Robotic Transvaginal Natural Orifice Transluminal Endoscopic Surgery for Resection of Parametrial and Bowel Deeply Infiltrated Endometriosis

Abstract

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

“…Furthermore, several studies have been published describing the use of vNOTES in different settings: large uteri, 12 obesity, 13 nulliparous patients, 14 repeat vNOTES, 15 and prior hysterectomy. 16 At this time, myomectomies, endometriosis excision, 17 lymph node sampling, 18 , 19 and sacrocolpopexies 20 are not done routinely via the vNOTES route and remain optimally addressed via laparoscopic and robotic routes.…”

“…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.…”

The comparison of gasless and traditional robot-assisted transvaginal natural orifice transluminal endoscopic surgery in hysterectomy

“…This was in consistent with previous studies. In 2021, Guan reported one case with endometriosis who successfully underwent robotic v-NOTES for hysterectomy (10). Zhang (11) reported the operative outcomes of 33 cases patients with endometriosis who underwent hysterectomy via robotic v-NOTES.…”

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

“…[14][15][16] Most studies on vNOTES focus on its feasibility without adequately analyzing the complications. 5,6,[17][18][19] Moreover, the possibility of underreporting complications cannot be denied when a researcher evaluates his own surgical technique. Most current reports are limited to a specific procedure such as hysterectomy, making it difficult to identify common problems associated with vNOTES.…”

“…However, as a new surgical approach, perioperative complications are crucial assessment indicators in addition to confirming the feasibility and advantages of vNOTES 14–16 . Most studies on vNOTES focus on its feasibility without adequately analyzing the complications 5,6,17–19 . Moreover, the possibility of underreporting complications cannot be denied when a researcher evaluates his own surgical technique.…”