Robotic Vaginal Natural Orifice Transluminal Endoscopic Hysterectomy for Benign Indications

Abstract

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/m 2 (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.

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

“…A recent case series of 114 patients described the feasibility performing R‐vNOTES hysterectomy, while comparing 35 cases of R‐vNOTES hysterectomy and 79 traditional vNOTES hysterectomy 16 . Surgical outcomes of both groups of patients were similar, but the study was limited by its small sample size 17,25 . This study appears to be the current largest case series of patients undergoing R‐vNOTES hysterectomy to date, allowing for further analysis of safety of this novel technology and surgical approach.…”

“…16 Surgical outcomes of both groups of patients were similar, but the study was limited by its small sample size. 17,25 This study appears to be the current largest case series of patients undergoing R-vNOTES hysterectomy to date, allowing for further analysis of safety of this novel technology and surgical approach.…”

Surgical Outcomes of Hysterectomy via Robot-assisted versus Traditional Transvaginal Natural Orifice Transluminal Endoscopic Surgery

“…Finally, all of the surgeries in this study were performed by a single minimally invasive surgeon with great familiarity with single-incision laparoscopy and T-vNOTES before adopting R-vNOTES and may not be generalizable to all surgeons. However, we are still hopeful that this study provides promising evidence for the integration of the robot in vNOTES hysterectomy, especially as robotic platforms developed specifically for use in vNOTES (Hominis surgical system; Memic Innovative Surgery, Portland, ME) have recently been shown to be safe and effective [28].…”

New Robotic Platforms for Gynecology. Are We Achieving One of the Golden Goals?

“…This platform was specifically designed to facilitate single-incision robotic vaginal natural orifice transluminal endoscopic surgery (RvNOTES), and two prospective clinical studies have reported the performance of eight bilateral salpingo-oophorectomies [87] and 30 hysterectomies [88] to treat benign diseases, with good intra-, peri-, and postoperative outcomes. A rapid learning curve was observed and no device-related adverse events were reported, proving the feasibility and user-friendliness of RvNOTES with this system.…”