{"paper_id":"f3a2e766-d168-4fd4-a58d-1dffc9cf049b","body_text":"Abstract\nTo evaluate the feasibility and safety of robotic single-port transvaginal natural orifice transluminal endoscopic surgery (RSP-vNOTES) compared to robotic multi-port vNOTES (RMP-vNOTES) for hysterectomy and associated procedures. 383 patients were retrospectively analyzed. Among the participants, 291 underwent RMP-vNOTES hysterectomy and 92 underwent RSP-vNOTES hysterectomy. The RSP-vNOTES group had a lower median BMI (26 vs. 29 kg/m2, p = 0.02), fewer patients with prior vaginal delivery (32% vs. 46%, p = 0.02), and lower median uterine weight (92 vs. 122 g, p = 0.02). Regarding additional surgical procedures performed, the RSP-vNOTES group had a higher proportion of endometriosis excision-related interventions (lysis of adhesions, endometriosis excision, ovarian cystectomy, appendectomy, bowel shaving, and bowel oversew, all p < 0.05). Multiple linear regression analysis was conducted to adjust for these variables. After adjustment, no significant differences were observed between the groups in total operative time, port placement time, hysterectomy time, estimated blood loss, or conversion rate. No significant differences existed in postoperative pain or complications. In total, three conversions to abdominal robotics occurred (0.8%), all due to complex endometriosis. Robotic vNOTES enhances the performance of vaginal surgeries by leveraging the established advantages of robotic technology with the minimally invasive advantage of vaginal surgery. Both RSP-vNOTES and RMP-vNOTES are effective and safe, but RSP-vNOTES offering logistical and ergonomic benefits while facilitating increased complexity of procedures, particularly endometriosis excision. 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J Minim Invasive Gynecol. https://doi.org/10.1016/j.jmig.2025.01.008\nFunding\nThe authors declare that no funds, grants, or other support were received during the preparation of this manuscript.\nAuthor information\nAuthors and Affiliations\nContributions\nAll authors contributed to the study conception and design. Material preparation, data collection and analysis were performed by Qiannan Yang, Jaden Kohn, and Xiaoming Guan. The first draft of the manuscript was written by Qiannan Yang and all authors commented on previous versions of the manuscript. All authors read and approved the final manuscript.\nCorresponding author\nEthics declarations\nConflict of interest\nThe authors declare no competing interests.\nEthical approval\nThis study was IRB-approved from Baylor College of Medicine on March 8, 2022, under the approval number H-51429. Patient consent was waived due to retrospective nature of the study by an Institutional Review Board (IRB).\nAdditional information\nPublisher's Note\nSpringer Nature remains neutral with regard to jurisdictional claims in published maps and institutional affiliations.\nSupplementary Information\nBelow is the link to the electronic supplementary material.\nRights and permissions\nSpringer Nature or its licensor (e.g. a society or other partner) holds exclusive rights to this article under a publishing agreement with the author(s) or other rightsholder(s); author self-archiving of the accepted manuscript version of this article is solely governed by the terms of such publishing agreement and applicable law.\nAbout this article\nCite this article\nYang, Q., Kohn, J. & Guan, X. Robotic single port versus robotic multiple port transvaginal orifice transluminal endoscopic surgery hysterectomy: a comparison of surgical outcomes. J Robotic Surg 19, 410 (2025). https://doi.org/10.1007/s11701-025-02593-x\nReceived:\nAccepted:\nPublished:\nVersion of record:\nDOI: https://doi.org/10.1007/s11701-025-02593-x","source_license":"public-domain-us","license_restricted":false}