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

Abstract

To evaluate the safety and feasibility of robot-assisted transvaginal natural orifice transluminal endoscopic surgery (R-vNOTES) hysterectomy when compared with traditional vNOTES (T-vNOTES) hysterectomy. Design: Retrospective chart review. Setting: Academic tertiary setting. Patients: Total of 114 patients with benign gynecologic indication for hysterectomy. Interventions: T-vNOTES or R-vNOTES hysterectomy performed by a single minimally invasive gynecologic surgeon in the study period.Measurements and Main Results: The primary outcome of this study was surgical equivalence, measured principally by total operative time between T-vNOTES and R-vNOTES hysterectomy. Secondary operative outcomes that were measured included estimated blood loss, length of hospital stay, reported postoperative pain levels, and number of conversions. A total of 79 women underwent T-vNOTES hysterectomy, and 35 women underwent R-vNOTES hysterectomy without differences in operative time (p = .37), estimated blood loss (p = .27), length of hospital stay (p = .06), or reported postoperative pain levels at weeks 1, 2, and 3 after surgery (p = .78, p = .36, p = .38, respectively). A total of 6 patients underwent conversion in the T-vNOTES hysterectomy group compared with 0 in the R-vNOTES hysterectomy group; however, this was not statistically significantly different, and there were no conversions to laparotomy. Conclusion: R-vNOTES hysterectomy is a feasible approach to surgery when compared with T-vNOTES hysterectomy and warrants further consideration as a skill set in a gynecologic surgeon's toolbox. Wristed instruments may allow surgeons who are inexperienced in single-site laparoscopy to adopt vNOTES more quickly as a new technique when performing hysterectomy through a comparable minimally invasive approach.

Vaginal Natural Orifice Transluminal Endoscopic Surgery Revolution: The Next Frontier in Gynecologic Minimally Invasive Surgery

“…Xiaoming Guan and colleagues published a small comparative feasibility study of traditional laparoscopic and robotic-assisted vNOTES hysterectomies. 36 Robotic-assisted vNOTES publications currently consist of case reports and series describing hysterectomies, 37 , 38 sacrocolpopexies, 39 , 40 bowel deep infiltrating endometriosis, 17 and myomectomy, 41 mostly by two surgical teams (Dr. Xiaoming Guan in Baylor, Texas and Dr. Chyi-Long Lee in Taiwan). Single site Xi da Vinci robotic system (Intuitive Surgical, Sunnyvale, CA) via vaginal LESS port to treat endometriosis is considered experimental at this time, with only one single institution retrospective review of 33 published cases.…”

Enabling Technologies for Gynecologic Vaginal Surgery

“…107 Robotic vaginal natural orifice transluminal endoscopic surgery was evaluated in eight studies (one nonrandomized comparative study, three prospective single-arm studies, and four retrospective single-arm studies), with a total of 306 patients (Appendix 16, available online at http://links.lww.com/AOG/ D576). [110][111][112][113][114][115][116][117] Six studies used the DaVinci robotic platform for vaginal natural orifice transluminal endoscopic surgery hysterectomy [110][111][112]114,117 or endometriosis resection, 116 and two studies evaluated the Hominis robotic system for hysterectomy 113 or BSO. 115 The only comparative study was fair quality (B) and retrospectively compared robotic vaginal natural orifice transluminal endoscopic surgery and traditional vaginal natural orifice transluminal endoscopic surgery hysterectomy, with no differences in operative time, blood loss, hospital stay, conversion rates, or pain scores.…”

Analysis and suggestions on the complications in 2000 cases of transvaginal natural orifice transluminal endoscopic surgery: Can it be a conventional surgery?

“…The overall complication rate of gynecologic vNOTES was 4.4% in the present study, which was comparable with that of existing minimally invasive surgical techniques, such as laparoscopic 29,30 and robotic 31,32 surgeries. The differences in study design and sample size 28,29,33,34 or the author's subjective bias in the reporting process may have caused this difference among the previous studies. However, the complication rate reported in the present study was still very low compared with that of previous studies under more stringent rating criteria.…”