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Robot-assisted vaginal Natural Orifice Transluminal Endoscopic Surgery (RvNOTES) with total hysterectomy for management of stage IV endometriosis with/without complete cul-de-sac obliteration: 23-case pilot feasibility study.

STUDY OBJECTIVE: To show feasibility and short-term outcomes of Robot-assisted vaginal NOTES (RvNOTES) for the treatment of stage IV endometriosis during total hysterectomy with/without complete cul-de-sac obliteration.

DESIGN: Retrospective case series.

SETTING: Single academic tertiary care hospital in Houston, Texas, USA.

PATIENTS: 23 adult women with stage IV endometriosis.

INTERVENTIONS: RvNOTES with total hysterectomy for excision of severe endometriosis.

MEASUREMENTS AND MAIN RESULTS: Patients were assessed for various metrics including total operative time, robot dock time, robot console time, hysterectomy time, estimated blood loss, peri-operative pain using the Visual Analogue Scale (VAS), and complications. The mean total operative time was 224.3 minutes. The study also found that patients with complete cul-de-sac obliteration had significantly longer operative times and higher estimated blood loss compared to those with partial or no obliteration. Postoperative VAS pain scores showed a significant reduction over a six-week period. Complications included one case of complete ureteral transection, pelvic hematoma with infection, vaginal abscess, urinary tract infection, and pneumonia.

CONCLUSION: Our findings suggest that RvNOTES may be a feasible surgical approach in expert hands for treating stage IV endometriosis, even in cases with complete obliteration of the cul-de-sac.

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