Design: We performed two cases of RSP-vNOTES hysterectomy for patients presenting with persistent vaginal bleeding resulting in atypical endometrial hyperplasia per endometrial biopsy. The robotic docking process was executed smoothly. Two elbowed instruments, a bipolar grasper, a pair of monopolar scissors, and a facing-upward camera were used.

Setting: Procedures were initiated with traditional TVH and seamlessly transitioned to the robotic platform when necessary to complete the entire process.

Patients or Participants: Situated in an academic tertiary care hospital, a 54-year-old woman, G4P2, She reported a doubling of menstrual blood volume and an extension of the menstrual period to 15 days in recent months, resulting in severe anemia. Diagnostic curettage pathology indicated endometrial atypical hyperplasia. Another 44-year-old woman, G2P2, with a history of two elective cesarean sections reported a menstrual period lasting 10-15 days over the past 6 months. Diagnostic curettage pathology suggested endometrial atypical hyperplasia.

Interventions: The hysterectomies were carried out precisely, without complications. Bilateral salpingo-oophorectomy was performed in the first patient and bilateral salpingectomy in the second. The vaginal cuff was closed continuously through a transvaginal approach after undocking.

Measurements and Main Results: Both patients were discharged on the third postoperative day, with satisfactory surgical results and no complications.

Conclusion: The domestically developed Chinese Robotic SP system demonstrates feasibility for RSP-vNOTES procedures of hysterectomy. This approach amalgamates the advantages of both vaginal and robotic surgeries, incorporating surgical triangulation with an elbowed function that simplifies surgical manipulation. However, further studies with larger sample sizes and potential comparative analyses are essential to validate the merits and safety of adopting this platform.