Robot-assisted Transvaginal Natural Orifice Transluminal Endoscopic Surgery for Management of Endometriosis: A Pilot Study of 33 Cases

Study Objective To describe the surgical techniques and short-term outcomes for 33 cases of robot-assisted transvaginal natural orifice transluminal endoscopic surgery (RvNOTES) to treat endometriosis. Design Retrospective case series study. Setting Academic tertiary care university hospital in Houston, TX. Patients Patients who underwent RvNOTES resection of endometriosis between March 2020 and March 2021. Interventions RvNOTES. Measurements and Main Results A 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 1 case was converted to robotic transumbilical single-incision laparoscopic surgery plus 1 additional port owing to 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) mL. The mean preoperative pain score using the visual analog scale (VAS) score was 8.08 ± 2.39 (2–10). The mean VAS pain score 1 week after surgery was 6.73 ± 2.62 (0–10), which was significantly lower than the preoperative scores (p = .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 = .001). There were 4 postoperative complications: urinary tract infection, pneumonia, headache requiring admission, and conversion disorder. Conclusion RvNOTES is a safe and feasible approach for the treatment of endometriosis, with promising short-term improvements in pain.