Division of Minimally Invasive Gynecologic Surgery, Department of Obstetrics and Gynecology, Baylor College of Medicine, 6651 Main Street, Suite F1020, Houston, TX, 77030, USA.
J Robot Surg. 2023 Oct;17(5):2487-2494. doi: 10.1007/s11701-023-01680-1. Epub 2023 Jul 31.
The objective of this study is to evaluate the surgical outcomes for robotic-assisted vaginal natural orifice transluminal endoscopic surgery (R-VNOTES) hysterectomy versus robotic-assisted single-site port (RSSP) hysterectomy when performed for benign indications. This is a retrospective chart review in an academic tertiary setting. 404 patients underwent hysterectomy for benign indications. R-VNOTES hysterectomy and RSSP hysterectomy were performed by a single minimally invasive gynecologic surgeon from January 2015 to August 2022. The primary outcome of our study was total operative time (minutes). Secondary outcomes included estimated blood loss (mL), length of hospital stay (days), and postoperative pain score. Other intraoperative and postoperative surgical complications were also compared. 159 patients underwent R-VNOTES hysterectomy, and 269 patients underwent RSSP hysterectomy. Median length of surgery (minutes) demonstrated a statistically significant shorter operative time in the R-VNOTES hysterectomy group when compared to the RSSP hysterectomy group, (132 min versus 146 min, respectively, p = 0.0001). Additionally, patients in the R-VNOTES hysterectomy group experienced decreased postoperative pain levels at week 1 (6 versus 7, respectively, p = 0.01) and week 3 (1.5 versus 2.5, respectively, p = 0.01) after surgery. There were no statistically significant differences between the two groups when comparing length of hospital stay, estimated blood loss, and weight of the uterus. There was no difference in rates of urinary tract infection, blood transfusion, bowel injury, readmission, reoperation, conversion, deep surgical site infection, and venous thromboembolism between both groups. However, there was a higher rate of superficial SSI in the RSSP hysterectomy group (0.6% versus 4.5%, respectively, p = 0.03). When compared to RSSP hysterectomy, R-VNOTES hysterectomy is safe and feasible, as both approaches have comparable surgical outcomes. Patients undergoing R-VNOTES hysterectomy had shorter length of surgery, decreased postoperative pain, and lower rates of superficial surgical site infections.
本研究旨在评估机器人辅助阴道自然腔道内镜手术（R-VNOTES）与机器人辅助单部位端口（RSSP）子宫切除术治疗良性疾病的手术结果。这是在学术三级医疗机构进行的回顾性图表审查。404 名患者因良性疾病接受了子宫切除术。R-VNOTES 子宫切除术和 RSSP 子宫切除术均由一位经验丰富的微创妇科医生于 2015 年 1 月至 2022 年 8 月进行。本研究的主要结局为总手术时间（分钟）。次要结局包括估计出血量（毫升）、住院天数和术后疼痛评分。还比较了其他术中及术后手术并发症。159 例患者接受了 R-VNOTES 子宫切除术，269 例患者接受了 RSSP 子宫切除术。中位手术时间（分钟）显示，与 RSSP 子宫切除术组相比，R-VNOTES 子宫切除术组的手术时间明显缩短（分别为 132 分钟和 146 分钟，p=0.0001）。此外，R-VNOTES 子宫切除术组患者在术后第 1 周（分别为 6 分和 7 分，p=0.01）和第 3 周（分别为 1.5 分和 2.5 分，p=0.01）的术后疼痛水平较低。两组在住院时间、估计出血量和子宫重量方面无统计学差异。两组间尿路感染、输血、肠损伤、再入院、再次手术、转换、深部手术部位感染和静脉血栓栓塞的发生率无统计学差异。然而，RSSP 子宫切除术组的浅表性手术部位感染发生率较高（分别为 0.6%和 4.5%，p=0.03）。与 RSSP 子宫切除术相比，R-VNOTES 子宫切除术安全可行，两种方法的手术结果相当。行 R-VNOTES 子宫切除术的患者手术时间更短，术后疼痛减轻，浅表性手术部位感染发生率更低。
