Single-port robotic versus conventional laparoscopic vNOTES hysterectomy: a propensity score-matched comparison of surgical outcomes and literature review

IF 1.9 4区医学 Q2 OBSTETRICS & GYNECOLOGY

European journal of obstetrics, gynecology, and reproductive biology Pub Date : 2025-10-06 DOI:10.1016/j.ejogrb.2025.114757

Kiyoshi Kanno, Ryo Taniguchi, Naofumi Higuchi, Tomoka Kashiwabara, Yuto Onishi, Taisuke Iwata, Yudai Sawai, Sayaka Masuda, Hiroshi Onji, Yoshifumi Ochi, Yoshiko Kurose, Mari Sawada, Shiori Yanai, Tsutomu Hoshiba, Masaaki Andou

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引用次数: 0

Abstract

Purpose

Robotic-assisted (RA) surgery has gained traction for transvaginal natural orifice transluminal endoscopic surgery (vNOTES) and has been applied across a range of gynecologic procedures. The da Vinci SP (SP) system, a recently developed single-port robotic platform, was designed to advance minimally invasive surgery, enabling precise surgery in deep, narrow spaces, such as the vagina. However, perioperative outcomes of RA-vNOTES hysterectomy using SP vaginal-assisted NOTES hysterectomy (SP-VANH) have not been compared with those of conventional laparoscopic (CL)-VANH.

Methods

A retrospective cohort study was conducted involving 184 patients who underwent VANH between January 2023 and December 2024. After propensity score matching (PSM), 130 patients (1:1 ratio) were included in the analysis. Perioperative outcomes were compared between the SP-VANH and CL-VANH. Potential confounding bias related to patient characteristics was minimized through the PSM analysis.

Results

The mean operative time, estimated blood loss, hemoglobin drop, length of postoperative hospital stay, perioperative complications, and visual analog score (VAS) for postoperative pain at 24 h were 75.4 vs. 83.8 min (p = 0.05), 94.5 vs. 82.2 mL (p = 0.60), −1.2 vs. −1.3 g/dL (p = 0.60), 4.0 vs. 4.0 days (p = 0.72), 4.6 vs. 0 % (p = 0.24), and 16.1 vs. 17.5 mm (p = 0.68) for the SP-VANH and CL-VANH groups, respectively, with no significant differences. All cases in both groups were completed without requiring blood transfusions or conversion to laparotomy or transabdominal laparoscopy.

Conclusion

SP-VANH offers a safe and feasible alternative to CL-VANH for the surgical management of benign gynecologic conditions.

查看原文本刊更多论文

单孔机器人与传统腹腔镜vNOTES子宫切除术：手术结果的倾向评分匹配比较和文献综述。

目的：机器人辅助手术（RA）在经阴道自然孔腔内窥镜手术（vNOTES）中获得了广泛的应用，并已应用于一系列妇科手术。达芬奇SP （da Vinci SP）系统是最近开发的一种单端口机器人平台，旨在推进微创手术，使在深、窄的空间（如阴道）进行精确手术成为可能。然而，采用SP阴道辅助NOTES子宫切除术（SP-VANH）的RA-vNOTES子宫切除术的围手术期结果尚未与传统腹腔镜(CL)-VANH进行比较。方法：对184例2023年1月至2024年12月间行VANH的患者进行回顾性队列研究。经倾向评分匹配（PSM）后，按1:1比例纳入130例患者分析。比较SP-VANH与CL-VANH围手术期疗效。通过PSM分析，与患者特征相关的潜在混杂偏倚被最小化。结果:平均手术时间,估计失血,血红蛋白下降,术后住院时间长度、围手术期并发症,并对术后疼痛视觉模拟评分(血管)24小时分别为75.4和83.8分钟(p = 0.05), 94.5和82.2毫升(p = 0.60), -1.2和-1.3 g / dL (p = 0.60), 4.0 (p = 0.72)和4.0天,4.6与0% (p = 0.24),和16.1和17.5毫米SP-VANH (p = 0.68), CL-VANH组,分别,没有显著差异。两组所有病例均无需输血或转开腹或经腹腹腔镜。结论：SP-VANH为妇科良性疾病的外科治疗提供了一种安全可行的替代方案。

本文章由计算机程序翻译，如有差异，请以英文原文为准。

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来源期刊

European journal of obstetrics, gynecology, and reproductive biology 医学-妇产科学

CiteScore

4.60

自引率

3.80%

发文量

898

审稿时长

8.3 weeks

期刊介绍： The European Journal of Obstetrics & Gynecology and Reproductive Biology is the leading general clinical journal covering the continent. It publishes peer reviewed original research articles, as well as a wide range of news, book reviews, biographical, historical and educational articles and a lively correspondence section. Fields covered include obstetrics, prenatal diagnosis, maternal-fetal medicine, perinatology, general gynecology, gynecologic oncology, uro-gynecology, reproductive medicine, infertility, reproductive endocrinology, sexual medicine and reproductive ethics. The European Journal of Obstetrics & Gynecology and Reproductive Biology provides a forum for scientific and clinical professional communication in obstetrics and gynecology throughout Europe and the world.