Natural Transluminal Endoscopic Surgery Research Articles

Repeated transvaginal natural orifice transluminal endoscopic surgery: An initial Chinese experience.

To investigate the perioperative outcomes and sexual function of patients undergoing repeated transvaginal natural orifice transluminal endoscopic surgery (vNOTES). We retrieved the records of patients who underwent vNOTES twice at our institute between April 2019 and December 2022 and analyzed their baseline information and perioperative complications, and compared the pre- and postoperative sexual function of both vNOTES. Patients' mean age and body mass index were 29.00 ± 3.59 and 30.4 ± 4.00 years and 21.89 ± 3.69 and 22.76 ± 3.88 kg/m2 , respectively, when receiving the first and second vNOTES. Ectopic pregnancy was the most frequent indication for vNOTES, with 7 cases in the first vNOTES and 11 cases in repeated vNOTES. The interval between the two vNOTESs ranged from 9 days to 38 months. The operation duration (63.33 ± 13.71 vs. 67.33 ± 22.51 min, p = 0.723), intraoperative estimated blood loss (32.00 ± 20.42 vs. 30.00 ± 9.26 mL, p = 0.429), and duration of postoperative hospital stay (2.20 ± 0.56 vs. 2.40 ± 0.51 days, p = 0.082) of both vNOTESs were comparable. No significant differences were found in any of the domains in the comparison of pre-first and post-first vNOTES, pre-second and post-second vNOTES, and pre-first and post-second vNOTES female sexual function index. None of the patients delivered after the second vNOTES. Repeated vNOTES is safe and feasible. No significant change in the patients' sexual function was found in our cohort after the first and second vNOTES.

Robotic-assisted vaginal natural orifice transluminal endoscopic surgery versus robotic-assisted single-site port for benign hysterectomy: a comparison of surgical outcomes.

The objective of this study is to evaluate the surgical outcomes for robotic-assisted vaginal natural orifice transluminal endoscopic surgery (R-VNOTES) hysterectomy versus robotic-assisted single-site port (RSSP) hysterectomy when performed for benign indications. This is a retrospective chart review in an academic tertiary setting. 404 patients underwent hysterectomy for benign indications. R-VNOTES hysterectomy and RSSP hysterectomy were performed by a single minimally invasive gynecologic surgeon from January 2015 to August 2022. The primary outcome of our study was total operative time (minutes). Secondary outcomes included estimated blood loss (mL), length of hospital stay (days), and postoperative pain score. Other intraoperative and postoperative surgical complications were also compared. 159 patients underwent R-VNOTES hysterectomy, and 269 patients underwent RSSP hysterectomy. Median length of surgery (minutes) demonstrated a statistically significant shorter operative time in the R-VNOTES hysterectomy group when compared to the RSSP hysterectomy group, (132min versus 146min, respectively, p = 0.0001). Additionally, patients in the R-VNOTES hysterectomy group experienced decreased postoperative pain levels at week 1 (6 versus 7, respectively, p = 0.01) and week 3 (1.5 versus 2.5, respectively, p = 0.01) after surgery. There were no statistically significant differences between the two groups when comparing length of hospital stay, estimated blood loss, and weight of the uterus. There was no difference in rates of urinary tract infection, blood transfusion, bowel injury, readmission, reoperation, conversion, deep surgical site infection, and venous thromboembolism between both groups. However, there was a higher rate of superficial SSI in the RSSP hysterectomy group (0.6% versus 4.5%, respectively, p = 0.03). When compared to RSSP hysterectomy, R-VNOTES hysterectomy is safe and feasible, as both approaches have comparable surgical outcomes. Patients undergoing R-VNOTES hysterectomy had shorter length of surgery, decreased postoperative pain, and lower rates of superficial surgical site infections.

Omentectomy for oncological surgical staging by transvaginal natural orifice transluminal endoscopic surgery (vNOTES): a preliminary study.

This study aimed to determine the feasibility of performing omentectomy by transvaginal natural orifice transluminal endoscopic surgery (vNOTES) for surgical staging of ovarian and high-risk endometrial malignancies. This descriptive study was realized in a non-university hospital in Switzerland. Eighteen patients with suspicious adnexal masses or high-risk endometrial cancer underwent surgical staging comprising infracolic omentectomy by vNOTES between May 2020 and April 2023. Patients underwent oncological surgical staging for suspicious adnexal masses in 14 cases (77.8%) and high-risk endometrial cancer in 4 cases (22.2%). vNOTES omentectomies were performed in all patients without complications. Associated procedures included salpingo-oophorectomy (94.4%), hysterectomy (55.6%), peritoneal biopsies (33.3%), pelvic sentinel lymph node biopsies (22.2%), and appendectomy (5.6%). The median time to perform omentectomies was 9 (4-13) min. All oncological staging were completed by vNOTES. No significant intraoperative complications occurred. We observed 1 case (5.6%) of postoperative fever probably associated with vaginal cuff infection (Clavien-Dindo grade II). This study demonstrated the feasibility of performing vNOTES oncological staging requiring complex extrapelvic procedures such as infracolic omentectomy, supporting its potential role for managing gynecological malignancies such as ovarian and high-risk endometrial cancers. However, before expanding this approach outside study settings, strong evidence of its feasibility, practical benefits, and long-term oncological outcomes are needed.

SINGLE-INCISION LAPAROSCOPY VERSUS STANDARD LAPAROSCOPY FOR COLORECTAL SURGERY : A SYSTEMATIC REVIEW

Background: Colorectal cancer (CRC) is the third most prevalent malignancy worldwide. Only surgical resection is curative for colorectal cancer. Recent advances in surgical techniques, such as robot-assisted laparoscopic surgery (RALS), single-incision laparoscopic surgery (SILS), and natural orifice transluminal endoscopic surgery (NOTES), etc., have benefited colorectal cancer patients tremendously. The aim: This study aims to compare single-incision laparoscopy and conventional laparoscopy for colorectal surgery. Methods: By comparing itself to the standards set by the Preferred Reporting Items for Systematic Review and Meta-Analysis (PRISMA) 2020, this study was able to show that it met all of the requirements. So, the experts were able to make sure that the study was as up-to-date as it was possible to be. For this search approach, publications that came out between 2013 and 2023 were taken into account. Several different online reference sources, like Pubmed and SagePub, were used to do this. It was decided not to take into account review pieces, works that had already been published, or works that were only half done. Result: In the PubMed database, the results of our search brought up 201 articles, whereas the results of our search on SagePub brought up 119 articles. The results of the search conducted for the last year of 2013 yielded a total 54 articles for PubMed and 23 articles for SagePub. In the end, we compiled a total of 16 papers, 11 of which came from PubMed and 5 of which came from SagePub. We included six research that met the criteria. Conclusion: Previous studies have consistently shown that complications within 30 days postoperatively and incision size in patients with single port are better than patients with multiport. Perioperative outcome and long-term survival rates were similar between the two groups.

Comparing vNOTES Hysterectomy with Laparoscopic Hysterectomy for Large Uteri

Our study aimed to compare conventional laparoscopic hysterectomies (LHs) with vaginal natural orifice transluminal endoscopic surgery (vNOTES) hysterectomies performed for patients with large uteri (weight >280 g) at our institution, which underwent a change in practice from conventional LH to vNOTES for large uteri. Retrospective cohort. French tertiary university hospital. Two cohorts: the last 54 patients who underwent vNOTES hysterectomy and the last 52 patients who underwent conventional LH for large uteri. Baseline characteristics and surgical outcomes were assessed, including uterine weight, mode of delivery for previous pregnancies, history of abdominal surgery, indication for hysterectomy, associated procedures, operative time (OT), complications, volume of intraoperative bleeding, and length of postoperative hospital stay. Both groups were comparable, with a mean uterine weight of 586.4 ± 289.2 g in the laparoscopy group compared with 686.7 ± 374.6 g in the vNOTES group. There was a significant decrease in the OT in the vNOTES group with a median of 99 minutes (66.5-138.5 minutes) compared with 171 minutes (131-208 minutes) in the laparoscopy group, p <.001. The length of hospital stay was also decreased in the vNOTES group with a median of 0.5 nights compared with 2 nights in the laparoscopy group, p <.001. More patients were managed in an ambulatory setting in the vNOTES group (50% vs 3.7%, p <.001). Our study did not find any significant difference in terms of bleeding or the number of conversions to another surgical approach. The frequency of intraoperative and postoperative complications was very low. Compared with the laparoscopic approach, vNOTES hysterectomy for large uteri (>280 g) is associated with decreased OT, a shorter hospital stay, and increased performance in the ambulatory setting.

Study on the Efficacy of "Information Platform + Self-Care Model" on the Health Status of Discharged Patients Following Vaginal Natural Orifice Transluminal Endoscopic Surgery.

To discuss the impact of the "information platform + self-care model" on the health status of discharged patients following vaginal natural orifice transluminal endoscopic surgery (vNOTES). Patients underwent vNOTES at a tertiary specialized women's and children's hospital in Chengdu. They were randomly assigned to one of two groups-the intervention group (29 patients) and the control group (29 patients). The control group received standard education after discharge, while the intervention group received guidance based on an "information platform + self-care model" on discharge; a questionnaire survey was conducted for both groups one month after discharge. The quality of life score in the intervention group was higher than that in the control group, and the difference was statistically significant (P < 0.05); the scores of the intervention group on dimensions such as vitality, general health perceptions, physical role functioning, social role functioning, emotional role functioning, and mental health, except for physical functioning (Z =0.034, P =0.973) and bodily pain (Z =1.470, P =0.141), were higher than those in the control group one month after discharge, and the difference was statistically significant (P <0.05). There was no patient (0) in the intervention group who had an unscheduled visit/admission, and there was 1 patient (3.6%) in the control group who had unscheduled visit/admission; there were no statistical differences between the two groups in the number of patients who had an unscheduled visit/admission 1 month after discharge (P =0.491). The application of the "information platform + self-care model" can, to a certain extent, improve the health status of patients following vNOTES after discharge, and it can also reduce unscheduled visits/admissions, but more research with a larger sample size is required.

Retracted: Hysterectomy by Transvaginal Natural Orifice Transluminal Endoscopic Surgery versus Transumbilical Laparoscopic Single-Site Surgery: A Single-Center Experience from East China.

[This retracts the article DOI: 10.1155/2022/8246761.].

Transvaginal natural orifice endoscopic surgery for ovarian cystectomy: a more suitable surgical approach for the day-care procedure.

Although previous studies have shown that vaginal natural orifice transluminal endoscopic surgery (vNOTES) has the advantages of causing less pain, faster recovery, and better concealment of surgical incisions, which aligns with the concept of the day-care procedure, this approach poses a greater risk of damaging adjacent organs (i. e., rectum and bladder) due to its anatomical specificity. Moreover, the day-care procedure may lead to relatively less preoperative evaluation and postoperative care. Hence, it is necessary to explore the safety and effectiveness of vNOTES for ovarian cystectomy in the day-care procedure, to provide a theoretical basis for the wider development of vNOTES surgery. This retrospective study included 131 patients at our hospital who underwent ovarian cystectomy from September 2021 to October 2022. Based on the surgical approach, patients were classified into transumbilical laparoendoscopic single-site surgery (LESS) and vNOTES groups. The patients' demographic characteristics and follow-up data were collected during the perioperative period and 1-month postoperatively. Vaginal natural orifice transluminal endoscopic surgery has less postoperative exhaust time, a lower postoperative 6-hour pain score, and a lower incidence of analgesic drug use, with higher surgical conversion incidence. Multiple linear regression analysis showed that the surgical conversion, chocolate cyst, bilateral cyst, and pelvic adhesion increased the operation duration by ~43 (95% CI: 10.309, 68.152, p < 0.001), 15 (95% CI: 6.342, 45.961, p = 0.036), 10 (95% CI: 3.07, 40.166, p = 0.019), and 8 (95% CI: 4.555, 26.779, p = 0.035) min, respectively. Interestingly, vNOTES decreased the operation duration by ~8.5 min (95% CI: -18.313, -2.699, p = 0.033). Vaginal natural orifice transluminal endoscopic surgery was equally safe and effective for ovarian cystectomy compared to LESS. vNOTES aligned with the concept of the day-care procedure due to its reduced postoperative pain, shorter exhaust time, and absence of scarring. However, surgeons should conduct a comprehensive preoperative evaluation and exclude patients suspected to have severe pelvic adhesions.

Open, Laparoscopic, and Robotic Approaches to Treat Colorectal Cancer: A Comprehensive Review of Literature.

Surgery is usually required to treat colorectal cancer (CRC). Medical technology has advanced, providing various approaches to tackle this disease. Different surgeries are available, such as laparoscopic surgery, single-incision laparoscopic surgery, natural orifice transluminal endoscopic surgery, and robotic surgery. Laparoscopic surgery has several benefits including reduced blood loss and shorter recovery time. It can also improve lung function and minimize complications. However, it requires more time to perform and has a higher risk of complications during the procedure. Robotic surgery provides a three-dimensional view of the surgical area allowing for greater precision in rectal surgeries and access to difficult-to-reach pelvic regions. This method utilizes robotics technology which reduces surgical time and speeds up recovery for patients. There are various surgical options available for treating CRC; however, laparoscopic surgery and robotic surgery offer unique advantages despite their own drawbacks. As technology continues to evolve, medical techniques will continue improving existing methods while providing new options resulting in better outcomes for patients. Compared to laparoscopy, robotic surgery has a lower rate of operative conversions and a shorter learning curve. However, it also has some drawbacks, such as a longer docking time, lack of tactile sensation, and higher cost. Therefore, the choice of surgical method should depend on patient characteristics, surgeon preference and expertise, and available resources. Currently, specialized centers offer robotic surgeries which are more expensive and take longer compared to open and laparoscopic approaches. Nonetheless, they are considered safe and feasible when compared to traditional surgery. Short-term outcomes for robotic surgeries are better, while long-term postoperative complicationrates remain similar. However, there is a need for additional well-defined randomized control trials conducted across multiple centers to validate the use of robotic surgery over open and laparoscopic approaches. Improving patient care and outcomes is the objective of this comprehensive literature overview on surgical approaches for CRC.

Hysteresis Modeling and Compensation for Tendon-Sheath Mechanisms in Robot-Assisted Endoscopic Surgery Based on the Modified Bouc-Wen Model With Decoupled Model Parameters

The tendon-sheath mechanism (TSM) has been widely applied in flexible endoscopy (FE) and natural orifice transluminal endoscopic surgery (NOTES) owing to its advantages of remote force and displacement transmission, size reduction, compactness, and convenient implementation. However, the positioning accuracy of TSMs is highly restrained by the motion hysteresis due to the complex friction condition between the tendon and sheath. The hysteresis phenomenon has posed significant challenges for modeling and controlling TSMs. This paper proposes a modified Bouc-Wen-based mathematical model to characterize the asymmetric hysteresis loop with distinct inflection points. The model parameters are decoupled, facilitating identification and reducing computational costs. Moreover, the model has retained the Bouc-Wen model structure, allowing for efficient derivation of the feedforward compensator based on the inverse multiplicative structure. The compensator was derived and cascaded with the TSM system to suppress the hysteresis phenomenon. Totally 120 trials of experiments were conducted to validate the proposed model and the feedforward control scheme on the two TSMs with different accumulated curvatures of 180∘ and 360∘. The results indicated that the proposed method achieved a 25.5% and 43.9% lower estimation and compensation error than the classical Bouc-Wen model. Further, it is worth noting that the model parameter identification time consumption has been significantly reduced to 5.8ms. The proposed model and the feedforward compensator can effectively linearize the TSM system and further facilitate delicate operations in robot-assisted surgical procedures.

Path Planning and Navigation of Miniature Serpentine Robot for Bronchoscopy Application.

The miniature serpentine robot can be applied to NOTES (Natural Orifice Transluminal Endoscopic Surgery). In this paper, a bronchoscopy application is addressed. This paper describes the basic mechanical design and control scheme of this miniature serpentine robotic bronchoscopy. In addition, off-line backward path planning and real-time and in situ forward navigation in this miniature serpentine robot are discussed. The proposed backward-path-planning algorithm utilizes the 3D model of a bronchial tree constructed from the synthetization of medical images such as images from CT (Computed Tomography), MRI (Magnetic Resonance Imaging), or X-ray, to define a series of nodes/events backward from the destination, for example, the lesion, to the original starting point, for example, the oral cavity. Accordingly, forward navigation is designed to make sure this series of nodes/events shall be passed/occur from the origin to the destination. This combination of backward-path planning and forward navigation does not require accurate positioning information of the tip of the miniature serpentine robot, which is where the CMOS bronchoscope is located. Collaboratively, a virtual force is introduced to maintain the tip of the miniature serpentine robot at the center of the bronchi. Results show that this method of path planning and navigation of the miniature serpentine robot for bronchoscopy applications works.

Comparing outcomes of ovarian cystectomy by vaginal natural orifice transluminal endoscopic surgery versus laparoendoscopic single-site surgery: A retrospective cohort study.

We aimed to compare the outcomes of ovarian cystectomy (OC) performed by vaginal natural orifice transluminal endoscopic surgery (vNOTES) vs transumbilical laparoendoscopic single-site surgery (LESS). We retrospectively analyzed the data of patients in our hospital who underwent OC either by vNOTES or LESS between January 2015 and September 2021. Demographic data were collected. The primary outcome was the conversion rate. The secondary outcomes were the duration of surgery, length of hospital stay, estimated blood loss, maximum body temperature within 48 hours after operation, and duration of maximum body temperature (hours), among others. Statistical analysis was done using the SPSS software. Exactly 284 patients were screened. The vNOTES and LESS groups consisted of 21 and 47 patients, respectively. There was no significant difference in the conversion rates between the two groups (0 vs 8.5% in vNOTES and LESS, respectively; p = 0.303). Compared with the vNOTES group, the LESS group had a larger cyst diameter (6.00 ± 2.32 vs 4.69 ± 1.29 cm; p = 0.004), more endometriotic cysts (42.6% vs 9.5%; p < 0.001), and more pelvic adhesions requiring adhesiolysis (57.4% vs 19.0%; p = 0.003). At baseline, there were no other differences between the groups. The secondary outcomes included a shorter duration of surgery (70.14 ± 27.30 vs 99.57 ± 36.26 minutes; p = 0.001) and lower estimated blood loss (64.29 ± 39.19 vs 163.43 ± 251.20 mL; p = 0.011) in the vNOTES group. Regression analysis showed the diameter of the ovarian cyst correlated with surgical time. The complication was comparable between the two groups. Above all, the advantages of vNOTES include an absence of visible scars, shorter surgical duration, and less blood loss when compared with LESS. Further large-scale prospective trials should confirm the results of our study.

Posterior rectus fascia prolapse (PREFAP) repair: a new native tissue approach to pelvic organ prolapse via vaginal natural orifice transluminal endoscopic surgery.

Pelvic organ prolapse (POP) is a common condition in women. During lifetime, up to 40% of all women will develop (POP). Between June and December 2021, five patients were successfully treated via vNOTES Posterior Rectus Fascia Prolapse ( PREFAP) repair. No intra-operative complications or conversions occurred. In this study we demonstrated a new technique for prolapse repair, harvesting the autologous posterior rectus fascia sheath via vaginal natural orifice transluminal endoscopic surgery (vNOTES) as an alternative for a synthetic mesh.

Dexterity enhancement of continuum robot for natural orifice transluminal endoscopic surgery in the dual-manipulator collaborative space.

Suturing and knotting in Natural Orifice Transluminal Endoscopic Surgery (NOTES) requires the robot not only to be able to work with multiple manipulators but also to have a high degree of dexterity. However, little attention has been paid to the design and enhancement of dexterity in multi-manipulated robots. In this paper, the dexterity of a new dual-manipulator collaborative continuum robot in collaborative space is analyzed and enhanced. A kinematic model of the continuum robot was developed. The dexterity function of the robot is evaluated based on the concepts of the low-Degree-of-FreedomJacobian matrix. Then an Adaptive Parameter Gray Wolf Coupled Cuckoo Optimization Algorithm with faster convergence and higher accuracy is innovatively proposed to optimize the objective function. Finally, experiments demonstrate that the dexterity of the optimized continuum robot is enhanced. The optimization results show that the optimized dexterity is 24.91% better than the initial state. Through the work of this paper, the robot for NOTES can perform suturing and knot more dexterously, which has significant implications for the treatment of digestive tract diseases.

Adaptive Control of a Master-Slave Based Robotic Surgical System With Haptic Feedback

A master-slave (M-S) based robotic surgical system with haptic feedback is presented in this work for natural orifice transluminal endoscopic surgery (NOTES) using an in-vivo robot. A novel dual-loop control, including closed-loop inverse kinematics (CLIK) and adaptive control with optimal control parameters, is developed for the slave robot to track a random trajectory upon updating the dynamic parameters of the slave robot. The interaction between the slave robot tip position and environment is controlled by an impedance controller that prevents damage to healthy tissues. Upon tracking a given desired 3D trajectory as input for the slave robot by the human operator handling the master robot, the slave robot-tissue interaction force is sensed as haptic feedback at the master side. Lyapunov direct method based stability analysis and performance evaluations involving both simulation and experimental studies prove the efficacy of our novelly developed M-S robotic system aiming NOTES regulated by the proposed adaptive control strategy with optimized control parameters. Note to Practitioners: The M-S based robotic surgical system is developed to perform NOTES using a cable-driven in-vivo robot attached to the tip of a flexible endoscope. It performs tissue manipulation as per the direction given by the operator. The inclusion of haptic imitates the NOTES performed using the in-vivo robot as conventional surgery. The developed system includes the following aspects: a) The adaptive control scheme with optimal control parameters; b) Interaction force between the slave robot and tissue environment is controlled using impedance control and given as haptic feedback to the surgeon; c) The proposed system can be potentially utilized for actual teleoperated surgery and surgical training for NOTES.

V03-04 FIRST HUMAN NOTES FOR BLADDER LEIOMYOMA ENUCLEATION AND CYSTORRAPHY

You have accessJournal of UrologyCME1 Apr 2023V03-04 FIRST HUMAN NOTES FOR BLADDER LEIOMYOMA ENUCLEATION AND CYSTORRAPHY Andreia Cardoso, Sara Anacleto, Catarina Laranjo Tinoco, Ricardo Matos Rodrigues, Ana Sofia Araújo, Mariana Capinha, Vera Marques, João Pimentel Torres, Carlos Oliveira, Miguel Mendes, and Emanuel Carvalho-Dias Andreia CardosoAndreia Cardoso More articles by this author , Sara AnacletoSara Anacleto More articles by this author , Catarina Laranjo TinocoCatarina Laranjo Tinoco More articles by this author , Ricardo Matos RodriguesRicardo Matos Rodrigues More articles by this author , Ana Sofia AraújoAna Sofia Araújo More articles by this author , Mariana CapinhaMariana Capinha More articles by this author , Vera MarquesVera Marques More articles by this author , João Pimentel TorresJoão Pimentel Torres More articles by this author , Carlos OliveiraCarlos Oliveira More articles by this author , Miguel MendesMiguel Mendes More articles by this author , and Emanuel Carvalho-DiasEmanuel Carvalho-Dias More articles by this author View All Author Informationhttps://doi.org/10.1097/JU.0000000000003241.04AboutPDF ToolsAdd to favoritesDownload CitationsTrack CitationsPermissionsReprints ShareFacebookLinked InTwitterEmail Abstract INTRODUCTION AND OBJECTIVE: Bladder leiomyomas (BL) are rare benign tumors, with roughly 250 cases reported worldwide. Surgical excision is the recommended treatment, classically through open partial cystectomy. As alternatives, minimally invasive approaches, such as laparoscopic (lap), robot-assisted and transurethral (TU) resection (TUR), are arising. In parallel, TU cystorraphy has been reported for vesicovaginal fistulas or traumatic perforations. Thus, to the best of our knowledge, we report the 1st Human Natural Orifice Transluminal Endoscopic Surgery (NOTES) with a purely TU approach for BL enucleation and cystorraphy, without transvesical access, gas insufflation, neither extracorporeal knot tying. METHODS: A 68-year-old woman presented an incidental 22mm lesion on the left posterolateral bladder wall on MRI, highly suspicious for BL. After cystocopic confirmation of a submucosal lesion, TUR was proposed. We performed a pioneer NOTES with total TU BL enucleation and cystorraphy using: 30° lens, white light only, saline irrigation, 26Ch resectoscope, operative cystoscope, Collin’s knife and standard resection loop, bipolar energy, 5mm lap needle holder and 3-0 V-Loc 23cm length suture. RESULTS: BL complete enucleation was done with bipolar energy on Collin’s knife and standard resection loop. Then, V-Loc suture was completely placed inside the bladder through the operative cystoscope, and with the lap needle holder inserted through it, a total intravesical cystorraphy with single hand continuous suture was performed. Operative time was 40min. Patient was discharged on the next day, with bladder catheter for 5 days. There were no complications. CONCLUSIONS: TUR has been used for BL, but without cystorraphy, which is a limitation for bigger or more profound infiltrative lesions. Cystorraphy techniques combining TU, transperitoneal and/or transmural bladder access were reported. A purely TU cystorraphy recently reported required extracorporeal sliding knot techniques, so, it was only possible in women. Thus, our approach may be the most minimally invasive possible for the safest treatment of BL. We combined several techniques aiming to reach an ideal one. Using only regular material, a single urethral route, and no gas insufflation, we achieved a quick and safe procedure, with no need for continuous bladder irrigation and short catheterization. Yet, it requires advanced skills such as single hand lap suturing. Our technique seems also feasible in small bladder perforations, fistulas, or other lesions (e.g.: endometriosis). Additionally, with total intravesical suture, it may also be viable in men. Source of Funding: None © 2023 by American Urological Association Education and Research, Inc.FiguresReferencesRelatedDetails Volume 209Issue Supplement 4April 2023Page: e247 Advertisement Copyright & Permissions© 2023 by American Urological Association Education and Research, Inc.MetricsAuthor Information Andreia Cardoso More articles by this author Sara Anacleto More articles by this author Catarina Laranjo Tinoco More articles by this author Ricardo Matos Rodrigues More articles by this author Ana Sofia Araújo More articles by this author Mariana Capinha More articles by this author Vera Marques More articles by this author João Pimentel Torres More articles by this author Carlos Oliveira More articles by this author Miguel Mendes More articles by this author Emanuel Carvalho-Dias More articles by this author Expand All Advertisement PDF downloadLoading ...

VNOTES Hysterectomy: What about Obese Patients?

To compare the surgical outcomes of hysterectomy by vaginal natural orifice transluminal endoscopic surgery (vNOTES) for patients with body mass index (BMI) <30 and BMI ≥30. A retrospective cohort study. A French teaching hospital. All patients who underwent a vNOTES hysterectomy from February 2020 to January 2022 were included (N=200). The vNOTES approach was chosen for all patients requiring a hysterectomy, unless the procedure was for endometriosis or cancer (except grade 1 endometrioid adenocarcinoma). Patients were categorized into 2 groups based on their BMI (<30 or ≥30 kg/m2). The population characteristics, surgical outcomes, and hospitalization outcomes were compared. The main outcome was the intraoperative conversion rate. Secondary end points were blood loss, operative time, perioperative and postoperative complications, and same-day surgery management. A total of 146 patients were included in the BMI <30 group, and 54 patients in the BMI ≥30 group. There was no statistical difference between obese and nonobese patients concerning intraoperative conversion (p=.150), with 4 cases occurring in the BMI <30 group (2.74%) and 4 occurring in the BMI ≥30 group (7.41%). Operative times were longer in obese patients (115.93 min [±55.28] vs 79.78 min [±40.38], p <.001). There was no significant difference in blood loss (p=.337) or perioperative and postoperative complications (p=.346 and p=.612, respectively). The ability to complete the surgery as a same-day procedure was no different between obese and nonobese patients (p=.150). The results concerning intraoperative conversion and perioperative and postoperative complications show that vNOTES hysterectomies seem to be feasible for obese patients. When same-day surgery was decided before surgery, no more obese than nonobese patients were converted to conventional hospitalization. Further studies are needed to confirm these observations.

Cumulative Sum Analysis of Learning Curve Process for Vaginal Natural Orifice Transluminal Endoscopic Surgery Hysterectomy

This study aimed to evaluate the learning curve of vaginal natural orifice transuminal endoscopic surgery (vNOTES) hysterectomy in expert minimal invasive and vaginal surgery team. This is a cohort study on a retrospective analysis. Department of Obstetrics and Gynecology of Cannizzaro Hospital in Catania Italy. First 50 women underwent vNOTES hysterectomy between February 2021 and February 2022. vNOTES hysterectomy performed by a team with optimal skills in laparoscopic and vaginal surgery. Primary outcome was surgical time. Secondary outcomes were intraoperative and postoperative complications, length of hospitalization, and first 24-hour postoperative pain. All patients underwent hysterectomy for benign indications: 27 fibromatosis, 13 metrorrhagia, and 10 precancerous. Concomitant procedures have been bilateral adnexectomy in 35 cases and bilateral salpingectomy in 15 cases. The median age was 51 years (range, 42-64). Median body mass index was 26 kg/m2 (range, 21-42). The median operative time was 75 minutes (range, 40-110). The median hospital stay was 2 days (range, 1-4). There was 1 intraoperative adverse event (bladder lesion) and 1 postoperative grade 3 complication (hemoperitoneum). The median visual analog scale score for pain assessment during the first 24 hours after surgery was 3 (range, 1-6). The experience in our surgical center with the first 25 vNOTES hysterectomies showed an accumulation of initial experience in the first 5 cases with stable operating time and a gradual reduction of mean operating time in the subsequent 17 surgeries. The learning curve plotted by cumulative sum analysis shows 3 phases: phase 1 of competence (cases 1-5), phase 2 of proficiency (cases 6-26), and phase 3 of mastering the procedure (after the 31st case) with the management of more complex cases. vNOTES hysterectomy is a feasible and reproducible approach for benign indications with a short learning curve and low rate of perioperative complications. For a team skilled in minimally invasive surgery, 5 cases are required to rich competence and 25 to rich proficiency in vNOTES hysterectomy. Mastering phase, with the introduction of more complex cases, should be addressed after 30 surgeries.

A Novel Distal Hybrid Pneumatic/Cable‐Driven Continuum Joint with Variable Stiffness Capacity for Flexible Gastrointestinal Endoscopy

The robot‐assisted flexible access surgery represented by the emerging robot‐assisted flexible endoscopy (FE) and natural orifice transluminal endoscopic surgery demands flexible and continuum manipulators instead of the rigid and straight instruments in the traditional minimally invasive surgery (MIS). These flexible manipulators are required to advance through the tortuous and narrow anatomic paths via natural orifices for dexterous diagnostic examination and therapeutic operations. Therefore, developing flexible endoscopic manipulators with the capacity of snake‐like movements for flexible access and variable stiffness regulation for operations to address these flexible access surgical difficulties is demanding but remains challenging. To address such challenges, herein, it is proposed that a novel distal continuum joint based on the hybrid pneumatic and cable‐driven approach achieves variable stiffness capacity, excellent bending characteristics in both flexible and rigid states, satisfactory motion consistency and shape‐locking ability during the rigid‐flexible transition, and relatively high loading capacity for flexible gastrointestinal endoscopic robots. Characterization experiments validate these performances, and phantom and ex vivo experiments have been performed to demonstrate the feasibility and effectiveness for FE. The presented method demonstrates an effective and practical approach to enabling continuum robots with both flexible access and tunable stiffness capacity and supports a convenient extension for MIS applications.

VNOTES (vaginal Natural Orifice Transluminal Endoscopic Surgery): is this the future of gynaecological surgery?

The Obstetrician & GynaecologistEarly View Commentary vNOTES (vaginal Natural Orifice Transluminal Endoscopic Surgery): is this the future of gynaecological surgery? Wai Yoong MD FRCOG, Corresponding Author Wai Yoong MD FRCOG [email protected] orcid.org/0000-0001-7286-5968 Consultant Obstetrician and Gynaecologist, Department of Obstetrics and Gynaecology, North Middlesex University Hospital, London, UKCorrespondence: Wai Yoong. Email: [email protected]Search for more papers by this authorVictoria Sampson MRCOG, Victoria Sampson MRCOG Consultant Obstetrician and Gynaecologist, Department of Obstetrics and Gynaecology, North Middlesex University Hospital, London, UKSearch for more papers by this authorLusekelo Mwenechanya MBBS, Lusekelo Mwenechanya MBBS Specialist Trainee, Department of Obstetrics and Gynaecology, North Middlesex University Hospital, London, UKSearch for more papers by this authorJan Baekelandt MD PhD, Jan Baekelandt MD PhD orcid.org/0000-0002-8344-8622 Gynaecological Oncologist, Department of Gynaecology, Imelda Hospital, Bonheiden, BelgiumSearch for more papers by this author Wai Yoong MD FRCOG, Corresponding Author Wai Yoong MD FRCOG [email protected] orcid.org/0000-0001-7286-5968 Consultant Obstetrician and Gynaecologist, Department of Obstetrics and Gynaecology, North Middlesex University Hospital, London, UKCorrespondence: Wai Yoong. Email: [email protected]Search for more papers by this authorVictoria Sampson MRCOG, Victoria Sampson MRCOG Consultant Obstetrician and Gynaecologist, Department of Obstetrics and Gynaecology, North Middlesex University Hospital, London, UKSearch for more papers by this authorLusekelo Mwenechanya MBBS, Lusekelo Mwenechanya MBBS Specialist Trainee, Department of Obstetrics and Gynaecology, North Middlesex University Hospital, London, UKSearch for more papers by this authorJan Baekelandt MD PhD, Jan Baekelandt MD PhD orcid.org/0000-0002-8344-8622 Gynaecological Oncologist, Department of Gynaecology, Imelda Hospital, Bonheiden, BelgiumSearch for more papers by this author First published: 20 February 2023 https://doi.org/10.1111/tog.12860Read the full textAboutPDF ToolsRequest permissionExport citationAdd to favoritesTrack citation ShareShare Give accessShare full text accessShare full-text accessPlease review our Terms and Conditions of Use and check box below to share full-text version of article.I have read and accept the Wiley Online Library Terms and Conditions of UseShareable LinkUse the link below to share a full-text version of this article with your friends and colleagues. Learn more.Copy URL Share a linkShare onFacebookTwitterLinkedInRedditWechat Early ViewOnline Version of Record before inclusion in an issue RelatedInformation