Robot-assisted vNOTES hysterectomy

Background. Vaginal natural orifice transluminal endoscopic surgery (VNOTES) is an innovative technique of endoscopic surgery in which abdominal organs are accessed through the vagina. The relevance of studying robot-assisted vNOTES hysterectomy is driven by the need for an objective assessment of its advantages and the potential for its introduction into widespread clinical practice, as well as identification of potential areas for more indications.

Aim. To analyze efficacy and safety of robot-assisted hysterectomy using transvaginal endoscopic access.

Materials and methods. The study included 5 patients with obesity and absence of severe prolapse of the pelvic organs. The following data were retrospectively assessed: indications for surgery, intraoperative characteristics, blood loss volume, postoperative pain intensity, requirement for analgesics, complication rate.

Results. Mean age of the patients was 51.6 ± 4.98 [46.5; 56.0] years. Mean operative time was 106.8 ± 14.25 [95.0; 122.0] minutes. No conversions to laparotomy or conventional laparoscopy were required. Blood loss volume amounted to 104.0 ± 46.15 [67.5; 150.0] mL. The VAS score assessed at 6 and 12 hours postoperatively was 5.0 ± 0.71 [4.5; 5.5] and 3.2 ± 0.45 [3.0; 3.5], respectively. The postoperative hospital stay was 5 days. In this case series, no complications were identified either during the surgical procedure or during the 6-month postoperative follow-up period.

Conclusion. Robotic vNOTES hysterectomy opens new horizons in the field of minimally invasive gynecology and warrants further implementation into clinical practice.

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