliation(s)
- Juan Liu
- Department of Obstetrics and Gynaecology, Baylor College of Medicine, Houston, Texas, USA.,Department of Obstetrics and Gynaecology, The Third Affiliated Hospital of Guangzhou Medical University, Guangzhou, China
| | - Liping Tan
- Department of Obstetrics and Gynaecology, The Third Affiliated Hospital of Guangzhou Medical University, Guangzhou, China
| | - Brooke Thigpen
- Department of Obstetrics and Gynaecology, Baylor College of Medicine, Houston, Texas, USA
| | - Tamisa Koythong
- Department of Obstetrics and Gynaecology, Baylor College of Medicine, Houston, Texas, USA
| | - Xingnan Zhou
- Department of Obstetrics and Gynaecology, The Third Affiliated Hospital of Guangzhou Medical University, Guangzhou, China
| | - Qihuang Liu
- Department of Obstetrics and Gynaecology, The Third Affiliated Hospital of Guangzhou Medical University, Guangzhou, China
| | | | - Xiaoming Guan
- Department of Obstetrics and Gynaecology, Baylor College of Medicine, Houston, Texas, USA
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Robot-assisted Transvaginal Natural Orifice Transluminal Endoscopic Surgery for Management of Endometriosis: A Pilot Study of 33 Cases. J Minim Invasive Gynecol 2021; 28:2060-2066. [PMID: 34144208 DOI: 10.1016/j.jmig.2021.06.004] [Citation(s) in RCA: 12] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/05/2021] [Revised: 06/07/2021] [Accepted: 06/09/2021] [Indexed: 11/23/2022]
Abstract
STUDY OBJECTIVE To describe the surgical techniques and short-term outcomes for 33 cases of robot-assisted transvaginal natural orifice transluminal endoscopic surgery (RvNOTES) to treat endometriosis. DESIGN Retrospective case series study. SETTING Academic tertiary care university hospital in Houston, TX. PATIENTS Patients who underwent RvNOTES resection of endometriosis between March 2020 and March 2021. INTERVENTIONS RvNOTES. MEASUREMENTS AND MAIN RESULTS A total of 33 cases of patients, with pathology-confirmed endometriosis, who underwent RvNOTES total hysterectomy with resection of endometriosis were included in the study. Thirty-two cases were completed successfully by RvNOTES, and 1 case was converted to robotic transumbilical single-incision laparoscopic surgery plus 1 additional port owing to an obliterated posterior cul-de-sac and upper abdominal wall endometriosis. The average operative time was 141.93 ± 40.22 (85-264) minutes, and the mean estimated blood loss was 52.25 ± 33.82 (25-150) mL. The mean preoperative pain score using the visual analog scale (VAS) score was 8.08 ± 2.39 (2-10). The mean VAS pain score 1 week after surgery was 6.73 ± 2.62 (0-10), which was significantly lower than the preoperative scores (p = .059). The mean VAS pain score in the second and third week after surgery was 4.81 ± 2.42 (0-9) and 2.63 ± 2.36 (0-7) respectively, which were both significantly lower than those before surgery (p = .001). There were 4 postoperative complications: urinary tract infection, pneumonia, headache requiring admission, and conversion disorder. CONCLUSION RvNOTES is a safe and feasible approach for the treatment of endometriosis, with promising short-term improvements in pain.
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Koythong T, Thigpen B, Sunkara S, Erfani H, Delgado S, Guan X. Surgical Outcomes of Hysterectomy via Robot-assisted versus Traditional Transvaginal Natural Orifice Transluminal Endoscopic Surgery. J Minim Invasive Gynecol 2021; 28:2028-2035. [PMID: 34033911 DOI: 10.1016/j.jmig.2021.05.014] [Citation(s) in RCA: 12] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/24/2021] [Revised: 05/05/2021] [Accepted: 05/19/2021] [Indexed: 12/12/2022]
Abstract
STUDY OBJECTIVE To evaluate the safety and feasibility of robot-assisted transvaginal natural orifice transluminal endoscopic surgery (R-vNOTES) hysterectomy when compared with traditional vNOTES (T-vNOTES) hysterectomy. DESIGN Retrospective chart review. SETTING Academic tertiary setting. PATIENTS Total of 114 patients with benign gynecologic indication for hysterectomy. INTERVENTIONS T-vNOTES or R-vNOTES hysterectomy performed by a single minimally invasive gynecologic surgeon in the study period. MEASUREMENTS AND MAIN RESULTS The primary outcome of this study was surgical equivalence, measured principally by total operative time between T-vNOTES and R-vNOTES hysterectomy. Secondary operative outcomes that were measured included estimated blood loss, length of hospital stay, reported postoperative pain levels, and number of conversions. A total of 79 women underwent T-vNOTES hysterectomy, and 35 women underwent R-vNOTES hysterectomy without differences in operative time (p = .37), estimated blood loss (p = .27), length of hospital stay (p = .06), or reported postoperative pain levels at weeks 1, 2, and 3 after surgery (p = .78, p = .36, p = .38, respectively). A total of 6 patients underwent conversion in the T-vNOTES hysterectomy group compared with 0 in the R-vNOTES hysterectomy group; however, this was not statistically significantly different, and there were no conversions to laparotomy. CONCLUSION R-vNOTES hysterectomy is a feasible approach to surgery when compared with T-vNOTES hysterectomy and warrants further consideration as a skill set in a gynecologic surgeon's toolbox. Wristed instruments may allow surgeons who are inexperienced in single-site laparoscopy to adopt vNOTES more quickly as a new technique when performing hysterectomy through a comparable minimally invasive approach.
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Affiliation(s)
- Tamisa Koythong
- Department of Obstetrics and Gynecology, Baylor College of Medicine, Houston, Texas (all authors)
| | - Brooke Thigpen
- Department of Obstetrics and Gynecology, Baylor College of Medicine, Houston, Texas (all authors)
| | - Sowmya Sunkara
- Department of Obstetrics and Gynecology, Baylor College of Medicine, Houston, Texas (all authors)
| | - Hadi Erfani
- Department of Obstetrics and Gynecology, Baylor College of Medicine, Houston, Texas (all authors)
| | - Stephanie Delgado
- Department of Obstetrics and Gynecology, Baylor College of Medicine, Houston, Texas (all authors)
| | - Xiaoming Guan
- Department of Obstetrics and Gynecology, Baylor College of Medicine, Houston, Texas (all authors).
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