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.

To improve Chinese hysteroscopic surgeons′ awareness of fluid management risks and standardize the prevention and treatment of operative hysteroscopy intravascular absorption syndrome (OHIA), these expert recommendations summarize the pathogenic factors of OHIA, standardized management of uterine distension media, as well as unified diagnosis, treatment and prevention strategies. The recommendations propose adhering to the principle of minimum effective intrauterine distension pressure during hysteroscopy, clarify influencing factors and monitoring key points of fluid deficit, and conclude clinical manifestations, auxiliary examinations of OHIA-related fluid overload and acute dilutional hypokalemia/hyponatremia, alongside the standardized emergency management workflow for OHIA. This paper highlights that prevention is the priority for OHIA control, and puts forward the "4L" rule and "4E" rule for clinical prevention. Finally, it highlights the critical value of fully automated intraoperative hysteroscopic fluid management in reducing OHIA risk, and prospects future research and development directions in this field.

At a time when gynecologic minimally invasive surgery has become relatively mature, the significance of robotic platforms should not be simply understood as a replacement for laparoscopy. For most routine cases, laparoscopy remains a stable, accessible, and relatively cost-controllable basic approach. Based on our clinical experience, the most representative scenarios for robotic application include: sentinel lymph node (SLN) tracing and precise staging, especially in obese patients with endometrial cancer; complex pelvic-abdominal anatomical reconstruction due to severe intestinal adhesions or deeply infiltrating endometriosis (DIE); ureteral injury repair or reimplantation requiring delicate suturing and reconstruction; and precise anatomical dissection with vital organ protection during large uterus hysterectomy. We believe that laparoscopy serves as the foundation, while robotics acts as an important augmentation platform for miniinvasive treatment of complex surgeries. Only by combining the technical advantages of robotics with strict patient selection, team collaboration, and standardized procedures can it truly translate into patient benefits. Future implementation should emphasize indication selection, team collaboration, standardized workflow, credentialed training, and explicit safety boundaries so that the robotic platform can support high quality minimally invasive management of complex gynecologic surgery.

Retroperitoneal lymphadenectomy is an important component of surgical staging and the removal of metastatic lymph nodes in gynecologic malignancies, but its staging value does not necessarily translate into a survival benefit. As clinical evidence accumulates, sentinel lymph node mapping becomes more widely used, and risk assessment based on pathological and molecular features improves, nodal surgery is moving from routine systematic dissection toward individualized assessment and selective lymphadenectomy. For patients who still require dissection, advances in laparoscopic, robotic, and transumbilical single-port surgery, together with appropriate selection of transperitoneal or extraperitoneal access, offer more options to reduce surgical morbidity. Selecting suitable patients and limiting complications without compromising the adequacy of dissection remain key clinical concerns. This review discusses the indications, extent of dissection, surgical approaches, and advances in minimally invasive techniques for retroperitoneal lymphadenectomy in cervical, endometrial, and ovarian cancers. It examines the benefits and limitations of the procedure in meeting staging and treatment needs while preserving long-term quality of life.

Ureteral endometriosis (UE) is one of the common types of deep infiltrating endometriosis (DE), easily causing upper urinary tract obstruction and being an important cause of "silent kidney loss" in women of reproductive age. At Peking University First Hospital, robot-assisted laparoscopic surgery for UE has been performed under the multidisciplinary team (MDT) model, with a high surgical success rate and a low recurrence rate. Our experience and characteristics mainly include five aspects: (1) re-recognition of prevalence: the actual prevalence of UE may be severely underestimated; given the limited detection ability of imaging, UE is often identified incidentally during intraoperative ureteral dissection in patients with DE; (2) shift of surgical philosophy: for patients with severe stenosis, especially those with concurrent DE undergoing conservative fertility-preserving surgery, ureteroneocystostomy with an anti-reflux mechanism has a lower recurrence rate than ureteroureterostomy or ureterolysis with lesion excision, fitting the philosophy of "one surgery in a lifetime" ; (3) innovation of collaboration model: routine preoperative multidisciplinary evaluation and the "dual-specialty same-table" surgical model of gynecology and urology are superior to intraoperative ad hoc consultation; (4) remote surgery and platform workflow: remote dual-specialty same-table surgery across hospitals based on the domestic "4+ 1" robotic platform, together with a unified postoperative follow-up pathway; (5) extension of fertility management: preoperative fertility assessment and preservation, multidisciplinary monitoring during pregnancy, and long-term postpartum management constitute full-life-cycle care.

To compare the short-term efficacy and long-term prognosis of robot-assisted hepatectomy versus laparoscopic hepatectomy in the treatment of hepatocellular carcinoma (HCC).

This retrospective study analyzed patients with hepatocellular carcinoma who underwent robot-assisted hepatectomy or laparoscopic hepatectomy in the Department of Hepatobiliary and Liver Transplantation Surgery, Gulou Hospital affiliated to Nanjing Medical University between 2021 and 2023. After applying the inclusion and exclusion criteria, a total of 221 patients were included, including 51 patients in the robotic group and 170 patients in the laparoscopic group. Propensity score matching (PSM) was performed at a 1∶1 ratio between the two groups. Perioperative outcomes, including hepatic inflow occlusion time, operative time, intraoperative blood loss, intraoperative transfusion volume, conversion to open surgery, 30-day readmission, postoperative complications, and length of hospital stay, were compared between the groups. Kaplan-Meier analysis was used to estimate and compare progression-free survival (PFS) between the two groups.

Before PSM, the robotic liver resection group exhibited shorter PT duration (P=0.022) and a lower incidence of cirrhosis (P=0.009). Patients in the robotic hepatectomy group had significantly larger tumor diameters in the resected specimens compared with those in the laparoscopic group (P=0.007). The robotic approach demonstrated a more pronounced advantage in conventional major hepatectomy (P<0.001) and showed stronger selectivity in surgeries with high Iwate difficulty scores (P<0.001). Perioperative outcomes before matching indicated that the robotic group had a significantly longer operative time than the laparoscopic group (200 min vs. 180 min, P=0.006) and a higher rate of Clavien-Dindo complications (Grade Ⅰ+ Ⅱ+ Ⅲ: 21.6% vs. 7.6%, P=0.020). After PSM, no significant differences were observed between the two groups in perioperative outcomes, including operative time, hepatic inflow occlusion time, intraoperative blood loss, intraoperative transfusion, postoperative hospital stay, conversion to open surgery, 30-day readmission, or Clavien-Dindo complication grade (all P>0.05). Long-term prognosis before and after PSM also showed no statistically significant difference in PFS between the robotic and laparoscopic groups (P>0.05).

Robot-assisted hepatectomy is an acceptable alternative to laparoscopic hepatectomy for the treatment of HCC, with no statistically significant difference in overall safety between the two approaches. Notably, the robotic approach may offer potential advantages in complex hepatectomy procedures and long-term prognosis (PFS).

To evaluate the feasibility and perioperative safety of three-dimensional computed tomography bronchography and angiography (3D-CTBA)-guided thoracoscopic split segmentectomy for deep pulmonary nodules.

Clinical data of consecutive patients screened for thoracoscopic split segmentectomy at a single center between Jan. 2020 and Dec. 2024 were retrospectively reviewed. A deep pulmonary nodule was defined as a nodule with a depth ratio >1/3. Preoperative thin-section computed tomography and three-dimensional reconstruction were used to assess the spatial relationships between the lesion and the segmental or subsegmental bronchi and vessels. A virtual 2-cm margin sphere was used to plan the individualized extent of resection. Intraoperatively, the lung parenchyma was split to establish an anatomical access route, followed by single segmentectomy or subsegmentectomy, or combined segmental and subsegmental resection. Outcomes included completion of the planned procedure, surgical margin distance, and perioperative outcomes.

Thirty patients were screened, of whom 6 with peripheral pulmonary nodules were excluded, leaving 24 patients for analysis. The mean lesion diameter was 0.99±0.27 cm, and the mean depth ratio was 0.40±0.06. Thirteen individualized resection combinations were performed. All 24 procedures were completed as planned, without extended resection or conversion to lobectomy. The mean surgical margin distance was 2.14±0.37 cm, operative time was 143.0±46.2 min, intraoperative blood loss was 44.2±17.5 mL, and postoperative hospital stay was 3.33±0.84 days. Prolonged air leak lasting >5 days occurred in 2 patients (8.3%). No reoperation, readmission, or 30-day mortality was observed.

With strict patient selection and three-dimensional reconstruction-based planning, split segmentectomy is safe and feasible for deep pulmonary nodules and can achieve adequate surgical margins.

To explore the feasibility and clinical efficacy of tubeless percutaneous transhepatic cholangioscopic lithotomy.

Two patients with hepatolithiasis admitted to The First Affiliated Hospital of Guangzhou Medical University on Apr. 2026 and Jun. 2026 were enrolled in this study. Two patients underwent tubeless percutaneous transhepatic cholangioscopic lithotomy. Clinical baseline data, operative time, surgical procedures, intraoperative blood loss, postoperative hospital stay, postoperative complications of the two patients were analyzed.

Ultrasound-guided one-step percutaneous transhepatic biliary puncture and sinus tract dilation for lithotomy were performed in both patients. Complete stone clearance was achieved in one case, an 8.5 Fr biliary internal stent was placed, then the percutaneous transhepatic sheath was removed without percutaneous transhepatic biliary external drainage. In the other case, after complete stone removal, the hepatic sinus tract was sealed with absorbable human fibrin glue, with neither biliary internal stent nor external biliary drainage placed. Tubeless percutaneous transhepatic cholangioscopic lithotomy was successfully accomplished in both patients. The operative time was 90 min and 70 min, respectively. Intraoperative blood loss was less than 10 ml in both cases. No intraoperative or postoperative complications such as biliary hemorrhage, peritoneal effusion or bile leakage occurred. Postoperative abdominal CT showed no residual stones in both patients.

Tubeless percutaneous transhepatic cholangioscopic lithotomy can achieve onestage complete stone clearance without placement of percutaneous transhepatic biliary external drainage tube. It provides a novel surgical strategy for percutaneous transhepatic cholangioscopic management of hepatolithiasis.

Local pancreatic duct stricture (LPDS) is defined as focal narrowing, cutoff or irregular tapering of the main pancreatic duct or branch pancreatic ducts, which may be accompanied by upstream pancreatic duct dilatation, parenchymal atrophy, impaired pancreatic juice drainage, calculi, pancreatic fistula or recurrent pancreatitis. LPDS can result from benign conditions including chronic pancreatitis, pancreatic duct stones, postoperative anastomotic stricture, trauma and autoimmune pancreatitis; it may also serve as an early indicator of pancreatic ductal adenocarcinoma, high-grade pancreatic intraepithelial neoplasia (PanIN), intraductal papillary mucinous neoplasm (IPMN) or other neoplasms. In recent years, advances in endoscopic retrograde cholangiopancreatography (ERCP), endoscopic ultrasonography (EUS), peroral pancreatoscopy (POPS), EUS-guided pancreatic duct drainage (EUS-PD), sequential pancreatic juice cytology, EUS-guided fine-needle aspiration/biopsy (EUS-FNA/FNB) and pancreatic duct stenting have transformed the diagnosis of LPDS from simple morphological assessment to an integrated "imaging-endoscopy-histology-molecular" evaluation. Correspondingly, treatment has evolved from straightforward dilation and stent placement to individualized strategies stratified by etiology, anatomical features and risk profiles. This review summarizes the definition, etiologies, endoscopic diagnostic algorithms, management of benign and malignant strictures, interventions for refractory strictures, prevention and treatment of complications, and cutting-edge advances of LPDS, aiming to provide evidence for establishing standardized and practical endoscopic diagnosis and treatment workflows in clinical practice.

Adenomyosis is a common benign gynecological disease in women of reproductive age, characterized by the invasion of endometrial glands and stroma into the myometrium, accompanied by hyperplasia and hypertrophy of the surrounding myocytes. Its clinical manifestations mainly include progressively worsening dysmenorrhea, menorrhagia, chronic pelvic pain, and infertility, severely affecting patients' quality of life. Treatment strategies primarily include medical therapy and surgical treatment. For patients with severe symptoms who do not respond to medical therapy or have fertility requirements, surgical treatment is an important option. Radical surgery, i. e., hysterectomy, can cure the disease but deprives patients of fertility and brings about a series of physiological and psychological impacts. Therefore, uterus-preserving conservative surgical approaches are receiving increasing attention. This article aims to systematically review the latest advances in conservative surgical treatment of adenomyosis and provide an outlook on future directions.

Laparoendoscopic single-site surgery (LESS) has become an increasingly adopted method in minimally invasive gynecologic surgery, its advantages include reduced abdominal wall trauma, improved cosmetic satisfaction, less postoperative pain, and shorter recovery. Enhanced Recovery After Surgery (ERAS) is built on evidence-based perioperative medicine, its core components involve preoperative patient education, intraoperative fluid and temperature management, multimodal analgesia, and early postoperative feeding and mobilization. In gynecologic surgeries, combining ERAS with LESS has shown obvious clinical benefits including reductions in length of stay, lower analgesic requirements, and complication rates below 10% in selected patient cohorts. This review mainly introduces the combining application of LESS and ERAS to optimize the results of patients with gynecologic surgeries in authors′ center.