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Robotic natural orifice transluminal endoscopic surgery (NOTES) hysterectomy as a scarless and gasless surgery

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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.

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References

  1. Langebrekke A, Qvigstad E (2009) Total laparoscopic hysterectomy with single-port access without vaginal surgery. J Minim Invasive Gynecol 16:609–611

    Article  Google Scholar 

  2. Yang YS, Oh KY, Hur MH, Kim SY, Yim HS (2014) Laparoendoscopic single-site surgery using conventional laparoscopic instruments and glove port technique in gynecology: a single surgeon’s experience. J Minim Invasive Gynecol 19:403–408

    Google Scholar 

  3. Yang YS, Kim SH, Jin CH, Oh KY, Hur MH, Kim SY, Yim HS (2014) Solo surgeon single-port laparoscopic surgery with a homemade laparoscope-anchored instrument system in benign gynecologic diseases. J Minim Invasive Gynecol 21:695–701

    Article  Google Scholar 

  4. Yang Y, Jin C, Oh K, Park J (2015) Hybrid laparoscopic myomectomy: a novel technique. Obstet Gynecol Sci 58:401–404

    Article  Google Scholar 

  5. Yang YS, Kim SY, Hur MH, Oh KY (2014) Natural orifice transluminal endoscopic surgery-assisted versus single-port laparoscopic-assisted vaginal hysterectomy: a case-matched study. J Minim Invasive Gynecol 21:624–631

    Article  Google Scholar 

  6. Yang YS, Hur MH, Oh KY, Kim SY (2013) Transvaginal natural orifice transluminal endoscopic surgery for adnexal masses. J Obstet Gynaecol Res 39:1604–1609

    Article  Google Scholar 

  7. Kim SH, Jin CH, Hwang IT, Park JS, Shin JH, Kim DW, Seo YS, Sohn JN, Yang YS (2018) Postoperative outcomes of natural orifice transluminal endoscopic surgery-assisted vaginal hysterectomy and conventional laparoscopic-assisted vaginal hysterectomy: a comparative study. Obstet Gynecol Sci 61:261–266

    Article  Google Scholar 

  8. Paraiso MF (2014) Robotic-assisted laparoscopic surgery for hysterectomy and pelvic organ prolapse repair. Fertil Steril 102:933–938

    Article  Google Scholar 

  9. Falcone T (2014) Introduction: robot-assisted laparoscopic surgery. Fertil Steril 102:909–910

    Article  Google Scholar 

  10. Matanes E, Lauterbach R, Boulus S, Amit A, Lowenstein L (2018) Robotic laparoendoscopic single-site surgery in gynecology: a systematic review. Eur J Obstet Gynecol Reprod Biol 231:1–7

    Article  Google Scholar 

  11. Kane S, Stepp KJ (2010) Laparo-endoscopic single-site surgery hysterectomy using robotic lightweight endoscope assistants. J Robot Surg 3(4):253–255

    Article  Google Scholar 

  12. Buckley de Meritens A, Kim J, Dinkelspiel H, Chapman-Davis E, Caputo T, Holcomb KM (2017) Feasibility and learning curve of robotic laparoendoscopic single-site surgery in gynecology. J Minim Invasive Gynecol 24(2):323–328

    Article  Google Scholar 

  13. Haber GP, Crouzet S, Kamoi K, Berger A, Aron M, Goel R, Canes D, Desai M, Gill IS, Kaouk JH (2008) Robotic NOTES (natural orifice translumenal endoscopic surgery) in reconstructive urology: initial laboratory experience. Urology 71:996–1000

    Article  Google Scholar 

  14. Hagen ME, Wagner OJ, Inan I, Morel P, Fasel J, Jacobsen G, Spivack A, Thompson K, Wong B, Fischer L, Talamini M, Horgan S (2010) Robotic single-incision transabdominal and transvaginal surgery: initial experience with intersecting robotic arms. Int J Med Robot 6(3):251–255

    Article  Google Scholar 

  15. Lee CL, Wu KY, Su H, Han CM, Huang CY, Yen CF (2015) Robot-assisted natural orifice transluminal endoscopic surgery for hysterectomy. Taiwan J Obstet Gynecol 54(6):761–765

    Article  Google Scholar 

  16. Bossotti M, Bona A, Borroni R, Mattio R, Coda A, Ferri F, Martino F, Dellepiane M (2001) Gasless laparoscopic-assisted ileostomy or colostomy closure using an abdominal wall-lifting device. Surg Endosc 15:597–599

    Article  CAS  Google Scholar 

  17. Akira S, Abe T, Igarashi K, Nishi Y, Kurose K, Watanabe M, Takeshita T (2005) Gasless laparoscopic surgery using a new intra-abdominal fan retractor system: an experience of 500 cases. J Nippon Med Sch 72:213–216

    Article  Google Scholar 

  18. Ishida H, Hashimoto D, Inokuma S, Nakada H, Ohsawa T, Hoshino T (2003) Gasless laparoscopic surgery for ulcerative colitis and familial adenomatous polyposis: initial experience of 7 cases. Surg Endosc 17:899–902

    Article  CAS  Google Scholar 

  19. Hoekstra AV, Jairam-Thodla A, Rademaker A, Singh DK, Buttin BM, Lurain JR, Schink JC, Lowe MP (2009) The impact of robotics on practice management of endometrial cancer: transitioning from traditional surgery. Int J Med Robot 5:392–397

    Article  Google Scholar 

  20. Advincula AP, Wang K (2009) Evolving role and current state of robotics in minimally invasive gynecologic surgery. J Minim Invasive Gynecol 16:291–301

    Article  Google Scholar 

  21. Liu H, Lu D, Wang L, Shi G, Song H, Clarke J (2012) Robotic surgery for benign gynaecological disease. Cochrane Database Syst Rev. https://doi.org/10.1002/14651858.CD008978.pub2

    Article  PubMed  Google Scholar 

  22. Wright JD, Ananth CV, Lewin SN, Burke WM, Lu YS, Neugut AI, Herzog TJ, Hershman DL (2013) Robotically assisted vs laparoscopic hysterectomy among women with benign gynecologic disease. JAMA 309:689–698

    Article  CAS  Google Scholar 

  23. Wright JD, Ananth CV, Tergas AI, Herzog TJ, Burke WM, Lewin SN, Lu YS, Neugut AI, Hershman DL (2014) An economic analysis of robotically assisted hysterectomy. Obstet Gynecol 123:1038–1048

    Article  Google Scholar 

  24. Baekelandt JF, De Mulder PA, Le Roy I, Mathieu C, Laenen A, Enzlin P, Weyers S, Mol BWJ, Bosteels JJA (2018) Transvaginal natural orifice transluminal endoscopic surgery (vNOTES) adnexectomy for benign pathology compared with laparoscopic excision (NOTABLE): a protocol for a randomised controlled trial. BMJ Open 8:e018059

    Article  Google Scholar 

  25. Ishikawa M, Nakagawa T, Nishioka M, Ogata S, Miyauchi T, Kashiwagi Y, Uemura N, Inoue S (2006) Costs and benefits of laparoscopic cholecystectomy: abdominal wall lifting vs. pneumoperitoneum procedure. Hepatogastroenterology 53:497–500

    CAS  PubMed  Google Scholar 

  26. Woolley DS, Puglisi RN, Bilgrami S, Quinn JV, Slotman GJ (1995) Comparison of the hemodynamic effects of gasless abdominal distention and CO2 pneumoperitoneum during incremental positive end-expiratory pressure. J Surg Res 58:75–80

    Article  CAS  Google Scholar 

  27. Paek J, Lee JD, Kong TW, Chang SJ, Ryu HS (2016) Robotic single-site versus laparoendoscopic single-site hysterectomy: a propensity score matching study. Surg Endosc 30:1043–1050

    Article  Google Scholar 

  28. Scheib SA, Fader AN (2015) Gynecologic robotic laparoendoscopic single-site surgery: prospective analysis of feasibility, safety, and technique. Am J Obstet Gynecol 212:179.e1–179.e8

    Article  Google Scholar 

  29. Moukarzel LA, Fader AN, Tanner EJ (2017) Feasibility of robotic-assisted laparoendoscopic single-site surgery in the gynecologic oncology setting. J Minim Invasive Gynecol 24:258–263

    Article  Google Scholar 

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Authors and Affiliations

  1. Department of Obstetrics and Gynecology, Eulji University Hospital, 1306 Doonsan-dong, Daejeon, 302-799, Korea

    Yun Seok Yang

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  1. Yun Seok Yang
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Correspondence to Yun Seok Yang.

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Disclosures

Dr. Yun Seok Yang has no conflict of interest or financial ties to disclose.

Ethical approval

The study protocol was reviewed and approved by the institutional review board at Eulji University Hospital in 2018 (reference number 2018-11-026).

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Yang, Y.S. Robotic natural orifice transluminal endoscopic surgery (NOTES) hysterectomy as a scarless and gasless surgery. Surg Endosc 34, 492–500 (2020). https://doi.org/10.1007/s00464-019-07115-z

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  • DOI: https://doi.org/10.1007/s00464-019-07115-z

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