Design: Retrospective case series.

Setting: Single academic tertiary care hospital in Houston, Texas, USA.

Patients or Participants: 22 adult women with chronic pelvic pain who underwent vNOTES hysterectomy, with or without endometriosis resection.

Interventions:

Pilot study in use of novel single-port robot-assisted vNOTES platform (intuitive Da Vinci SP Platform).

Measurements and Main Results: 22 patients, mean age 40.8 years (range 24.0-54.0 years), mean BMI 28.5 kg/m2 (range 20.2-48.4 kg/m2), who underwent RSP-vNOTES from November 11, 2023 to April 13, 2023 were included. Sole total hysterectomy was performed in four (18.2%) patients, while 18 (81.8%) patients underwent additional endometriosis resection at various stages (stage I 36.4%, stage II 27.3%, stage III 4.5%, stage IV 13.6%). Mean total operative time was 175.7 minutes (range 135.0-292.0 minutes), with robot dock time of 3.0 minutes (range 1.0-10.0 minutes), robot console time was 94.9 minutes (range 51.0-221.0 minutes), and total hysterectomy time was 55.8 minutes (range 24.0-170.0 minutes). Mean estimated blood loss was 31.8 mL (range 25.0-50.0mL). Complications included one case of vaginal cuff cellulitis and one case of urinary tract infection.

Conclusion: Our findings indicate that RSP-vNOTES, a novel single-port surgical approach, presents a feasible option for hysterectomy, with or without endometriosis resection. This technique offers a promising alternative surgical platform in vaginal surgeries.