Clinical Report: Outcomes of Robotic Single-Port vNOTES vs RXi-SITS Hysterectomy

Overview

This study evaluates the safety and feasibility of robotic single-port vNOTES compared to robotic Xi-assisted single-incision transumbilical surgery for hysterectomy. Findings indicate comparable surgical outcomes, with RSP-vNOTES showing potential efficiency advantages despite greater procedural complexity.

Background

Hysterectomy is one of the most common surgical procedures among women, with robotic-assisted techniques gaining popularity due to their minimally invasive nature. Understanding the comparative outcomes of different robotic approaches is crucial for optimizing surgical strategies and improving patient care. This study addresses a gap in the literature regarding the direct comparison of RSP-vNOTES and RXi-SITS techniques.

Data Highlights

Key Findings

• RSP-vNOTES showed a higher prevalence of endometriosis-associated procedures (p < 0.05).
• RXi-SITS had more uterosacral ligament suspensions and ovarian vein ligations (p < 0.05).
• After multivariable adjustment, estimated blood loss and postoperative pain were comparable between both groups.
• RXi-SITS was associated with a significantly longer total operative time (mean increase of 21.8 min, p = 0.007).
• RSP-vNOTES demonstrated safety and feasibility across a range of gynecologic procedures.

Clinical Implications

The findings suggest that RSP-vNOTES may be a more efficient option for selected patients undergoing hysterectomy, particularly those with complex conditions. Clinicians should consider the procedural complexity and associated outcomes when choosing between robotic surgical techniques.

Conclusion

RSP-vNOTES and RXi-SITS are both viable options for hysterectomy, with RSP-vNOTES potentially offering advantages in efficiency despite greater complexity. Further studies are warranted to confirm these findings across broader patient populations.

References

1. Frontiers in Surgery, 2026 -- Uterine-Sparing vNOTES vs. laparoscopic lateral suspension for pelvic organ prolapse repair: a prospective comparative study of feasibility and early outcomes
2. Impact of Previous Hysterectomy on Transvaginal/Transumbilical Hybrid NOTES Cholecystectomy: A Comparative Study of Prospectively Gathered Data
3. Updates in Surgery, 2024 -- A Retrospective Study Comparing Robot-Assisted Laparoscopic Myomectomy to Traditional Laparoscopy in a Tertiary Care Facility in Southern Italy
4. Surgical Endoscopy -- Robotic Cholecystectomy: Insights from a Single-Center Study of Over 600 Cases with Propensity Score Matching Analysis
5. Choosing the Route of Hysterectomy for Benign Disease | ACOG
6. Choosing the Route of Hysterectomy for Benign Disease | ACOG
7. (PDF) HALON (Hysterectomy by Trans-Abdominal Laparoscopy or Transvaginal NOTES): A Randomized Controlled Trial
8. Assessing Feasibility and Outcomes of Robotic Single Port Transvaginal NOTES (RSP-vNOTES) Hysterectomy: A Case Series - ScienceDirect