Surgical Outcomes of Hysterectomy Via Robotic Assisted Versus Traditional Transvaginal Natural Orifice Transluminal Endoscopic Surgery

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

“…In our study, urinary tract infection was the most common postoperative complication, occurring in 8 patients (9.52%), and is similar to the rate of UTI described in prior studies evaluating vaginal hysterectomy 26 . A previous study evaluating both traditional vNOTES and R‐vNOTES hysterectomy found 6% of patients were diagnosed with a postoperative urinary tract infection 16 . UTI may be more common after transvaginal surgery due to the presence of natural flora within the vagina, which can be copiously manipulated in surgery 27,28 …”

“…In our study, the complication rate seemed to be similar to traditional vNOTES hysterectomy (11.68%–27.84%) 8,16 . In our study, urinary tract infection was the most common postoperative complication, occurring in 8 patients (9.52%), and is similar to the rate of UTI described in prior studies evaluating vaginal hysterectomy 26 .…”

“…The robotic platform has more recently been implemented in vNOTES, allowing for improved 3D visualization and increased dexterity with wristed instruments, therefore leading to improved suturing ability and reduction of tremor necessary for delicate pelvic dissection 15 . 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 .…”

“…For new emerging surgical approaches like R‐vNOTES, conversion rate is a significant factor predicting the feasibility of the procedure. A recent study compared traditional versus robotic‐assisted vNOTES hysterectomy and found 6/79 (7.6%) cases performed via traditional vNOTES were converted to a transabdominal approach due to poor visualization, inability to achieve homoeostasis, presence of a large broad ligament fibroid or markedly enlarged uterus, or obliteration of the posterior cul‐de‐sac; however there were no conversions in 35 R‐vNOTES cases 16 . In this study, two cases (2.38%) were converted to transabdominal approach via robotic‐assisted single site incision laparoscopy due to stage IV endometriosis with an obliterated pouch of Douglas and the other due to dense adhesions of anterior sigmoid colon.…”

“…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 16,17 . However, none of these studies describes the learning curve associated with performing R‐vNOTES hysterectomy.…”