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Alshiek J, Marroquin J, Shobeiri SA. Vaginal ultrasound-guided Pouch of Douglas robotic entry in a live ovine model and human female cadaveric specimens. J Robot Surg 2021; 16:73-79. [PMID: 33576913 DOI: 10.1007/s11701-021-01203-w] [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: 06/05/2020] [Accepted: 01/18/2021] [Indexed: 10/22/2022]
Abstract
We aimed to determine whether intraoperative ultrasound is a feasible tool for visualization of the pouch of Douglas (POD) to facilitate a safe vaginal entry for direct robotic vaginal trocar insertion for pelvic floor surgery. Endovaginal ultrasound-guided needle insertion of a trocar into the POD was performed in six fresh frozen female cadavers and a live sheep animal model. Using an endovaginal probe the POD was identified as a fluid-filled space clear of bowel or adhesions, then a Veress needle was also used to confirm POD localization. Access to the POD was achieved using a robotic trocar designed for this purpose. The animal study was approved by the Ethics Committee of Asaf-Harofe hospital. Direct visualization during laparoscopy in cadavers and open cadaveric dissections confirmed safe POD entry and accurate trocar placement. This method was found feasible in the development of a safe vaginal entry in both the animal and cadaveric model, possibly negating the need for laparoscopic umbilical observation.
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Affiliation(s)
- Jonia Alshiek
- Department of Obstetrics and Gynecology, Hillel Yafe Hospital, Hadera, Israel.,Department of Obstetrics and Gynecology, INOVA Women's Hospital, Virginia Commonwealth University, Professor, Biomedical Engineering, George Mason University, 3300 Gallows Road, Second Floor South Tower, Falls Church, VA, 22042-3307, USA.,Department of Bioengineering, George Mason University, Fairfax, VA, USA
| | - Joanna Marroquin
- Department of Obstetrics and Gynecology, INOVA Women's Hospital, Virginia Commonwealth University, Professor, Biomedical Engineering, George Mason University, 3300 Gallows Road, Second Floor South Tower, Falls Church, VA, 22042-3307, USA
| | - S Abbas Shobeiri
- Department of Obstetrics and Gynecology, INOVA Women's Hospital, Virginia Commonwealth University, Professor, Biomedical Engineering, George Mason University, 3300 Gallows Road, Second Floor South Tower, Falls Church, VA, 22042-3307, USA. .,Department of Bioengineering, George Mason University, Fairfax, VA, USA.
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Kumakiri J, Kikuchi I, Kitade M, Kuroda K, Matsuoka S, Tokita S, Takeda S. Incidence of Complications during Gynecologic Laparoscopic Surgery in Patients after Previous Laparotomy. J Minim Invasive Gynecol 2010; 17:480-6. [DOI: 10.1016/j.jmig.2010.03.004] [Citation(s) in RCA: 22] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/25/2009] [Revised: 03/03/2010] [Accepted: 03/07/2010] [Indexed: 10/19/2022]
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