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 v...
Source: Gynecological Surgery - Category: OBGYN Source Type: research