Surgical Results of Hysterectomy Using Traditional Robot Assisted Transvaginal Natural Orifice Transluminal Endoscopic Surgery


Goal of the study

To assess the safety and feasibility of robot-assisted transluminal endoscopic transvaginal natural orifice hysterectomy (R-vNOTES) compared to traditional vNOTES hysterectomy (T-vNOTES).


A retrospective review of files.


A senior university executive.

The patients

114 patients with a benign gynecological indication for a hysterectomy.


T-vNOTES or R-vNOTES hysterectomy performed by a single minimally invasive gynecologic surgeon during the study period.

Measures and main results

The main outcome of this study was surgical equivalence, measured primarily by the total operative time between T-vNOTES and R-vNOTES hysterectomy. Secondary operative outcomes measured included estimated blood loss, length of hospital stay, reported postoperative pain levels, and number of conversions. 79 women underwent T-vNOTES hysterectomy and 35 women underwent R-vNOTES hysterectomy with no difference in operative time (p = 0.37), estimated blood loss (p = 0.27), hospital stay (p = 0.06) or reported postoperative pain levels at weeks 1, 2, and 3 after surgery (p = 0.78, p = 0.36, p = 0.38, respectively). 6 patients underwent conversion in the T-vNOTES hysterectomy group versus 0 in the R-vNOTES hysterectomy group; however, it was not statistically significantly different, and there was no conversion to laparotomy.


VNOTES robotic hysterectomy is a feasible approach to surgery over traditional vNOTES hysterectomy and warrants further consideration as a skill in a gynecologic surgeon’s toolkit. Wrist instruments may allow surgeons inexperienced in single-site laparoscopy to adopt vNOTES as a new technique more quickly when performing hysterectomy by a comparable minimally invasive approach.


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