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中华腔镜外科杂志(电子版)

中华腔镜外科杂志(电子版) ›› 2026, Vol. 19 ›› Issue (04) : 193 -200. doi: 10.3877/cma.j.issn.1674-6899.2026.04.001

指南与共识

机器人辅助经阴道自然腔道妇科内镜手术专家共识(2026年版)
世界华人医师协会妇产科分会   
  1. 1. 210003　南京医科大学第二附属医院，美国贝勒医学院
    2. 210003　南京医科大学第二附属医院
  • 收稿日期:2026-06-30 出版日期:2026-08-30

Expert consensus on robotic-assisted transvaginal natural orifice transluminal endoscopic gynecologic surgery (2026 Version)

World Chinese Association of Obstetricians and Gynecologists   

  1. 1. The Second Affiliated Hospital of Nanjing Medical University, 210003, China, Baylor College of Medicine, USA
    2. The Second Affiliated Hospital of Nanjing Medical University, 210003, China
  • Received:2026-06-30 Published:2026-08-30
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世界华人医师协会妇产科分会. 机器人辅助经阴道自然腔道妇科内镜手术专家共识(2026年版)[J/OL]. 中华腔镜外科杂志(电子版), 2026, 19(04): 193-200.

World Chinese Association of Obstetricians and Gynecologists. Expert consensus on robotic-assisted transvaginal natural orifice transluminal endoscopic gynecologic surgery (2026 Version)[J/OL]. Chinese Journal of Laparoscopic Surgery(Electronic Edition), 2026, 19(04): 193-200.

随着机器人辅助腹腔镜手术系统在妇科领域的广泛应用，机器人辅助经阴道自然腔道内镜手术(robotic-assisted transvaginal natural orifice transluminal endoscopic surgery，R-vNOTES)通过提升器械灵活度、优化手术操作三角、提供三维高清视野并增强精准操作能力，有效避免腹壁创伤、提高复杂解剖区域手术的安全性和可重复性，成为微创妇科手术的重要发展方向。世界华人医师协会妇产科分会组织相关领域专家制定本专家共识，系统总结了R-vNOTES相关技术规范、适应证、禁忌证以及在子宫切除术、附件手术、子宫肌瘤剔除术、子宫内膜异位病灶切除术、盆底重建手术及部分恶性肿瘤手术方面的临床应用，展望了R-vNOTES在人工智能辅助规划、5G远程操作与规范化培训等方面的发展方向，旨在为R-vNOTES的临床实践提供规范化指导。

关键词: 妇科, 机器人, 经阴道自然腔道内镜手术, 机器人辅助vNOTES, 专家共识

With the widespread application of robotic-assisted surgical systems in gynecology, robotic-assisted vNOTES (R-vNOTES) has emerged as an important direction in minimally invasive gynecologic surgery. By improving instrument dexterity, establishing an optimal surgical triangulation, providing threedimensional visualization, and enabling precise manipulation, R-vNOTES effectively avoids abdominal wall trauma and enhances the safety and reproducibility of procedures in complex anatomical regions. This expert consensus systematically summarizes the relevant technical specifications, indications, contraindications, and clinical applications of R-vNOTES in procedures such as hysterectomy, adnexal surgery, myomectomy, endometriosis resection, pelvic floor reconstructive surgery, and selected malignant tumor surgeries. It also discusses future directions in artificial intelligence-assisted planning, 5G based remote operation, and standardized training, aiming to provide standardized guidance for the clinical practice of R-vNOTES.

Key words: Gynecology, Robot, Transvaginal natural orifice transluminal endoscopic surgery, Robotic-assisted vNOTES, Expert consensus
表1 机器人系统产品参数
机器人系统 核心技术特点 vNOTES临床应用 优势
da Vinci Xi 4臂多孔平台
7个自由度器械
3D高清摄像头		 2015年11月首例全子宫切除术[10]
完成大多数妇科vNOTES手术[9,11]		 可向单孔转化，系统成熟
da Vinci SP 4臂单孔平台：3手术臂＋ 1视觉臂经单鞘管进入
多关节机械臂：6个自由度(位姿调节)＋1个自由度(夹钳开合)
3D高清摄像头
单臂负载能力2牛顿		 2023年11月首次用于R-vNOTES全子宫切除术[12]
与da Vinci Xi对比均安全有效[13]		 单孔灵活性高
人体工学更优
适合子宫内膜异位症等复杂手术[14]
Memic Hominis 混合2臂平台
首个专为R-vNOTES设计的人形机械臂系统[5]
3D高清摄像头		 2019年8月在动物模型上完成R-vNOTES次全子宫切除术[2]
2020年应用于人体[5]		 重量轻、机械臂长、学习曲线快[15]
术锐SRENS600 4臂单孔平台
"眼镜蛇"姿态3D电子内窥镜可形变对偶连续体机构
单臂负载能力：不小于10牛顿		 2023年6月上市
2024年2月首例动物模型R-vNOTES全子宫切除术[4]
目前已完成全子宫切除术、卵巢囊肿剔除、子宫肌瘤剔除、附件切除、高位骶韧带悬吊术、骶骨固定术等[4,16]		 连续体机构灵活，三角展开利于操作，视野调节范围大
精锋SP1000 4臂单孔平台
裸眼3D控制台
器械可及深度7~27 cm，套管调节最大深度34 cm
单臂负载能力：7牛顿		 2023年11月上市
2024年2月首例R-vNOTES全子宫切除术[17]，后相继完成骶骨固定术及卵巢癌分期手术等[18,19]		 单臂设计，调节范围大，支持复杂操作
图1 多臂机器人鞘管位置图
图2 单孔机器人鞘管位置图
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