Department of Obstetrics and Gynecology, Eulji University Hospital, 1306 Doonsan-dong, Daejeon, 302-799, Korea.
Surg Endosc. 2020 Jan;34(1):492-500. doi: 10.1007/s00464-019-07115-z. Epub 2019 Nov 14.
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 290 g (range 115-892 g). Median docking and console times were 15 min (range 5-25 min) and 135 min (range 92-215 min), respectively. Mean change in hemoglobin on the first postoperative day was 0.67 ± 0.7 g/dL. Median EBL was 50 mL (20-450 mL). Median postoperative hospital stay was 3 days (3-4 days). 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.
报告一种新的使用机器人自然腔道内镜手术（NOTES）进行子宫切除术的手术技术，作为一种无疤痕和无气操作。
2017 年 2 月至 2018 年 5 月，在延世大学医院，对 13 例良性子宫疾病患者连续进行了机器人NOTES 子宫切除术。
由于存在盆腔粘连，其中 1 例患者在等压单端口腹腔镜辅助下进行了混合式机器人NOTES 子宫切除术，但没有转换为其他子宫切除术类型，如传统腹腔镜、剖腹手术或传统多孔机器人手术。子宫重量中位数为 290 克（范围 115-892 克）。中位对接和控制台时间分别为 15 分钟（范围 5-25 分钟）和 135 分钟（范围 92-215 分钟）。术后第 1 天血红蛋白平均变化为 0.67±0.7g/dL。中位 EBL 为 50 毫升（20-450 毫升）。中位术后住院时间为 3 天（3-4 天）。没有患者发生邻近器官损伤、再次手术或阴道袖口血肿等术后并发症。
我们的研究结果表明，机器人NOTES 子宫切除术是一种可行且安全的无疤痕和无气手术技术。它是一种有效的微创阴道进入替代方法，适用于良性子宫疾病的 NOTES 辅助阴道子宫切除术或传统机器人腹腔镜单部位手术子宫切除术的手术治疗。然而，仍需要进一步的前瞻性对照研究来确定其在临床上的全面应用。
