Total Transvaginal Vaginal Hysterectomy Using a Novel Robotic Approach

Abstract

Study Objective This technique video illustrates a novel hysterectomy procedure using a humanoid shaped robot assisted surgical system designed to combine the advantages of laparoscopic surgery, robot assisted surgery and the vaginal approach. Design N/A Setting N/A Patients or Participants N/A Interventions Total transvaginal laparoscopic hysterectomy with salpingectomy or salpingo-oophorectomy performed with a novel robotic system This system is an endoscopic instrument control system intended for single site, transvaginal surgical procedures. The robot consists of two flexible snake-like robotic arms mimicking the human arm. Each end effector includes a monopolar spatula and bipolar graspers. Measurements and Main Results During this procedure, transvaginal access is achieved using a GYN trocar kit. The two robotic arms are inserted transvaginally into the pelvic cavity through the pouch of Douglas, under visual guidance of a laparoscopic camera which is inserted per standard transumbilical procedures. After accessing the pelvic cavity, the robotic arms are retro-flexed towards the point of entry. With this retroflexion, the arms are positioned in the pelvic cavity at an orientation comparable to those of standard, transumbilical laparoscopic instruments, thus allowing the surgeon to perform the procedure from a familiar vantage point and in a manner not possible with traditional manual vaginal tools. The surgeon controls joysticks while the robotic arms mimic the movements of the joystick. Standard uterine manipulators may be used as deemed necessary and the target organs are removed through the posterior fornix. Conclusion This video demonstrates how this new robotic technology enables performance of laparoscopic gynecologic procedures such as benign hysterectomy and salpingo-oophorectomy using single-site transvaginal access. This technique video illustrates a novel hysterectomy procedure using a humanoid shaped robot assisted surgical system designed to combine the advantages of laparoscopic surgery, robot assisted surgery and the vaginal approach. N/A N/A N/A Total transvaginal laparoscopic hysterectomy with salpingectomy or salpingo-oophorectomy performed with a novel robotic system This system is an endoscopic instrument control system intended for single site, transvaginal surgical procedures. The robot consists of two flexible snake-like robotic arms mimicking the human arm. Each end effector includes a monopolar spatula and bipolar graspers. During this procedure, transvaginal access is achieved using a GYN trocar kit. The two robotic arms are inserted transvaginally into the pelvic cavity through the pouch of Douglas, under visual guidance of a laparoscopic camera which is inserted per standard transumbilical procedures. After accessing the pelvic cavity, the robotic arms are retro-flexed towards the point of entry. With this retroflexion, the arms are positioned in the pelvic cavity at an orientation comparable to those of standard, transumbilical laparoscopic instruments, thus allowing the surgeon to perform the procedure from a familiar vantage point and in a manner not possible with traditional manual vaginal tools. The surgeon controls joysticks while the robotic arms mimic the movements of the joystick. Standard uterine manipulators may be used as deemed necessary and the target organs are removed through the posterior fornix. This video demonstrates how this new robotic technology enables performance of laparoscopic gynecologic procedures such as benign hysterectomy and salpingo-oophorectomy using single-site transvaginal access.