Objective: The aim of this research was to compare two new hysterectomy techniques by robotic vaginal natural orifice transluminal endoscopic surgery and to demonstrate that transvaginal robotic hysterectomy can be performed in nulliparous patients by natural orifice transluminal endoscopic surgery (NOTES). Materials and Methods: This research was conducted in a case series format. Previous experience with total vaginal NOTES hysterectomy (TVNH) and with transvaginal robotic surgery for robotic vaginally assisted NOTES hysterectomy (RVANH), led to the decision to combine these techniques to perform robotic TVNH (RTVNH) in nulliparous patients. Twenty patients were included in this study. In 10 nulliparous patients, RTVNH was performed. A gloveport was inserted into the vagina to create a pneumovagina. A Da Vinci Xi surgical robot was side-docked between the legs of each patient. The hysterectomy was performed via transvaginal NOTES using the surgical robot. Once the hysterectomy was completed, the robot and gloveport were removed. The colpotomy was closed as in classical vaginal surgery. The data of these patients were compared to that of 10 parous patients who underwent RVANH. Results: All procedures were completed without conversion to transabdominal laparoscopy or laparotomy. Mean patient data and results for RTVNH/RVANH were: age, 49–63; body mass index, 26.4–27.8; total operating time, 90–118 minutes; hemoglobin drop, 1.2–1.3 g/dL; uterus weight, 149–213 g; pain scores at day 1, 2–2, and at day 2, 2–2. There was one complication in the RVANH group: superficial thrombophlebitis. Conclusions: This cohort study confirmed that robotic transvaginal surgery is feasible and can be used to perform total hysterectomy. RTVNH enabled hysterectomies to be performed without any abdominal incisions in nulliparous patients, who had been determined as unsuitable candidates for classical vaginal hysterectomy. RTVNH and RVANH are novel techniques and require further validation. Further developments in robotic technology will help overcome the practical problem of arm collision and will increase the time efficiency of the procedure. (J GYNECOL SURG 32:270)
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References
1.
BurpeeSE, KurianM, MurakameY, BenevidesS, GagnerM. The metabolic and immune response to laparoscopic versus open liver resection. Surg Endosc, 2002; 16:899.
2.
GrandeM, TucciGF, AdorisioO, et al.Systemic acute-phase response after laparoscopic and open cholecystectomy. Surg Endosc, 2002; 16:313.
3.
RattnerD, KallooA; ASGE/SAGES Working Group. ASGE/SAGES Working Group on natural orifice transluminal endoscopic surgery: October 2005. Surg Endosc, 2006; 20:329.
4.
SantosBF, HungnessES. Natural orifice transluminal endoscopic surgery: Progress in humans since white paper. World J Gastroenterol, 2011; 17:1655.
5.
TolcherMC, KalogeraE, HopkinsMR, WeaverAL, BingenerJ, DowdySC. Safety of culdotomy as a surgical approach: Implications for natural orifice transluminal endoscopic surgery. JSLS, 2012; 16:413.
6.
SuH, YenCF, WuKY, HanCM, LeeCL. Hysterectomy via transvaginal natural orifice transluminal endoscopic surgery (NOTES): Feasibility of an innovative approach. Taiwan J Obstet Gynecol, 2012; 51:217.
7.
LeeCL, WuKY, SuH, WuPJ, HanCM, YenCF. Hysterectomy by transvaginal natural orifice transluminal endoscopic surgery (NOTES): A series of 137 patients. J Minim Invasive Gynecol, 2014; 21:818.
8.
BaekelandtJ. Total vaginal NOTES hysterectomy: A new approach. J Minim Invasive Gynecol, 2015; 22:1088.
9.
BaekelandtJ.Transvaginal robotic surgery: The first case reports of robotic NOTES hysterectomy [presentation]. Society of European Robotic Gynecologic Surgery's 7th Annual Meeting on Gynaecological Robotic Surgery. Istanbul, June 11–13, 2015.
10.
BaekelandtJ. Robotic vaginally assisted NOTES hysterectomy: The first case series demonstrating a new surgical technique. Gynecol Surg, 2015; 13:57.
11.
FerrariMM, MezzopaneR, BulfoniA, GrijuelaB, CarminatiR, FerrazziE, PardiG. Surgical treatment of ovarian dermoid cysts: A comparison between laparoscopic and vaginal removal. Eur J Obstet Gynecol Reprod Biol, 2003; 109:88.
12.
NieboerTE, JohnsonN, LethabyA, et al.Surgical approach to hysterectomy for benign gynaecological disease. Cochrane Database Syst Rev, 2009; 3:CD003677.
13.
HwangJL, SeowKM, TsaiYL, HuangLW, HseihBC, LeeC. Comparative study of vaginal, laparoscopically assisted vaginal and abdominal hysterectomies for uterine myoma larger than 6 cm in diameter or uterus weighing at least 450 g: A prospective randomized study. Acta Obstet Gynecol Scand, 2002; 81:1132.
14.
AgostiniA, BretelleF, CravelloL, MaisonneuveAS, RogerV, BlancB. Vaginal hysterectomy in nulliparous women without prolapse: A prospective comparative study. BJOG, 2003; 110:515.
