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

doi:10.3877/cma.j.issn.1674-6899.2026.04.001

Abstract

Abstract:

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

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

/ / Recommend

Add to citation manager EndNote|Ris|BibTeX

URL: https://zhqjwkzz.cma-cmc.com.cn/EN/10.3877/cma.j.issn.1674-6899.2026.04.001

https://zhqjwkzz.cma-cmc.com.cn/EN/Y2026/V19/I04/193

Figures/Tables 3

References 70

[1]	Lee C, Wu K, Su H, et al. Robot-assisted natural orifice transluminal endoscopic surgery for hysterectomy[J]. Taiwan J Obstet Gynecol, 2015, 54(6): 761-765.
[2]	Alshiek J, Bar-El L, Shobeiri SA. Vaginal Robotic Supracervical Hysterectomy in an Ovine Animal Model: The Proof of Concept[J]. Open J Obstet Gynecol, 2019, 9(8): 1114-1129.
[3]	Chan K, Yeung C, Lam K, et al. Robotic Natural Orifice Transluminal Endoscopic Surgery Hysterectomy and Salpingo-Oophorectomy in a Porcine Model[J]. Surg Innov, 2022, 29(2): 215-224.
[4]	Mei Y, Wang Y, Zhang Q, et al. Gasless transvaginal natural orifice transluminal endoscopic surgery for hysterectomy and salpingectomy on a robot platform with flexible devices in a porcine model[J]. Sci Rep, 2024, 14(1): 5366.
[5]	Lowenstein L, Mor O, Matanes E, et al. Robotic Vaginal Natural Orifice Transluminal Endoscopic Hysterectomy for Benign Indications[J]. J Minim Invasive Gynecol, 2020, 28(5): 1101-1106.
[6]	纪妹，刘亚芬. 机器人辅助腹腔镜在妇科经自然腔道内镜手术中的应用[J]. 中国实用妇科与产科杂志，2019, 35(12): 1321-1324.
[7]	Kanno K, Taniguchi R, Higuchi N, et al. Single-port robotic versus conventional laparoscopic vNOTES hysterectomy: a propensity score-matched comparison of surgical outcomes and literature review[J]. Eur J Obstet Gynecol Reprod Biol, 2025, 315: 114757.
[8]	Yang Q, Lovell D, Wu J, et al. A comparative analysis of hysterectomy outcomes: robotic single-port vs. traditional transvaginal NOTES approaches[J]. Front Med (Lausanne), 2025, 12: 1614384.
[9]	Guan X, Lovell D, Zurawin R. The Evolution of Transvaginal Robot-Assisted Surgery in Gynecology[J]. Surg Technol Int, 2024, 44: 181-184.
[10]	Baekelandt J. Robotic vaginally assisted NOTES hysterectomy: the first case series demonstrating a new surgical technique[J]. Gynecol Surg, 2016, 13(1): 57-62.
[11]	Dapeng S, Jie C, Pu X, et al. Transvaginal single-hole laparoscopic (V-NOTES) total hysterectomy assisted by the Da Vinci Xi system: A case report[J]. Asian J Surg, 2022, 45(7): 1505-1506.
[12]	Guan X, Lovell D, Sendukas E. Pioneering case: Robotic single port (SP) transvaginal NOTES (RSP-vNOTES) for hysterectomy in ten steps[J]. Intelligent Surgery, 2024, 7: 1-6.
[13]	Yang Q, Kohn J, Guan X. Robotic single port versus robotic multiple port transvaginal orifice transluminal endoscopic surgery hysterectomy: a comparison of surgical outcomes[J]. J Robot Surg, 2025, 19(1): 410.
[14]	Guan X, Yang Q, Lovell D. Assessing Feasibility and Outcomes of Robotic Single Port Transvaginal NOTES (RSP-vNOTES) Hysterectomy: A Case Series[J]. J Minim Invasive Gynecol, 2024, 31(12): 1041-1049.
[15]	Farinha R, Sarchi L, Paciotti M, et al. New Robotic Platforms for Gynecology. Are We Achieving One of the Golden Goals？[J]. Clin Exp Obstet Gynecol, 2022, 49(11): 246.
[16]	Huang Q, Zhang C. Single-Port Robotic-Assisted Transvaginal Natural Orifice Transluminal Endoscopic Surgery for high Uterosacral Ligament Suspension[J]. J Minim Invasive Gynecol, 2025, 32(11): S137.
[17]	Zhang C, Li Q, Fang F, et al. Transvaginal NOTES hysterectomy with the Chinese robotic single port platform - Report of two cases[J]. Intelligent Surgery, 2024, 7: 30-35.
[18]	Zhang C, Fu X, Fang F, et al. 13587 Transvaginal Robotic Single-Port (RSP) Sacrocolpopexy with Y-Mesh[J]. J Minim Invasive Gynecol, 2025, 32(11): S138.
[19]	Zhang C, Li Q, Fang F, et al. Using robotic single-port vNOTES for gynaecological oncology: omentectomy in a patient with an ovarian granulosa cell tumor-a case study[J]. J Obstet Gynaecol, 2025, 45(1): 2556279.
[20]	Lin WL, Su YY, Mak KS, et al. Transvaginal robotic-assisted natural orifice laparoscopic hysterectomy for benign gynecologic disease: Determining appropriate candidates[J]. Taiwan J Obstet Gynecol, 2025, 64(6): 990-995.
[21]	Yang Q, Lovell DY, Ma Y, et al. The Feasibility and Safety of Robot-Assisted Vaginal Natural Orifice Transluminal Endoscopic Surgery (RA-vNOTES) for Gynecologic Disease: 298-Case Series[J]. Healthcare (Basel), 2025, 13(7): 720.
[22]	Marchand G, Ulibarri H, Arroyo A, et al. The feasibility and surgical outcomes of robotic vaginal natural orifice transluminal endoscopic single port hysterectomy for benign gynecologic diseases: a systematic review and meta-analysis[J]. AJOG Glob Rep, 2025, 5(3): 100512.
[23]	Xu P, Zhao Y, Tian Y, et al. A retrospective analysis of robot-assisted total hysterectomy by transvaginal natural orifice transluminal endoscopic surgery[J]. Heliyon, 2023, 9(9): e19207.
[24]	Thigpen B, Connell P, Erfani H, et al. Robotic-assisted vaginal natural orifice transluminal endoscopic surgery versus robotic-assisted single-site port for benign hysterectomy: a comparison of surgical outcomes[J]. J Robot Surg, 2023, 17(5): 2487-2494.
[25]	Wang Y, Jiang L, Chen Y. 13588 Robotic Transvaginal Notes Vs. Multiport Hysterectomy: A Comparative Study with Surgical Technique Demonstration[J]. J Minim Invasive Gynecol, 2025, 32(11): S72.
[26]	Imai K, Suzuki Y, Hiiragi K, et al. Comparison of quality of life after robotic-transvaginal natural orifice transluminal endoscopic surgery and robot-assisted laparoscopic hysterectomy[J]. Eur J Obstet Gynecol Reprod Biol, 2023, 288: 211-215.
[27]	Guan X, Yang Q, Zhang V, et al. Robotic-assisted transumbilical single-site and transvaginal NOTES resection of abdominal wall cesarean scar endometriosis: Two case reports[J]. Int J Gynecol Obstet, 2025.
[28]	Kanno K, Higuchi N, Taniguchi R, et al. Vaginal assisted NOTES hysterectomy for large uterus using the da Vinci SP[J]. J Minim Invasive Gynecol, 2025, 32(5): 415-416.
[29]	Yang Q, Izaddoost A, Lovell D, et al. Large uterus as a surgical challenge in robot-assisted vNOTES hysterectomy: a retrospective propensity score-matched analysis[J]. J Robot Surg, 2025, 19(1): 639.
[30]	Lim J, Yang L, Lin W, et al. Redefining hysterectomy: Robotic versus conventional approaches in transvaginal natural orifice transluminal endoscopic surgery and laparoscopically-assisted vaginal hysterectomy[J]. J Formos Med Assoc, 2025.
[31]	Liu Y, Sun L, Chen K, et al. Robot-assisted transvaginal natural orifice transluminal endoscopic surgery for a 32-year-old patient with early-stage endometrial carcinoma: A case report (with video)[J]. Intelligent Surgery, 2022.
[32]	Higuchi N, Kanno K, Kashiwabara T, et al. Robot-assisted transvaginal staging surgery using da Vinci SP for suspected ovarian borderline tumor: a case report[J]. Gynecol Oncol Rep, 2025, 62: 101987.
[33]	Thigpen B, Sun J, Guan X. Robotic transvaginal NOTES: A step-by-step approach to surgical technique[J]. Intelligent Surgery, 2022.
[34]	Guan X, Yang Q, Lovell DY, et al. Application of "4-P" port anchoring in transvaginal natural orifice transluminal endoscopic surgery (vNOTES): technique and initial feasibility[J]. J Robot Surg, 2025, 19(1): 473.
[35]	Yang YS. Robotic natural orifice transluminal endoscopic surgery (NOTES) hysterectomy as a scarless and gasless surgery[J]. Surg Endosc, 2020, 34(1): 492-500.
[36]	Mei Y, He L, Zhang Q, et al. The comparison of gasless and traditional robot-assisted transvaginal natural orifice transluminal endoscopic surgery in hysterectomy[J]. Front Med (Lausanne), 2023, 10: 1117158.
[37]	Guan X, Guan Z, Sunkara S, et al. Indocyanine Green-Assisted Retrograde Ureterolysis in Robotic Transvaginal NOTES for the Management of Stage IV Endometriosis with Obliterated Cul-de-sac[J]. J Minim Invasive Gynecol, 2023, 30(4): 266-267.
[38]	杨艳，李萌，梁华茂，等. 全子宫切除术后阴道断端裂开：病例分析及文献回顾[J]. 现代妇产科进展，2022, 31(6): 407-411.
[39]	世界华人医师协会妇产科专业组. 妇科经阴道自然腔道内镜手术专家共识[J]. 中国微创外科杂志，2023, 23(7): 481-490.
[40]	张春花，关小明. 妇科经自然腔道单孔手术发展现状与未来方向[J]. 中国临床新医学，2024, 17(6): 601-606.
[41]	孙大鹏，刘婧，陈捷，等. 经自然腔道机器人辅助单孔腹腔镜治疗宫颈高级别鳞状上皮内病变一例报道[J]. 机器人外科学杂志(中英文), 2023, 4(3): 277-280.
[42]	王景涛，黄桔园，张蔚，等. 第四代达芬奇机器人Xi系统辅助经阴道自然腔道内镜手术在妇科中的应用效果[J]. 武汉大学学报(医学版), 2024, 45(2): 147-151, 179.
[43]	Lowenstein L, Mor O, Matanes E, et al. Feasibility and Safety of Robotic Vaginal Natural Orifice Transluminal Endoscopic Hysterectomy for Benign Indications[J]. J Minim Invasive Gynecol, 2020, 27(7 Suppl): S92.
[44]	赵嘉慧，廖渊，张蔚，等. 机器人辅助经阴道自然腔道腹腔镜全子宫切除术的临床优势：回顾性队列研究[J]. 海军军医大学学报，2025, 46(11): 1407-1413.
[45]	张春花，黄倩，傅雪淑，等. 单孔机器人辅助经阴道自然腔道内镜手术与传统经阴道自然腔道内镜手术全子宫切除术临床对比研究[J]. 中国实用妇科与产科杂志，2026, 42(4): 460-463.
[46]	Yang Q, Lovell DY, Wu J, et al. A comparative analysis of hysterectomy outcomes: robotic single-port vs. traditional transvaginal NOTES approaches[J]. Front Med (Lausanne), 2025, 12: 1614384.
[47]	纪妹. 机器人辅助与传统经阴道自然腔道内镜手术子宫切除术的结果比较[J]. 机器人外科学杂志(中英文), 2022, 3(3): 246-247.
[48]	Yang Q, Pasternak D, Zhang C, Guan X. Comparative outcomes of robotic single-port vNOTES versus robotic-Xi assisted single-incision transumbilical surgery for hysterectomy[J]. Front Surg, 2026, 13: 1820180.
[49]	Yang Q, Kohn J, Guan X. Impact of obesity on surgical outcomes for robotic-assisted transvaginal natural orifice transluminal endoscopic surgery (RA-vNOTES) hysterectomy[J]. Eur J Obstet Gynecol Reprod Biol, 2025, 314: 114693.
[50]	Sunkara S, Guan X. Robotic vaginal natural orifice transluminal endoscopic myomectomy[J]. Fertil Steril, 2022, 118(2): 414-416.
[51]	Sendukas E, Guan X. Robotic Assisted vNOTES for Emergency Detorsion in a Patient with Morbid Obesity: Case Presentation[J]. J Minim Invasive Gynecol, 2025, 32(11): 958.
[52]	Lovell D, Guan X. 13271 Robotic SP Vnotes Right Ovarian Cystectomy[J]. J Minim Invasive Gynecol, 2025, 32(11 Suppl): S129.
[53]	刘洋，方芳，李莹，等. 国产单孔手术机器人辅助vNOTES治疗妇科良性疾病[J/OL]. 中华腔镜外科杂志(电子版), 2024, 17(4): 234-238.
[54]	Yang Q, Kohn J, Zhang C, et al. Stage-Specific outcomes of robotic transvaginal NOTES hysterectomy in endometriosis: A comparative study[J]. J Robot Surg, 2025, 19(1): 715.
[55]	Zhang Y, Delgado S, Liu J, et al. Robot-assisted Transvaginal Natural Orifice Transluminal Endoscopic Surgery for Management of Endometriosis: A Pilot Study of 33 Cases[J]. J Minim Invasive Gynecol, 2021, 28(12): 2060-2066.
[56]	Yang Q, Guan X. 13680 Robotic Single-Incision Laparoscopic Surgery for the Management of Endometriosis: First Experience Via the Da Vinci SP Platform[J]. J Minim Invasive Gynecol, 2025, 32(11 Suppl): S79.
[57]	Guan X, Lovell D. 11819 Robotic SP Transvaginal Notes Total Laparoscopic Hysterectomy with Bowel Endometriosis Shaving[J]. J Minim Invasive Gynecol, 2024, 31(11 Suppl): S115.
[58]	Lovell DY, Sendukas E, Yang Q, et al. Surgical enhancement with the placement of temporary bilateral ureteral stents with Indocyanine Green injection for all stages of endometriosis in vNOTES: Retrospective cross-sectional study[J]. J Minim Invasive Gynecol, 2025, 32(2): 166-170.
[59]	Delgadillo Chabolla L, Alpuing Radilla L, Koythong T, et al. Exploring the feasibility of indocyanine green fluorescence for intraoperative ureteral visualisation in robotic transvaginal natural orifice transluminal endoscopy surgery during endometriosis resection[J]. Int J Med Robot, 2024, 20(30): e2636.
[60]	Guan X, Guan Z, Koythong T, et al. Integration of a Robotic Platform for Sacrocolpopexy in Transvaginal Natural Orifice Transluminal Endoscopic Surgery: A Novel Surgical Technique[J]. Urology, 2021, 154: 109-114.
[61]	刘娟，肖媛月，王倩青，等. 盆腔器官脱垂手术新入路：机器人辅助经阴道腹腔镜阴道骶骨固定术[J/OL]. 中华腔镜外科杂志(电子版), 2021, 14(3): 168-171.
[62]	Wong P, Sood A, Eleswarapu S, et al. Robot-assisted laparoscopic transvaginal repair of ileal conduit fistula to vagina[J]. J Urol, 2019, 201(Suppl 1): e673-e674.
[63]	Ratanapornsompong W, Sarawong S, Elbakry A, et al. Video_02 - Single-Port Robotic-Assisted Transvaginal Retroperitoneal Ureteral Reimplantation[J]. Urology, 2025, 206: 76.
[64]	Bogani G, Giannini A, Vizza E, et al. Sentinel node mapping in endometrial cancer[J]. J Gynecol Oncol, 2024, 35(1): 1-12.
[65]	Simsek E, Karakas S, Karaaslan O, et al. Comparison of robotic and natural orifice transluminal endoscopic surgical technique procedures in patients undergoing sentinel lymph node biopsy during endometrial cancer surgery[J]. Surg Oncol, 2025, 63: 102282.
[66]	Jung G, Lee S, Lee K. Enhanced Operative Efficiency In Robotic SP^®-Assisted VNOTES For Gynecologic Oncology: A Case Series Analysis Of Endometrial And Cervical Cancer Surgeries[J]. Int J Gynecol Cancer, 2025, 35(2 Suppl 1): 100261.
[67]	Liu J, Tan L, Thigpen B, et al. Evaluation of the learning curve and safety outcomes in robotic assisted vaginal natural orifice transluminal endoscopic hysterectomy: A case series of 84 patients[J]. Int J Med Robot, 2022, 18(3): e2385.
[68]	Yang Q, Lovell DY, Guan X. Surgical Outcomes and Learning Curve of Robotic Single-Port Vaginal Natural Orifice Transluminal Endoscopic Surgery (vNOTES) Hysterectomy Using the Da Vinci Single-Port System[J]. Cureus, 2026, 18(1): e102729.
[69]	Servais E, Rashidi L, PP, et al. Novel force feedback technology improves suturing in robotic-assisted surgery: a pre-clinical study[J]. Surg Endosc, 2025, 39(2): 1217-1226.
[70]	Kawarabayashi Y, Hayase C, Ogawa S. Nerve-Guided and Tissue Attribute-Oriented Dissection to Improve Anatomical Recognition in Deep Endometriosis: AI-Enhanced Visualization[J]. J Minim Invasive Gynecol, 2026.

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

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

Please choose a citation manager

Content to export