Objective:

To evaluate the safety and feasibility of robotic single-port transvaginal natural orifice transluminal endoscopic surgery (RSP-vNOTES) compared with robotic Xi-assisted single-incision transumbilical surgery (RXi-SITS) for hysterectomy, focusing on primary outcomes such as operative time, blood loss, and postoperative pain.

Key Findings:

• RSP-vNOTES group had a higher prevalence of endometriosis-associated procedures (p < 0.05), indicating a need for tailored surgical approaches.
• RXi-SITS group more commonly performed uterosacral ligament suspension and ovarian vein ligation (p < 0.05), suggesting differences in surgical strategies.
• After multivariable adjustment, estimated blood loss, hysterectomy time, and postoperative pain outcomes were comparable between both approaches, highlighting the effectiveness of both methods.
• RXi-SITS was associated with a significantly longer total operative time (mean increase of 21.8 min) compared to RSP-vNOTES (p = 0.007), which may influence surgical decision-making.

Interpretation:

RSP-vNOTES demonstrated comparable surgical outcomes to RXi-SITS, supporting its safety and feasibility, with potential efficiency advantages in selected patients despite greater procedural complexity, warranting further investigation into its broader application.

Limitations:

• Retrospective design may introduce selection bias, limiting the generalizability of the findings.
• Single surgeon's experience may not generalize to other practitioners, suggesting the need for multi-center studies.

Conclusion:

RSP-vNOTES is a safe and feasible alternative to RXi-SITS for hysterectomy, with comparable outcomes and potential efficiency benefits, emphasizing the importance of considering surgical approach based on patient-specific factors.