LAUSR

Study Objective The vaginal approach is considered safer than umbilical access in gynecological surgeries. However, despite the growing popularity of robotic surgery, it has not been performed through the vagina. We set out to evaluate the feasibility of vaginal access in robotic surgery. Here we present a case series of the revolutionary technology of robotic vaginal natural orifice transluminal endoscopic surgery (vNOTES), using the Hominis system, on vaginal hysterectomy. Design This is a prospective analysis of hysterectomy performed by robotic vNOTES. 10 women with nonmalignant indications were recruited. Setting Prospective study. Patients or Participants 10 women with nonmalignant indications for hysterectomy were recruited. Interventions Hysterectomy. Measurements and Main Results Two robotic arms were inserted through the posterior fornix. Each arm has built-in mono- and bi-polar capabilities, their actions are controlled by the surgeon sitting at the console a few feet away. Surgical data were collected during the procedures. The median age was 60 years [range: 43-73]; the median BMI was 26 [range: 17-33], the median total operative time was 60 minutes [range: 24-88]. decreasing duration over time indicated a fast learning curve. There were no intraoperative and postoperative adverse events. Conclusion This is the first documentation of a robotic hysterectomy performed via the vagina. Outstanding features of vNOTES include its portability and easy handling due to its light weight (less than 10 pounds), scarless surgery, and access to any part of the abdomen by articulation of the flexible robotic arms. No special maintenance is required. The approach combines the benefits of vaginal procedures and laparoscopic techniques and maintains safety in regard to proximity to pelvic organs. This case series demonstrates the feasibility of using vNOTES for hysterectomy for benign gynecologic indications