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Published on: January 17, 2019
Enabling Technologies for Gynecologic Vaginal Surgery: A Systematic Review.
Sunil Balgobin1, Ethan M Balk, Anne E Porter
1Division of Urogynecology, Department of Obstetrics and Gynecology, University of Texas Southwestern Medical Center, Dallas, the Department of Obstetrics and Gynecology, University of Texas Health Science Center at San Antonio, San Antonio, and the Division of Urogynecology, Department of Obstetrics and Gynecology, Houston Methodist Hospital, Houston, Texas; the Center for Evidence Synthesis in Health, Brown University School of Public Health, Providence, Rhode Island; the Department of Obstetrics and Gynecology, The Ohio State University Wexner Medical Center, Columbus, Ohio; the Department of Obstetrics and Gynecology, University of California, Los Angeles, Los Angeles, California; the Division of Urogynecology, Department of Obstetrics and Gynecology, University of New Mexico, Albuquerque, New Mexico; the Woman's Center for Advanced Pelvic Surgery, Phoenix, Arizona; the Departments of Obstetrics and Gynecology and Urology, School of Medicine & Dentistry, University of Rochester, Rochester, New York; the Department of Obstetrics and Gynecology, Medical College of Wisconsin, Waukesha, Wisconsin; the Division of Urogynecology, Brigham and Women's Hospital, Harvard Medical School, Boston, Massachusetts; the Department of Obstetrics and Gynecology, Wayne State University School of Medicine, Detroit, Michigan; the Department of Obstetrics, Gynecology, and Reproductive Health, Rutgers New Jersey Medical School, Newark, and the Department of Obstetrics and Gynecology, Cooper Medical School of Rowan University, Camden, New Jersey; and the Division of Female Pelvic Medicine & Reconstructive Surgery, University of Louisville Health, Louisville, Kentucky.
Pedicle sealing devices significantly reduce operative time, blood loss, hospital stay, and pain for vaginal hysterectomy. Further research is needed for other technologies facilitating vaginal surgery.
Area of Science:
- Gynecologic Surgery
- Surgical Technology Evaluation
- Minimally Invasive Procedures
Background:
- Systematic review of clinical and surgical outcomes for technologies aiding vaginal procedures.
- Evaluation of contemporary tools for benign gynecologic surgery via vaginal approach.
Approach:
- Searched MEDLINE, EMBASE, and ClinicalTrials.gov (1990-2022).
- Included comparative and single-arm studies on vaginal surgery technologies.
- Extracted data on study characteristics, technology, patient demographics, and outcomes.
- Assessed risk of bias and conducted meta-analyses where indicated.
Key Points:
- Pedicle sealing devices reduced operative time by 15.9 min, blood loss by 36.9 mL, hospital stay by 0.2 days, and pain scores by 1.4 points in vaginal hysterectomy.
- Nonrobotic vaginal natural orifice transluminal endoscopic surgery (vNOTES) demonstrated feasibility for hysterectomy, adnexal surgery, pelvic reconstruction, and myomectomy.
- Limited data exists for robotic vNOTES, suture capture devices, loop ligatures, and telescopic cameras due to study heterogeneity or scarcity.
Conclusions:
- Pedicle sealing devices offer clear benefits for vaginal hysterectomy, improving efficiency and patient recovery.
- While vNOTES shows promise, more comparative studies are essential to establish the effectiveness of various technologies in facilitating vaginal surgical procedures.
- Further research is recommended to fully understand the potential and limitations of emerging technologies in gynecologic surgery.
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