Robotic Natural Orifice Transluminal Surgery Research Articles

Robotic natural orifice transluminal endoscopic surgery (R-NOTES) in gynecologic surgeries, a case report and review of literature

Background: Natural Orifice Transluminal Endoscopic Surgery (NOTES) involves accessing the abdominal cavity through a natural orifice. It provides easier access for the surgeon; has a reduced recovery times and decreases postoperative pain Objective: To present an initial experience with robotic natural orifice transluminal surgery (R-NOTES) in gynecology using the da Vinci surgical system. Case: We present a case of a 40 year old, Asian female, Gravida 2- Para 1-0-1-1 with irregular, heavy menstrual cycle, abnormal uterine bleeding due to uterine leiomyoma (AUB-L) who under went Da Vinci Natural Orifice Transluminal Endoscopic Surgery (NOTES), total Laparoscopic hysterectomy (TLH), bilateral salpingectomy (BS), Lysis of adhesions (LOA), and cystoscopy. The patient had uncomplicated recovery and postoperative care and was discharged on postoperative day zero. Conclusion: Robotic NOTES Total laparoscopic hysterectomy with bilateral salpingectomy is feasible and safe in gynecology patient. This approach has the potential for a less morbid and scarless outcome.

Vaginal Robotic Supracervical Hysterectomy in an Ovine Animal Model: The Proof of Concept

Objective: To gain insight into the feasibility and safety of a novel vaginal robot for performing supracervical hysterectomy in an ovine model. Introduction: The clinical application of transvaginal natural or fice transluminal endoscopic surgery (vNOTES) has broadened significantly. vNOTES reduces wound complications such as infection, hematoma formation, or herniation and is currently utilized for hysterectomy, adnexal surgery, myomectomy, and staging surgery for endometrial cancer. Robotic assistance has been proposed to overcome the current vNOTES mechanical obstacles. The implementation of the current robots has limited utility due to their bulk and inflexibility. Robotic Natural Orifice Transluminal Surgery (rNOTES) is the new frontier in advancement of surgical robots. In developing new task specific robots, it is important to utilize an accurate model for testing. A novel vaginal robot introduced through the posterior cul-de-sac to perform a complete retrograde hysterectomy is the subject of this study. Methods: The study was conducted at the animal lab, Asaf-Harofe hospital, Israel. The ovine model was preferred since the anatomical landmarks and vascular anatomy are comparable to the human except for a bicornuate uterus in sheep. A vaginal robotic supra-cervical hysterectomy was performed in a sheep. Results: A vaginal robotic supracervical hysterectomy was performed successfully in an ovine model. The uterus was extracted via the entry point in the pouch of Douglas. 20 cc of blood loss was reported and no complications were observed. Conclusions: Vaginal supracervical hysterectomy via a vaginal approach using a novel robotic system was found to be feasible.