Natural Orifice Transluminal Endoscopic Surgery Hysterectomy Research Articles

Vaginal assisted NOTES hysterectomy in The Netherlands; A prospective cohort study

ObjectivesVaginal assisted Natural Orifice Transluminal Endoscopic Surgery (NOTES) combines the benefits of vaginal and endoscopic surgery. This study presents the results of the first vaginal assisted NOTES hysterectomies (VANH) in The Netherlands. Study designA prospective cohort study was performed in two non-academic teaching hospitals in The Netherlands. Data was collected from patients who underwent a VANH for benign indications between August 2019 and April 2023. Baseline characteristics and data of intra- and postoperative surgical outcomes were recorded and analysed. The VANHs were performed by four experienced vaginal and endoscopic gynaecological surgeons. ResultsA total of 200 patients underwent a VANH. Indications were dysfunctional menstrual bleeding (61 %; n = 122), abnormal cervical cytology (15.5 %; n = 31), abdominal pain (11.5 %; n = 23), post ablation/sterilization pain syndrome (3.5 %; n = 7), uterine fibroids (5.0 %; n = 10), atypical endometrial hyperplasia (2.5 %; n = 5) and Lynch or BRCA gene mutation carriers (1.0 %, n = 2). The mean surgical time was 61.4 min ( ± 22.8 min) with a mean blood loss of 88 mL ( ± 89 mL) and a mean uterine weight of 150 g ( ± 112 g). In 2.0 % (n = 4) of the cases a conversion was necessary. Same day discharge (SDD) was feasible in 80.2 % (n = 105) of the patients planned in day-care. In 2.0 % (n = 4) an intra-operative complication and in 9.0 % (n = 18) a post-operative complication occurred. ConclusionThis study shows vNOTES to be a safe and feasible surgical technique and can be safely implemented with appropriate patient selection and skilled surgeons. It highlights the importance of surgeon awareness of the challenges inherent in the initial stages of the implementation of a new surgical technique when performing their first vNOTES procedures. Additional randomized clinical trials are needed to show superiority of vNOTES compared to traditional surgery.

Robotic glove port technique for the endowristed rigid instruments in robotic single-site transabdominal and transvaginal surgery.

Although robotic single-site (RSS) surgery employing cross setup of semirigid instruments allows effective triangulation of instruments, it has some limitations in performing RSS transabdominal and transvaginal surgeries. We introduced the robotic glove port technique (RGPT) using parallel setup of endowristed rigid instruments in performing RSS transabdominal surgery and transvaginal surgery in July of 2017. Thirty-five patients underwent RSS surgery with RGPT. Twenty-one patients had RSS transabdominal reconstructive or fertility-preserving surgeries such as myomectomy (12 patients), adenomyomectomy (3 patients), and ovarian endometriosis cystectomy (6 patients). Fourteen patients underwent robotic transvaginal surgery for natural orifice transluminal endoscopic surgery (NOTES) hysterectomy. All procedures were successfully performed, and no postoperative complications were observed. In all patients, the median total operative time, console time, and docking time were 160min (range 106-240), 120min (range 65-180), and 10min (range 4-25), respectively. There was no conversion to another type of surgery, such as conventional laparoscopy, laparotomy, or traditional multiport robotic surgery. The findings showed that RSS surgery via the RGPT is safe and feasible, using the parallel setup of endowristed rigid instruments is easily performed on transvaginal routes and transabdominal routes. Therefore, this procedure may be an important complement to gynecologic surgeons' armamentarium in the field of robotic reconstructive or fertility-preserving surgeries such as myomectomy, adenomyomectomy, ovarian cystectomy, and transvaginal surgery for NOTES hysterectomy. Nevertheless, further prospective controlled studies are needed to determine its full clinical application.

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

To report a new surgical technique for hysterectomy using robotic natural orifice transluminal endoscopic surgery (NOTES) as a scarless and gasless procedure. Thirteen consecutive patients with benign uterine disease underwent robotic NOTES hysterectomy at Eulji University Hospital between February 2017 and May 2018. 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 290g (range 115-892g). Median docking and console times were 15min (range 5-25min) and 135min (range 92-215min), respectively. Mean change in hemoglobin on the first postoperative day was 0.67 ± 0.7g/dL. Median EBL was 50mL (20-450mL). Median postoperative hospital stay was 3days (3-4days). No patients experienced postoperative complications such as damage to adjacent organs, re-operation, or vaginal cuff hematoma. 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.

1867 Transvaginal Single-Port Laparoscopic Hysterectomy for Large Uterus

Video Objective To demonstrate the tansvaginal natural orifice transluminal endoscopic surgery (NOTES) hysterectomy for large uterine (the size of six months pregnancy) with combined transvaginal surgical and single-site surgical skills Setting Academic tertiary care hospital Patient A 55-year-old woman Interventions Transvaginal NOTES hysterectomy with combined transvaginal surgical and single-site surgical skills Measurements and Main Results A 55-year-old woman (gravida 2 para 2) with a preoperative magnetic resonance imaging diagnosis of myoma associated necrosis (the uterine is as large as 6 months pregnancy) requested hysterectomy and bilateral adnexectomy. She presented with a 5-year history of myoma. The operation took roughly 85 minutes, and total blood loss was approximately 100ml. The patient recovered well and was discharged 2 days after surgery. The pathology revealed a necrotic myoma. Conclusion Combined with traditional transvaginal anterior / posterior colpotomy, single-site surgical skills allow the surgeon to accomplish hysterectomy for large uterine without abdominal incision, and let patient recover rapidly.

224 - Natural Orifice Transluminal Endoscopic Surgery (NOTES) of Hysterectomy and Bilateral Salpingo-Oophrectomy for Female to Male Transgender Men

Hysterectomy is the most common procedure in department of gynecology. The indication varies. Here, we focused on female to male transgender men. Traditionally, we may perform vaginal hysterectomy, abdominal hysterectomy, total laparoscopic hysterectomy or laparoscopic assisted vaginal hysterectomy for them. Vaginal hysterectomy is advantageous in transgender men due to testosterone induced small uteri. However, because of low parity and testosterone use, the vagina quality is not good, and it makes vaginal hysterectomy more difficult. Here we present natural orifice transluminal endoscopic surgery(NOTES) of hysterectomy and bilateral salpingo-oophrectomy. This technique initiated like vaginal hysterectomy but offered better surgical field in the pelvic cavity. Therefore, it is good for checking bleeding and reduces blood loss. This surgery could also enhance cosmetic benefits which transgender men doesn't need to explain abdominal scar. In conclusion, NOTES hysterectomy is feasible for female to male transgender men.

Hysterectomy and ovarian cystectomy using natural orifice transluminal endoscopic surgery: An initial experience at Tzu Chi General Hospital.

Objectives:The objective of this study is to report our initial experience with patients undergoing transvaginal natural orifice transluminal endoscopic surgery (NOTES).Materials and Methods:From September 2016 to December 2016, patients who were not virgins and did not have pelvic inflammation or obliteration of the cul-de-sac who underwent NOTES hysterectomy or ovarian cystectomy (OC) were included in the study.Results:Transvaginal NOTES was performed smoothly in six patients, two patients (mean age 35 years, mean body mass index [BMI] 25) received an OC and four patients (mean age 49 years, mean BMI 27) underwent a hysterectomy. One patient with a hysterectomy received concurrent adhesiolysis. The mean surgical times were 74 and 75 min and blood loss was 50 and 87.5 ml in the OC and hysterectomy groups, respectively. One patient with a hysterectomy had a postoperative fever with 38°C last for 2 days. Pain scores were 0 at 48 h postoperatively in both groups.Conclusion:Transvaginal NOTES is a feasible and safe technique for hysterectomy and OC in our patients and those in previous reports. This procedure was minimally invasive with no scars on the abdomen as well as little pain.

Robotic Vaginal NOTES Hysterectomy: Two New Surgical Techniques

Abstract Objective: The aim of this research was to compare two new hysterectomy techniques by robotic vaginal natural orifice transluminal endoscopic surgery and to demonstrate that transvaginal robotic hysterectomy can be performed in nulliparous patients by natural orifice transluminal endoscopic surgery (NOTES). Materials and Methods: This research was conducted in a case series format. Previous experience with total vaginal NOTES hysterectomy (TVNH) and with transvaginal robotic surgery for robotic vaginally assisted NOTES hysterectomy (RVANH), led to the decision to combine these techniques to perform robotic TVNH (RTVNH) in nulliparous patients. Twenty patients were included in this study. In 10 nulliparous patients, RTVNH was performed. A gloveport was inserted into the vagina to create a pneumovagina. A Da Vinci Xi surgical robot was side-docked between the legs of each patient. The hysterectomy was performed via transvaginal NOTES using the surgical robot. Once the hysterectomy was completed, th...

Robot-assisted natural orifice transluminal endoscopic surgery for hysterectomy

ObjectiveTo describe the surgical procedures of robot-assisted natural orifice transluminal endoscopic surgery (NOTES) for hysterectomy and to evaluate its feasibility. Materials and methodsFrom December 2014 to February 2015, four patients with benign diseases who were eligible for robot-assisted NOTES at Chang Gung Memorial Hospital were recruited to this study. Intraoperative and postoperative surgical outcomes were evaluated. ResultsRobot-assisted NOTES hysterectomy was successfully performed in all these patients. None of the patients had vaginal delivery, with two being nulliparous. The mean ± standard error of the mean uterine weight was 365.5 ± 69.2 g, the mean operative time was 198.8 ± 39.0 minutes, the mean docking time was 38.3 ± 2.4 minutes, the mean blood loss was 180.0 ± 56.1 mL, and the mean postoperative hospital stay was 2.5 ± 0.3 days. The final pathologic diagnoses were adenomyosis and/or leiomyomas. ConclusionThe novel robot-assisted NOTES technology created scarless skin wounds. More importantly, the device allows the surgeon to reach deeper places to achieve hemostasis, and perform surgery on larger tumors using the curved cannulae-wristed instrument. However, its implementation is limited by the lack of appropriate instrumentation, which requires further development and break through. At this stage, robot-assisted NOTES is only useful for limited applications in highly selected patients.

Robotic vaginally assisted NOTES hysterectomy: the first case series demonstrating a new surgical technique

The objective of this case report is to demonstrate a new hysterectomy technique via transvaginal natural orifice transluminal endoscopic surgery (NOTES) using robotic surgery. Previous experience with the Da Vinci Xi (Intuitive Surgery) for gynaecological oncology, and with NOTES for adnexal surgery and hysterectomy, led to the decision to combine the advantages of these techniques, namely to reduce the invasiveness of robotic surgery and improve the ergonomics of NOTES. A robotic vaginally assisted NOTES hysterectomy (VANH) was performed in five patients with a myomatous uterus. The circumcision of the cervix, the opening of the anterior and posterior peritoneum and the transection of both sacro-uterine ligaments were performed by classical vaginal surgery. A NOTES port was constructed by assembling a surgical glove, a wound protector, 4 Da Vinci 8-mm trocars and 1 reusable 5-mm trocar. The ring of the wound protector was then inserted transvaginally into the peritoneal cavity to create a pneumoperitoneum. The hysterectomy was performed via transvaginal NOTES using the surgical robot. Subsequently, a bilateral adnexectomy was performed in the same way. Once the hysterectomy and bilateral adnexectomy were completed, the robot and gloveport were removed. When the uterus was too large to extract in toto, it was manually morcellated so that it could be removed vaginally. The colpotomy was closed as in classical vaginal surgery. This is the first case report demonstrating that vaginal robotic surgery is possible and that it can be used to perform a hysterectomy. Robotic vaginally assisted NOTES hysterectomy (RVANH) makes use of the advantages of robotic surgery to broaden the indications for vaginal hysterectomy and can help overcome its limitations, while the NOTES approach avoids abdominal wall wounds and trocar-related complications. Further developments in robotic technology will help overcome the problem of robotic arm collision. Robotic hysterectomy via vaginal access is a novel approach that requires further validation. The extra cost and setup time of RVANH will also need to be assessed in comparison to the advantages it provides over a vaginally assisted NOTES hysterectomy or total laparoscopic hysterectomy.

The Role of Uterine Manipulator in Laparoscopic Hysterectomy without General Anesthesia

Study Objective: Preliminary advances in s natural orifice transluminal endoscopic surgery (NOTES) as applied to urologic and gastrointestinal surgery demonstrate that the techniques are feasible provided that both optimal surgical technical expertise with advanced skills and optimal instrumentation are available. Vaginal hysterectomy is a procedure for small size or prolapsed uterus; but laparoscopic-assisted vaginal hysterectomy (LAVH) is for moderate size and non-prolapsed uterus. It is reasonable to perform vaginal NOTES hysterectomy for moderate size and non-prolapsed uterus. Design: Prospective clinical study. Setting: Teritary university teaching medical center. Patients: From August 2011 to March 2012, eight patients underwent transvaginal NOTES of hysterectomy in one single operative setting. Intervention: Transvaginal NOTES of hysterectomy and bilateral Salpingoovariectomy. Measurements and Main Results: Eight patients underwent transvaginal NOTES of hysterectomy. Five were identified as Female to Male (FtM) transsexuals. The transsexuals were younger (22-45 years. median 27 years), with no parity (P0).The operating times were 70-120minutes (median 80 minutes). Blood loss during surgery (100-650mL, median 200 mL). There was no complication after surgery. We also showed the video of vaginal NOTES surgery in this presentation. Conclusion: Transvaginal natural orifice transluminal endoscopic surgery (NOTES) hysterectomy and bilateral Salpingoovariectomy for female-tomale transsexuals seems a safe, feasible, and valuable procedure for FtM transsexuals.

How To Avoid Laparotomy during Hysterectomy

Study Objective: Preliminary advances in s natural orifice transluminal endoscopic surgery (NOTES) as applied to urologic and gastrointestinal surgery demonstrate that the techniques are feasible provided that both optimal surgical technical expertise with advanced skills and optimal instrumentation are available. Vaginal hysterectomy is a procedure for small size or prolapsed uterus; but laparoscopic-assisted vaginal hysterectomy (LAVH) is for moderate size and non-prolapsed uterus. It is reasonable to perform vaginal NOTES hysterectomy for moderate size and non-prolapsed uterus. Design: Prospective clinical study. Setting: Teritary university teaching medical center. Patients: From August 2011 to March 2012, eight patients underwent transvaginal NOTES of hysterectomy in one single operative setting. Intervention: Transvaginal NOTES of hysterectomy and bilateral Salpingoovariectomy. Measurements and Main Results: Eight patients underwent transvaginal NOTES of hysterectomy. Five were identified as Female to Male (FtM) transsexuals. The transsexuals were younger (22-45 years. median 27 years), with no parity (P0).The operating times were 70-120minutes (median 80 minutes). Blood loss during surgery (100-650mL, median 200 mL). There was no complication after surgery. We also showed the video of vaginal NOTES surgery in this presentation. Conclusion: Transvaginal natural orifice transluminal endoscopic surgery (NOTES) hysterectomy and bilateral Salpingoovariectomy for female-tomale transsexuals seems a safe, feasible, and valuable procedure for FtM transsexuals.

Transvaginal Natural Orifice Transluminal Endoscopic Surgery (NOTES) Hysterectomy and Bilateral Salpingoovariectomy for Female-to-Male Transsexuals

Preliminary advances in s natural orifice transluminal endoscopic surgery (NOTES) as applied to urologic and gastrointestinal surgery demonstrate that the techniques are feasible provided that both optimal surgical technical expertise with advanced skills and optimal instrumentation are available. Vaginal hysterectomy is a procedure for small size or prolapsed uterus; but laparoscopic-assisted vaginal hysterectomy (LAVH) is for moderate size and non-prolapsed uterus. It is reasonable to perform vaginal NOTES hysterectomy for moderate size and non-prolapsed uterus.