Surgical Outcomes of Hysterectomy Via Robotic Assisted Versus Traditional Transvaginal Natural Orifice Transluminal Endoscopic Surgery

Abstract

<h3>Study Objective</h3> To evaluate the safety and feasibility of robotic assisted transvaginal natural orifice transluminal endoscopic surgery (R-vNOTES) hysterectomy when compared to traditional vNOTES (T-vNOTES) hysterectomy. <h3>Design</h3> A retrospective chart review. <h3>Setting</h3> An academic tertiary setting. <h3>Patients or Participants</h3> 114 patients with benign gynecologic indication for hysterectomy. <h3>Interventions</h3> T-vNOTES or R-vNOTES hysterectomy performed by a single minimally invasive gynecologic surgeon in the study period. <h3>Measurements and Main Results</h3> The primary outcome of this study was surgical equivalence, measured principally by total operative time between T-vNOTES and R-vNOTES hysterectomy. Secondary operative outcomes measured included estimated blood loss, length of hospital stay, reported postoperative pain levels, and number of conversions. 79 women underwent T-vNOTES hysterectomy and 35 women underwent R-vNOTES hysterectomy without differences in operative time (p = .37), estimated blood loss (p = .27), length of hospital stay (p = .06), or reported postoperative pain levels at weeks 1, 2, and 3 after surgery (p = .78, p = .36, p = .38, respectively). 6 patients underwent conversion in the T-vNOTES hysterectomy group compared to 0 in the R-vNOTES hysterectomy group; however, this was not statistically significantly different, and there were no conversions to laparotomy. <h3>Conclusion</h3> Robotic vNOTES hysterectomy is a feasible approach to surgery when compared to traditional vNOTES hysterectomy and warrants further consideration as a skillset in a gynecologic surgeon's toolbox. Wristed instruments may allow surgeons unexperienced in single site laparoscopy to more quickly adopt vNOTES as a new technique when performing hysterectomy through a comparable minimally invasive approach.