Robot-assisted Transvaginal Natural Orifice Transluminal Endoscopic Surgery for Management of Endometriosis: A Pilot Study of 33 Cases

Zhang, Yiming; Delgado, Stephanie; Liu, Juan; Guan, Zhenkun; Guan, Xiaoming

doi:10.1016/j.jmig.2021.06.004

Cited by 19 publications

(16 citation statements)

References 38 publications

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“…In the past 10 years, robotic surgery has made great progress in the field of minimally invasive surgery and has recently been applied to vNOTES 11–13 . However, unlike traditional vNOTES, robotic assisted vNOTES (R‐vNOTES) enables the use of wristed instruments, therefore improving the ability to proficiently suture and perform delicate pelvic dissection needed for complex surgery 14 . Lee et al.…”

Section: Introductionmentioning

confidence: 99%

“…[11][12][13] However, unlike traditional vNOTES, robotic assisted vNOTES (R-vNOTES) enables the use of wristed instruments, therefore improving the ability to proficiently suture and perform delicate pelvic dissection needed for complex surgery. 14 Lee et al first reported 4 cases of R-vNOTES hysterectomy in 2015, suggesting that the use of the robotic platform in vNOTES hysterectomy is feasible and may have some advantages over traditional vNOTES. 15 Currently, few studies involving R-vNOTES hysterectomy have been published, with the majority of studies being case series.…”

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confidence: 99%

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Evaluation of the learning curve and safety outcomes in robotic assisted vaginal natural orifice transluminal endoscopic hysterectomy: A case series of 84 patients

Liu

Tan

Thigpen

et al. 2022

Robotics Computer Surgery

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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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Section: Introductionmentioning

confidence: 99%

mentioning

confidence: 99%

Evaluation of the learning curve and safety outcomes in robotic assisted vaginal natural orifice transluminal endoscopic hysterectomy: A case series of 84 patients

Liu

Tan

Thigpen

et al. 2022

Robotics Computer Surgery

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“…[19][20][21][22][23][24][25][26][27][28][29][30][31] ; Table 2, Ref. [17,[32][33][34][35][36][37][38][39][40][41][42][43]). PRISMA guidelines were followed during the selection process [44,45] (Fig.…”

Section: Methodsmentioning

confidence: 99%

Robotic Surgery and Deep Infiltrating Endometriosis Treatment: The State of Art

Alboni¹,

Mattos²,

Marca³

et al. 2023

Clin. Exp. Obstet. Gynecol.

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Objective: Surgical treatment of endometriosis, when indicated, has demonstrated to be effective in reducing painful symptoms and improve quality of life of patients affected with endometriosis. The minimally invasive approach via laparoscopy is the preferred method when compared with laparotomy but in the last two decades another minimally invasive approach has become available, the robotically assisted laparoscopic surgery. Robotic technology is widely used in different surgical branches, such as general surgery and urology. Moreover, the use of robotic surgery is already accepted for different gynecological procedures either for benign and for oncological diseases. The advantages of robotic surgery such as improve dexterity of movements, avoided tremor, increased magnification of 3dimensional vision seem strategic in the context of a complex surgery as is deep endometriosis eradication. However, to date there is no unanimous consensus on whether robotically assisted procedures are a valid and safe alternative to laparoscopy in the treatment of endometriosis. Mechanism: In this narrative review we analyze the available literature assessesing the robotic treatment of all types of endometriosis and specifically deep infiltrating endometriosis, compared to the outcomes of conventional laparoscopy. Findings in Brief: Indeed, the evidence of safety and effectiveness of robotically assisted laparoscopy in endometriosis treatment is strong and almost unanimous. There is no clear superiority of one approach to the other but robotic-related advantages and future prospective are promising to be able to improve operative outcomes, reduce surgeon's fatigue and provide a technology easy to implement with a fast learning curve. Conclusions: Robotic technology applied to laparoscopy in the treatment of endometriosis could be seen as an effective and safe alternative to the conventional laparoscopic treatment.

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“…If the preoperative evaluation suggests active pelvic infection, intrauterine pregnancy, fixed pelvis, or obliterated cul-de-sac, then a traditional approach may be necessary. In addition to physical examination, imaging studies may include transvaginal ultrasound for assessment of sliding sign, or magnetic resonance imaging (MRI) [36 ▪ ]. Intraoperative rectovaginal exam and transvaginal or transabdominal ultrasound can also guide entry [43,44].…”

Section: Implementation Of Vaginal Natural Orifice Transluminal Endos...mentioning

confidence: 99%

Applications of vaginal natural orifice transluminal endoscopic surgery (vNOTES) in gynecologic surgery

Reddy

Kim

Plewniak

2022

Current Opinion in Obstetrics &Amp; Gynecology

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Purpose of reviewNatural orifice transluminal endoscopic surgery (NOTES) is an emerging approach used across surgical disciplines. This review seeks to assess the growing body of literature on experiences and outcomes using vaginal NOTES (vNOTES) in gynecologic surgery. Recent findingsMany limitations of vaginal surgery including lack of descensus or restricted vaginal space can be overcome with vNOTES whereas avoiding risks of abdominal incisions in traditional laparoscopy. vNOTES may have superior outcomes in pain, length of stay, and satisfaction for multiple gynecologic indications however additional data is needed to assess cost-effectiveness and long-term outcomes. Surgeons implementing this technique should have adequate experience with both traditional vaginal and laparoscopic approaches. The current body of high-quality studies is heavily influenced by single site, single surgeon studies and as such may not be fully applicable to all practices incorporating this novel technique, and adequate training should precede implementation of Vnotes.

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Robot-assisted Transvaginal Natural Orifice Transluminal Endoscopic Surgery for Management of Endometriosis: A Pilot Study of 33 Cases

Cited by 19 publications

References 38 publications

Evaluation of the learning curve and safety outcomes in robotic assisted vaginal natural orifice transluminal endoscopic hysterectomy: A case series of 84 patients

Evaluation of the learning curve and safety outcomes in robotic assisted vaginal natural orifice transluminal endoscopic hysterectomy: A case series of 84 patients

Robotic Surgery and Deep Infiltrating Endometriosis Treatment: The State of Art

Applications of vaginal natural orifice transluminal endoscopic surgery (vNOTES) in gynecologic surgery

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