Robot-Assisted Vaginal Natural Orifice Transluminal Endoscopic Surgery (RvNOTES) with Total Hysterectomy for Management of Stage IV Endometriosis with/without Complete Cul-de-Sac Obliteration: 23-Case Pilot Feasibility Study

Abstract

Study ObjectiveTo show feasibility and short-term outcomes of robot-assisted vaginal NOTES (RvNOTES) for the treatment of stage IV endometriosis during total hysterectomy with/without complete cul-de-sac obliteration. DesignRetrospective case series. SettingSingle academic tertiary care hospital in Houston, Texas, USA. PatientsTwenty-three adult women with stage IV endometriosis. InterventionsRvNOTES with total hysterectomy for excision of severe endometriosis. Measurements and Main ResultsPatients were assessed for various metrics including total operative time, robot dock time, robot console time, hysterectomy time, estimated blood loss, perioperative pain using the Visual Analogue Scale (VAS), and complications. The mean total operative time was 224.3 minutes. The study also found that patients with complete cul-de-sac obliteration had significantly longer operative times and higher estimated blood loss compared to those with partial or no obliteration. Postoperative VAS pain scores showed a significant reduction over a 6-week period. Complications included one case of complete ureteral transection, pelvic hematoma with infection, vaginal abscess, urinary tract infection, and pneumonia. ConclusionOur findings suggest that RvNOTES may be a feasible surgical approach in expert hands for treating stage IV endometriosis, even in cases with complete obliteration of the cul-de-sac.