Transvaginal Natural Orifice Transluminal Endoscopic Hysterectomy and Apical Suspension of the Vaginal Cuff to the Uterosacral Ligament

Löwenstein, Lior; Baekelandt, Jan; Paz, Yuri; Lauterbach, Roy; Matanes, Emad

doi:10.1016/j.jmig.2019.04.007

Cited by 34 publications

(27 citation statements)

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“…In recent years, some scholars have reported the advantages of transvaginal natural orifice transluminal endoscopic surgery (vNOTES) for USLS, which include no incisional pain and a better cosmetic outcome than laparoscopy via the abdominal approach, as well as direct visualization of key structures, such as the ureters and rectum, which is not available with the traditional transvaginal approach [ 12 , 13 ]. At present, there have been few studies on this topic.…”

Section: Introductionmentioning

confidence: 99%

Transvaginal natural orifice transluminal endoscopic surgery for uterosacral ligament suspension: pilot study of 35 cases of severe pelvic organ prolapse

Chen

Wang

et al. 2021

BMC Surg

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Background To describe the short-term outcomes of transvaginal natural orifice transluminal endoscopic surgery (vNOTES) for uterosacral ligament suspension (USLS) in patients with severe prolapse. Methods This was a retrospective study of patients with severe prolapse (≥ stage 3) who underwent vNOTES for USLS between May 2019 and July 2020. The Pelvic Organ Prolapse Quantification (POP-Q) score, Pelvic Organ Prolapse/Urinary Incontinence Sexual Questionnaire short form (PISQ-12) and Pelvic Floor Inventory-20 (PFDI-20) were used to evaluate physical prolapse and quality of life before and after vNOTES for USLS. Results A total of 35 patients were included. The mean operative duration was 111.7 ± 39.4 min. The mean blood loss was 67.9 ± 35.8 ml. Statistically significant differences were observed between before and after vNOTES USLS in Aa (+ 0.6 ± 1.7 versus − 2.9 ± 0.2), Ba (+ 1.9 ± 2.2 versus − 2.9 ± 0.3), C (+ 1.5 ± 2.2 versus − 6.9 ± 0.9), Ap (− 1.4 ± 1.0 versus − 3.0 ± 0.1) and Bp (− 1.1 ± 1.4 versus − 2.9 ± 0.1) (P < 0.05 for all). The mean pre- and postoperative PFDI-20 score was 19.9 ± 6.7 and 3.2 ± 5.4, respectively, and the mean pre- and postoperative PISQ-12 score was 24.8 ± 2.3 and 38.3 ± 4.1, respectively (P < 0.05 for both). During 1–13 months of follow-up, there were no cases of severe complications or recurrence. Conclusions vNOTES for USLS may be a feasible technique to manage severe prolapse, with promising short-term efficacy and safety. Larger studies with more patients and longer follow-up periods should be performed to evaluate the long-term efficacy and safety profile of vNOTES for USLS.

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Section: Introductionmentioning

confidence: 99%

Transvaginal natural orifice transluminal endoscopic surgery for uterosacral ligament suspension: pilot study of 35 cases of severe pelvic organ prolapse

Chen

Wang

et al. 2021

BMC Surg

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“…vNOTES decreases the risk of abdominal wound infection because of the absence of incisions on the abdomen [10,11]. However, infection remains the most concerning complication after transvaginal laparoscopic surgery [12].…”

Section: Discussionmentioning

confidence: 99%

“…This surgical procedure was originally described by Lowenstein et al in 2019 [10]. Bilateral salpingooophorectomy (BSO) was performed for patients in whom it was indicated.…”

Section: Hysterectomy With Uslsmentioning

confidence: 99%

Transvaginal Natural Orifice Transluminal Endoscopic Surgery for Uterosacral Ligament Suspension: a Pilot Study of 35 Caseswith Severe Pelvic Organ Prolapse

Chen

Wang

et al. 2021

Preprint

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Background To describe the short-term outcomes of transvaginal natural orifice transluminal endoscopic surgery (vNOTES) for uterosacral ligament suspension (USLS) in patients with severe prolapse.Methods This is a retrospective study conducted for patients with severe prolapsed (≥stage 3) who underwent vNOTES USLS between May 2019 and July 2020. The Pelvic Organ Prolapse Quantification (POP-Q) score, Pelvic Organ Prolapse/Urinary Incontinence Sexual Questionnaire short form (PISQ-12) and Pelvic Floor Inventory-20 (PFDI-20) were used to evaluate physical prolapse and quality of life before and after vNOTES USLS.Results A total of 35 patients were included. The mean operative time was 111.7±39.4 minutes. The mean blood loss was 67.9±35.8 ml. Statistically significant differences were observed before and after vNOTES USLS in regard to Aa (+0.6±1.7 versus −2.9±0.2), Ba (+1.9±2.2 versus −2.9±0.3), C (+1.5±2.2 versus -6.9±0.9), Ap (-1.4±1.0 versus −3.0±0.1) and Bp (-1.1±1.4 versus −2.9±0.1) (P < 0.05 for all). The mean pre- and post-operative PFDI-20 score was 19.9±6.7 versus 3.2±5.4, and the PISQ-12 score was 24.8±2.3 versus 38.3±4.1 (P < 0.05 for both). During 1–13 months of follow-up, no severe complications or recurrence.Conclusions vNOTES USLS may be a feasible technique to manage severe prolapse, with promising short-term efficacy and safety data. However, a study with a larger number of patients and a longer follow-up period should be conducted.

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“…The disruptive technology of vNOTES has the potential to dramatically increase the types and volume of gynecological surgeries performed vaginally [ [32] , [33] , [34] , [35] ], and to make this non-incision surgical option accessible to more women. In addition, robotic-assisted vNOTES will facilitate vaginal access for diverse non-gynecological surgeries including those of the upper-abdomen.…”

Section: Discussionmentioning

confidence: 99%

Robotic transvaginal natural orifice transluminal endoscopic surgery for bilateral salpingo oophorectomy

Löwenstein

Matanes

Weiner

et al. 2020

European Journal of Obstetrics & Gynecology and Reproductiv

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Objectives The vaginal surgical approach has not become the standard of care, despite its advantages. The Hominis™ Surgical System is a humanoid shaped robot-assisted system that was designed specifically for robotic vaginal natural orifice transluminal endoscopic surgery (RvNOTES). We aimed to present our experience with the first RvNOTES bilateral salpingo-oophorectomy (BSO) performed by the Hominis system. Study design A two-center prospective study of BSO by RvNOTES in women with nonmalignant indications conducted between August and December 2018. Women older than 18 years were offered to participate. Exclusion criteria included a history of abdominal malignancy, pelvic or abdominal irradiation, Crohn's disease, pelvic inflammatory disease, severe infections in the lower abdomen, active diverticulitis, deep infiltrating recto-vaginal endometriosis, and an active vaginal infection. The primary outcome of the study was the rate of conversion to open or laparoscopic approaches. Secondary outcomes included intra- and postoperative adverse events, operative time, estimated blood loss, length of hospital stay, and 6-week follow-up assessment. Results Eight women aged 50–70 years with BMI of 19–30 kg/m 2 were recruited. All the procedures were completed successfully without conversions to open surgery. No intraoperative complications were observed. Median blood loss was 10 mL (range: 10−50). The median duration of the procedure was 45 min (range: 38−91), and decreased over the study period. Surgeons’ usability assessment was very favorable, with a median of 5 on a 1–5 scale. The median visual analog scale (VAS) score was 1 (range: 1–3). Conclusions This is the first documentation of a surgery performed via the vagina using robotic instrumentation developed for this purpose. The disruptive technology of RvNOTES, with its fast learning curve, will make gynecological surgeries accessible to more women.

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Transvaginal Natural Orifice Transluminal Endoscopic Hysterectomy and Apical Suspension of the Vaginal Cuff to the Uterosacral Ligament

Cited by 34 publications

References 0 publications

Transvaginal natural orifice transluminal endoscopic surgery for uterosacral ligament suspension: pilot study of 35 cases of severe pelvic organ prolapse

Transvaginal natural orifice transluminal endoscopic surgery for uterosacral ligament suspension: pilot study of 35 cases of severe pelvic organ prolapse

Transvaginal Natural Orifice Transluminal Endoscopic Surgery for Uterosacral Ligament Suspension: a Pilot Study of 35 Caseswith Severe Pelvic Organ Prolapse

Robotic transvaginal natural orifice transluminal endoscopic surgery for bilateral salpingo oophorectomy

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