Handheld Robotic Arm Assisted Vaginal Hysterectomy

To demonstrate a case of successful vNOTES (vaginal natural orifice transluminal endoscopic surgery) hysterectomy for a large uterus with contained transvaginal specimen retrieval using a novel hand held robotic surgical arm assistance.

Methods

Stepwise demonstration using a narrated video of hand-held robotic arm assisted vNOTES hysterectomy with right salpingo-oophorectomy and left salpingectomy followed by contained transvaginal specimen retrieval. In the setting of a tertiary care private hospital, a 44-year-old female presented with refractory abnormal uterine bleeding. She had a history of two normal vaginal deliveries and a tubal ligation surgery. Transvaginal ultrasound revealed multiple fibroid uterus and right ovarian haemorrhagic cyst. Handheld robotic arm assisted vNOTES hysterectomy with contained transvaginal specimen retrieval was planned.

Results

The duration of the surgery was 88 minutes. The weight of the specimen retrieved was 824 grams. The blood loss was about 76 ml. There were no intra operative or post operative complications. The patient was discharged on day 2.

Conclusion

Hand held robotic arm offers significant articulation and multiple degrees of freedom compared to the straight stick instruments. This articulation is helpful in vNOTES as it offers better dexterity to the surgeon and prevents clashing of the instruments. Such a robotic arm can be helpful in difficult vNOTES procedures like a large uterus hysterectomy. The feasibility and the utility of this device in vNOTES procedure should be further evaluated.