A Review of Robotic vNOTES Surgery: Current Applications, Advantages, and Future Directions

Over the past 500 years, the convergence of three distinct paths - vaginal surgery, laparoscopy, and robotic technologies - has enabled the development of robot-assisted vaginal natural orifice transluminal endoscopic surgery (RA-vNOTES). The ongoing evolution of vaginal surgery has led to contemporary procedures such as hysterectomy, myomectomy, sacrocolpopexy, adnexal interventions, and oncologic operations, applicable to a wide range of diagnoses and pathologies. This approach offers patients significant benefits, including superior cosmetic outcomes, less pain, lower infection rates, and faster recovery of baseline quality of life. Surgeons benefit from improved ergonomics, better visualization, the ability to use multiple instruments, and enhanced tremor control. Robotic assistance has greatly expanded the ability to safely perform more complex cases, such as excision of stage 4 endometriosis with complete posterior cul-de-sac obliteration, as well as other procedures previously considered contraindicated in traditional vaginal surgery. Here, we present current findings and advances in RA-vNOTES and consider future developments in robotic surgery aimed at further improving minimally invasive techniques.