Surgical Outcomes and Learning Curve of Robotic Single-Port Vaginal Natural Orifice Transluminal Endoscopic Surgery...

This study aims to assess the surgical outcomes and learning curve of robotic single-port vaginal natural orifice transluminal endoscopic surgery (RSP-vNOTES) for hysterectomy in benign gynecologic conditions.

A retrospective observational analysis was conducted of 97 consecutively enrolled patients who underwent RSP-vNOTES hysterectomy using the da Vinci (single-port) SP system between December 2023 and July 2025 at a single tertiary care center.

Median procedural durations included a total operative time of 151 minutes, a port placement time of five minutes, a docking time of two minutes, a robotic console time of 78 minutes, and a hysterectomy time of 35 minutes. One case (1.0%) required conversion to a transumbilical single-incision robotic approach for management of diaphragmatic endometriosis after completion of the vaginal hysterectomy, rather than due to failure of the hysterectomy itself. Fourteen patients (14.4%) experienced perioperative complications. Cumulative sum analysis revealed that hysterectomy time stabilized after approximately 30 cases, while port placement and docking times plateaued after 43 and 37 cases, respectively.

These findings suggest that proficiency in RSP-vNOTES can be achieved with sequential case experience. RSP-vNOTES appears to be a safe and effective surgical approach for hysterectomy, including complex scenarios such as endometriosis. Proficiency is typically achieved after 30 cases, particularly among surgeons with prior experience in robotic-assisted single-site and vNOTES techniques.