Robot-assisted transvaginal natural orifice transluminal endoscopic surgery (RvNOTES) for management of endometriosis: A pilot study of 33 cases.

Abstract

STUDY OBJECTIVE\nTo describe the surgical techniques and short-term outcomes for 33 cases of robot-assisted transvaginal natural orifice transluminal endoscopic surgery (RvNOTES) to treat endometriosis.\n\n\nDESIGN\nRetrospective case series study SETTING: Academic tertiary care university hospital in Houston, TX USA.\n\n\nPATIENTS\nPatients who underwent RvNOTES resection of endometriosis between March 2020 and March 2021.\n\n\nINTERVENTIONS\nRvNOTES.\n\n\nMEASUREMENTS AND MAIN RESULTS\nA total of 33 cases of patients, with pathology confirmed endometriosis, who underwent RvNOTES total hysterectomy with resection of endometriosis were included in the study. Thirty-two cases were completed successfully by RvNOTES, and one case was converted to robotic trans-umbilical single incision laparoscopic surgery (SILS) plus one additional port due an obliterated posterior cul-de-sac and upper abdominal wall endometriosis. The average operative time was 141.93±40.22(85-264) minutes, and the mean estimated blood loss was 52.25±33.82(25-150) milliliters. The mean preoperative pain score using the visual analogue score (VAS) was 8.08±2.39(2-10). The mean VAS pain score one week after surgery was 6.73±2.62(0-10), which was significantly lower when compared to scores preoperatively (P=0.059). The mean VAS pain score in the second and third week after surgery was 4.81±2.42(0-9) and 2.63±2.36(0-7) respectively, which were both significantly lower than those before surgery (P=0.001). There were four postoperative complications: urinary tract infection, pneumonia, headache requiring admission, and conversion disorder.\n\n\nCONCLUSION\nRvNOTES is a safe and feasible approach for the treatment of endometriosis, with promising short-term improvements in pain.