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

Abstract

Study objectiveTo describe the surgical technique and compare the operative outcomes of gasless and traditional robot-assisted transvaginal natural orifice transluminal endoscopic surgery (GR-vNOTES vs. TR-vNOTES) in hysterectomy.MethodsThe patients undergoing hysterectomy via GR-vNOTES or TR-vNOTES between February 2020 and January 2022 in our hospital were included. Clinical data regarding patient demographics, operative time, blood loss, complications, and postoperative hospital stays were collected and analyzed.ResultsFive cases underwent hysterectomy via GR-vNOTES, and nine cases via TR-vNOTES. The baseline demographics and operative outcomes were not significantly different in GR-vNOTES and TR-vNOTES groups. There was no conversion to multiport robotic laparoscopy, conventional laparoscopy or laparotomy. No complications were seen in both groups, except two cases had fever postoperatively in the TR-vNOTES group. For those with early stage cervical/endometrial cancer, no recurrence or metastasis was observed in the follow-up of six months.ConclusionBoth GR-vNOTES and TR-vNOTES were feasible and safe for hysterectomy. GR-vNOTES was a promising alternative to TR-vNOTES in hysterectomy.

Gasless transvaginal natural orifice transluminal endoscopic surgery for hysterectomy and salpingectomy on a robot platform with flexible devices in a porcine model

“…As we know, smoke generated during the surgery led to unclear surgical vision, especially when it was performed in an enclosed space. Therefore, we adopted the gasless technique which has been proven effective in our hospital 5 . According to our experience and previous studies, gasless technique not only decreased the complications associated with CO2 pneumoperitoneum, but also reduced the operation difficulty and cost 10 , 11 .…”

“…Therefore, we adopted the gasless technique which has been proven effective in our hospital 5 . According to our experience and previous studies, gasless technique not only decreased the complications associated with CO2 pneumoperitoneum, but also reduced the operation difficulty and cost 10 , 11 . There may be concerns about the limited exposure of surgical space in gasless surgery.…”

“…In this case, robotic laparoscopy could play to its strength as it provides accurate and fine surgical procedures 3 . Although traditional robotic V-NOTES was proven to be non-inferiority compared to traditional laparoscopy 4 , 5 , challenge still existed as there was significant arm collisions due to space confinement and rigid-link instrumental arms 6 . For this reason, robotic platform with flexible devices was developed 7 .…”