TY - JOUR
T1 - Enabling Technologies for Gynecologic Vaginal Surgery
T2 - A Systematic Review
AU - Balgobin, Sunil
AU - Balk, Ethan M.
AU - Porter, Anne E.
AU - Misal, Meenal
AU - Grisales, Tamara
AU - Meriwether, Kate V.
AU - Jeppson, Peter C.
AU - Doyle, Paula J.
AU - Aschkenazi, Sarit O.
AU - Miranne, Jeannine M.
AU - Hobson, Deslyn T.
AU - Howard, David L.
AU - Mama, Saifuddin
AU - Gupta, Ankita
AU - Antosh, Danielle D.
N1 - Publisher Copyright:
© 2024 by the American College of Obstetricians and Gynecologists. Published by Wolters Kluwer Health, Inc. All rights reserved.
PY - 2024/4/1
Y1 - 2024/4/1
N2 - OBJECTIVE:To systematically review the literature to evaluate clinical and surgical outcomes for technologies that facilitate vaginal surgical procedures.DATA SOURCES:We systematically searched MEDLINE, EMBASE, and ClinicalTrials.gov from January 1990 to May 2022.METHODS OF STUDY SELECTION:Comparative and single-arm studies with data on contemporary tools or technologies facilitating intraoperative performance of vaginal gynecologic surgical procedures for benign indications were included. Citations were independently double screened, and eligible full-text articles were extracted by two reviewers. Data collected included study characteristics, technology, patient demographics, and intraoperative and postoperative outcomes. Risk of bias for comparative studies was assessed using established methods, and restricted maximum likelihood model meta-analyses were conducted as indicated.TABULATION, INTEGRATION, AND RESULTS:The search yielded 8,658 abstracts, with 116 eligible studies that evaluated pedicle sealing devices (n=32), nonrobotic and robotic vaginal natural orifice transluminal endoscopic surgery (n=64), suture capture devices (n=17), loop ligatures (n=2), and table-mounted telescopic cameras (n=1). Based on 19 comparative studies, pedicle sealing devices lowered vaginal hysterectomy operative time by 15.9 minutes (95% CI, -23.3 to -85), blood loss by 36.9 mL (95% CI, -56.9 to -17.0), hospital stay by 0.2 days (95% CI, -0.4 to -0.1), and visual analog scale pain scores by 1.4 points on a subjective 10-point scale (95% CI, -1.7 to -1.1). Three nonrandomized comparative studies and 53 single-arm studies supported the feasibility of nonrobotic vaginal natural orifice transluminal endoscopic surgery for hysterectomy, adnexal surgery, pelvic reconstruction, and myomectomy. Data were limited for robotic vaginal natural orifice transluminal endoscopic surgery, suture capture devices, loop ligatures, and table-mounted cameras due to few studies or study heterogeneity.CONCLUSION:Pedicle sealing devices lower operative time and blood loss for vaginal hysterectomy, with modest reductions in hospital stay and pain scores. Although other technologies identified in the literature may have potential to facilitate vaginal surgical procedures and improve outcomes, additional comparative effectiveness research is needed.
AB - OBJECTIVE:To systematically review the literature to evaluate clinical and surgical outcomes for technologies that facilitate vaginal surgical procedures.DATA SOURCES:We systematically searched MEDLINE, EMBASE, and ClinicalTrials.gov from January 1990 to May 2022.METHODS OF STUDY SELECTION:Comparative and single-arm studies with data on contemporary tools or technologies facilitating intraoperative performance of vaginal gynecologic surgical procedures for benign indications were included. Citations were independently double screened, and eligible full-text articles were extracted by two reviewers. Data collected included study characteristics, technology, patient demographics, and intraoperative and postoperative outcomes. Risk of bias for comparative studies was assessed using established methods, and restricted maximum likelihood model meta-analyses were conducted as indicated.TABULATION, INTEGRATION, AND RESULTS:The search yielded 8,658 abstracts, with 116 eligible studies that evaluated pedicle sealing devices (n=32), nonrobotic and robotic vaginal natural orifice transluminal endoscopic surgery (n=64), suture capture devices (n=17), loop ligatures (n=2), and table-mounted telescopic cameras (n=1). Based on 19 comparative studies, pedicle sealing devices lowered vaginal hysterectomy operative time by 15.9 minutes (95% CI, -23.3 to -85), blood loss by 36.9 mL (95% CI, -56.9 to -17.0), hospital stay by 0.2 days (95% CI, -0.4 to -0.1), and visual analog scale pain scores by 1.4 points on a subjective 10-point scale (95% CI, -1.7 to -1.1). Three nonrandomized comparative studies and 53 single-arm studies supported the feasibility of nonrobotic vaginal natural orifice transluminal endoscopic surgery for hysterectomy, adnexal surgery, pelvic reconstruction, and myomectomy. Data were limited for robotic vaginal natural orifice transluminal endoscopic surgery, suture capture devices, loop ligatures, and table-mounted cameras due to few studies or study heterogeneity.CONCLUSION:Pedicle sealing devices lower operative time and blood loss for vaginal hysterectomy, with modest reductions in hospital stay and pain scores. Although other technologies identified in the literature may have potential to facilitate vaginal surgical procedures and improve outcomes, additional comparative effectiveness research is needed.
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U2 - 10.1097/AOG.0000000000005522
DO - 10.1097/AOG.0000000000005522
M3 - Review article
C2 - 38301255
AN - SCOPUS:85188760687
SN - 0029-7844
VL - 143
SP - 524
EP - 537
JO - Obstetrics and gynecology
JF - Obstetrics and gynecology
IS - 4
ER -