Robotic transvaginal natural orifice transluminal endoscopic surgery for bilateral salpingo oophorectomy

Abstract

Objectives The vaginal surgical approach has not become the standard of care, despite its advantages. The Hominis™ Surgical System is a humanoid shaped robot-assisted system that was designed specifically for robotic vaginal natural orifice transluminal endoscopic surgery (RvNOTES). We aimed to present our experience with the first RvNOTES bilateral salpingo-oophorectomy (BSO) performed by the Hominis system. Study design A two-center prospective study of BSO by RvNOTES in women with nonmalignant indications conducted between August and December 2018. Women older than 18 years were offered to participate. Exclusion criteria included a history of abdominal malignancy, pelvic or abdominal irradiation, Crohn's disease, pelvic inflammatory disease, severe infections in the lower abdomen, active diverticulitis, deep infiltrating recto-vaginal endometriosis, and an active vaginal infection. The primary outcome of the study was the rate of conversion to open or 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. Results Eight women aged 50–70 years with BMI of 19–30 kg/m 2 were recruited. All the procedures were completed successfully without conversions to open surgery. No intraoperative complications were observed. Median blood loss was 10 mL (range: 10−50). The median duration of the procedure was 45 min (range: 38−91), and decreased over the study period. Surgeons’ usability assessment was very favorable, with a median of 5 on a 1–5 scale. The median visual analog scale (VAS) score was 1 (range: 1–3). Conclusions This is the first documentation of a surgery performed via the vagina using robotic instrumentation developed for this purpose. The disruptive technology of RvNOTES, with its fast learning curve, will make gynecological surgeries accessible to more women.

Robotic Vaginal Natural Orifice Transluminal Endoscopic Hysterectomy for Benign Indications

“…The robotic Hominis surgical system enables entrance to the cul-de sac of a narrow habitus. Moreover, the broad range of motion facilitates uterine mobilization and adhesiolysis, safely and effectively [29]. The size, because of multiple myomas, of some of the uteri that were removed during the study at 15 weeks gestation was 13.5 £ 10 cm with a weight of 509 g. Three enlarged uteri were placed in a bag, cut using a scalpel and then extracted vaginally in smaller pieces.…”

“…This is because of the low complication rate, short surgical time, fast recovery, reduced postoperative pain, and low costs of vaginal hysterectomy [3]. Additional advantages of the Hominis robot are its light weight and small footprint (12 pounds), which ensures easy mobility, short setup time, and fast docking [29].…”

Advancement of Flexible Robot Technologies for Endoluminal Surgeries

“…Notably, several articles have been recently published in the medical field reviewing robotics applications for endoluminal and transluminal endoscopic surgeries [115]- [117], [189]. As a recent update in robotic vaginal NOTES, Hominis 2 (Memic Ltd., Or Yehuda, Israel) [230] attained the FDA approval in 2021.…”

A Robotic System with Robust Remote Center Motion Constraint for Endometrial Regeneration Surgery

“…For the RCM constraint, whether the insertion motion or the rotation motion will not cause error of the RCM. Finally, the joint velocity of the supporting arm is expressed as (11).…”

“…surgical procedures [11]. It is also not applicable for endometrial regeneration surgery since its instruments work outside the uterus.…”