TITLE:
Vaginal Robotic Supracervical Hysterectomy in an Ovine Animal Model: The Proof of Concept
AUTHORS:
Jonia Alshiek, Liron Bar-El, S. Abbas Shobeiri
KEYWORDS:
Hysterectomy, Robot, Supracervical, Robotic, Vaginal, vNOTES
JOURNAL NAME:
Open Journal of Obstetrics and Gynecology,
Vol.9 No.8,
August
9,
2019
ABSTRACT: Objective: To gain insight into the feasibility and safety of a novel vaginal robot
for performing supracervical hysterectomy in an ovine model. Introduction: The clinical application of transvaginal natural or fice transluminal
endoscopic surgery (vNOTES) has broadened significantly. vNOTES reduces wound
complications such as infection, hematoma formation, or herniation and is
currently utilized for hysterectomy, adnexal surgery, myomectomy, and staging
surgery for endometrial cancer. Robotic assistance has been proposed to overcome
the current vNOTES mechanical obstacles. The implementation of the current
robots has limited utility due to their bulk and inflexibility. Robotic Natural
Orifice Transluminal Surgery (rNOTES) is the new frontier in advancement of
surgical robots. In developing new task specific robots, it is important to
utilize an accurate model for testing. A novel vaginal robot introduced through
the posterior cul-de-sac to perform a complete retrograde hysterectomy is the
subject of this study. Methods: The study was conducted at the animal
lab, Asaf-Harofe hospital, Israel. The ovine model was preferred since the
anatomical landmarks and vascular anatomy are comparable to the human except
for a bicornuate uterus in sheep. A vaginal robotic supra-cervical hysterectomy
was performed in a sheep. Results: A vaginal robotic supracervical
hysterectomy was performed successfully in an ovine model. The uterus was
extracted via the entry point in the pouch of Douglas. 20 cc of blood loss was
reported and no complications were observed. Conclusions: Vaginal
supracervical hysterectomy via a vaginal approach using a novel robotic system was
found to be feasible.