Yun Seok Yang1. 1. Department of Obstetrics and Gynecology, Eulji University Hospital, 1306 Doonsan-dong, Daejeon, 302-799, Korea. womanmed@eulji.ac.kr.
Abstract
BACKGROUND: To report a new surgical technique for hysterectomy using robotic natural orifice transluminal endoscopic surgery (NOTES) as a scarless and gasless procedure. METHODS: Thirteen consecutive patients with benign uterine disease underwent robotic NOTES hysterectomy at Eulji University Hospital between February 2017 and May 2018. RESULTS: Due to the presence of pelvic adhesions, one of these patients underwent hybrid robotic NOTES hysterectomy with the assistance of isobaric single port laparoscopy; however, there was no conversion to another hysterectomy type such as conventional laparoscopy, laparotomy, or traditional multiport robotic surgery. Median uterine weight was 290 g (range 115-892 g). Median docking and console times were 15 min (range 5-25 min) and 135 min (range 92-215 min), respectively. Mean change in hemoglobin on the first postoperative day was 0.67 ± 0.7 g/dL. Median EBL was 50 mL (20-450 mL). Median postoperative hospital stay was 3 days (3-4 days). No patients experienced postoperative complications such as damage to adjacent organs, re-operation, or vaginal cuff hematoma. CONCLUSIONS: Our findings show that robotic NOTES hysterectomy is a feasible and safe scarless and gasless surgical technique. It is an effective, minimally invasive vaginal access alternate to NOTES-assisted vaginal hysterectomy or conventional robotic laparoendoscopic single-site surgery hysterectomy in the surgical management of benign uterine disease. Nevertheless, further prospective controlled studies are needed to determine its full clinical application.
BACKGROUND: To report a new surgical technique for hysterectomy using robotic natural orifice transluminal endoscopic surgery (NOTES) as a scarless and gasless procedure. METHODS: Thirteen consecutive patients with benign uterine disease underwent robotic NOTES hysterectomy at Eulji University Hospital between February 2017 and May 2018. RESULTS: Due to the presence of pelvic adhesions, one of these patients underwent hybrid robotic NOTES hysterectomy with the assistance of isobaric single port laparoscopy; however, there was no conversion to another hysterectomy type such as conventional laparoscopy, laparotomy, or traditional multiport robotic surgery. Median uterine weight was 290 g (range 115-892 g). Median docking and console times were 15 min (range 5-25 min) and 135 min (range 92-215 min), respectively. Mean change in hemoglobin on the first postoperative day was 0.67 ± 0.7 g/dL. Median EBL was 50 mL (20-450 mL). Median postoperative hospital stay was 3 days (3-4 days). No patients experienced postoperative complications such as damage to adjacent organs, re-operation, or vaginal cuff hematoma. CONCLUSIONS: Our findings show that robotic NOTES hysterectomy is a feasible and safe scarless and gasless surgical technique. It is an effective, minimally invasive vaginal access alternate to NOTES-assisted vaginal hysterectomy or conventional robotic laparoendoscopic single-site surgery hysterectomy in the surgical management of benign uterine disease. Nevertheless, further prospective controlled studies are needed to determine its full clinical application.
Entities:
Keywords:
Isobaric (gasless) NOTES platform; Laparoendoscopic single-site surgery (LESS); NOTES hysterectomy; Robotic surgery
Authors: Alexandre Buckley de Meritens; Julia Kim; Helen Dinkelspiel; Eloise Chapman-Davis; Thomas Caputo; Kevin M Holcomb Journal: J Minim Invasive Gynecol Date: 2016-11-17 Impact factor: 4.137