Comparative Analysis of Single-Port Robotic-Assisted vNOTES and Traditional vNOTES in Total Hysterectomy

Comparative Analysis of Single-Port Robotic-Assisted vNOTES and Traditional vNOTES in Total Hysterectomy | Research Square window.SnipcartSettings = { analytics: { enabled: false } }; (function() { var accessVector = localStorage.getItem('access_vector') || ''; window.dataLayer = window.dataLayer || []; if (accessVector) { window.dataLayer.push({ user: { profile: { profileInfo: { snid: accessVector } } } }); } })(); (function(w,d,s,l,i){w[l]=w[l]||[];w[l].push({'gtm.start':new Date().getTime(),event:'gtm.js'});var f=d.getElementsByTagName(s)[0],j=d.createElement(s),dl=l!='dataLayer'?'&l='+l:'';j.async=true;j.src='https://www.googletagmanager.com/gtm.js?id='+i+dl;f.parentNode.insertBefore(j,f);})(window,document,'script','dataLayer','GTM-K279D39R'); Browse Preprints In Review Journals COVID-19 Preprints AJE Video Bytes Research Tools Research Promotion AJE Professional Editing AJE Rubriq About Preprint Platform In Review Editorial Policies Our Team Advisory Board Help Center Sign In Submit a Preprint Cite Share Download PDF Research Article Comparative Analysis of Single-Port Robotic-Assisted vNOTES and Traditional vNOTES in Total Hysterectomy Xiaoming Guan, Chunhua Zhang, Xiaojie Hu, Qian Huang, Yunxia Chen, and 2 more This is a preprint; it has not been peer reviewed by a journal. https://doi.org/ 10.21203/rs.3.rs-7917529/v1 This work is licensed under a CC BY 4.0 License Status: Posted Version 1 posted You are reading this latest preprint version Abstract Objective To explore the clinical effects of single-port robot-assisted vNOTES (RSP-vNOTES) and traditional vNOTES (T-vNOTES) in total hysterectomy. Methods Thirty patients who underwent total hysterectomy using RSP-vNOTES in our hospital from January 2024 to July 2025 were selected as the observation group, and 60 patients who underwent total hysterectomy using T-vNOTES from January 2024 to July 2025 were selected as the control group. Compare the differences in surgical effects, subjective feelings of the surgeons, and the intensity of surgical operation workload between the two groups of patients. Result The maximum uterine volume resected in the control group was 699.23cm³, and that in the observation group was 919.93cm³. The surgical triangle was shown in the observation group, while that in the control group was not. The operation time of the observation group was longer than that of the control group ( P < 0.05), and the intraoperative blood loss and intraoperative fluid infusion volume were less than those of the control group (both P < 0.05). There was no statistically significant difference in pain conditions 24 hours after surgery, the time of first defecation after surgery, and hospital stay between the two groups of patients (all P > 0.05). One case in the control group was transferred to transumbilical single-port laparoscopic surgery due to severe pelvic adhesion, and the rest of the patients completed the surgery successfully without postoperative complications and any cases of secondary surgery. The scores of binocular focusing difference, visual depth perception, coordination of field and viewing Angle control, pixel stability, color resolution, and rapid image update rate of the surgeons in the observation group were higher than those in the control group (all P < 0.05). The scores of mental demand, physical demand, task completion and effort in the observation group were all lower than those in the control group (all P 0.05). Conclusion Compared with T-vNOTES for total hysterectomy, RSP-vNOTES causes less trauma to patients and has higher surgical accuracy. RSP-vNOTES has more advantages for complex surgical operations. RSP-vNOTES surgeons have a better subjective experience during operation, a lighter workload intensity, which is conducive to shortening the learning time of vNOTES for surgeons, improving the comfort of operation, and enabling less experienced physicians to master vNOTES surgery more quickly. Single-hole robot vNOTES Total hysterectomy Surgical outcome The subjective feelings of the surgeon The intensity of surgical operation workload Introduction Hysterectomy is the most commonly used and effective method for treating benign uterine diseases such as uterine fibroids, adenomyosis, and atypical endometrial hyperplasia. Specific surgical procedures include transabdominal total hysterectomy, transvaginal total hysterectomy, laparoscopic transumbilical total hysterectomy, transvaginal natural orifice transluminal endoscopic surgery (v-NOTES) and so on. Among them, v-NOTES can not only give full play to the minimally invasive advantages of laparoscopy, avoiding the scar formed by the traditional laparoscopic abdominal wall skin incision and the related complications caused by trocar puncture, but also reduce postoperative pain and accelerate postoperative recovery, so that the patients can experience more humanistic care. Traditional vNOTES (T-vNOTES) have good safety and reliability and are increasingly widely used in the field of gynecological diseases. However, there are defects such as loss of "surgical triangle", mutual interference of surgical instruments, no assistant assistance and insufficient exposure of some target surgical sites. These defects increase the operation complexity, surgical risk and learning difficulty, which cause some gynaecologists not to dare to try it, and impede the popularity of v-NOTES. Surgical robotic system-assisted vNOTES (robotic vNOTES, R-vNOTES) improves visual field, reduces surgical difficulty, and enables breakthroughs in minimally invasive gynaecological surgery. Currently, more studies are conducted on multi-port R-vNOTES total hysterectomy, whose safety and feasibility are not inferior to that of traditional laparoscopic surgery, whereas the overall number of reports of new-generation single port (SP) robotic surgical system-assisted vNOTES (robotic single port vNOTES, RSP-vNOTES) total hysterectomy The number of cases is relatively small, and its surgical efficacy, safety, and surgical perception of the operator need to be further evaluated [1] . In our hospital, 30 cases of total hysterectomy using RSP-vNOTES were performed from January 2024 to July 2025, and good clinical results were achieved. This paper retrospectively analyses the clinical data of RSP-vNOTES and T-vNOTES total hysterectomy, in order to provide reference for the clinical promotion and application of RSP-vNOTES. Materials and Methods 1.1 general data Fifty patients who underwent total hysterectomy with RSP-vNOTES in our hospital from January 2024 to July 2025 were selected as the observation group, and 100 patients who underwent total hysterectomy with T-vNOTES from January 2024 to July 2025 were selected as the control group. The comparison of basic data of the two groups of patients is shown in Table 1. Among them, the volume of the uterus = long diameter (cm) × transverse diameter (cm) × anteroposterior diameter (cm) ×0.542. Inclusion criteria: All patients were married, pathologically diagnosed with benign uterine diseases, and had indications for vNOTES surgery; Patients with contraindications to surgical anesthesia, vaginal stenosis, combined severe cardiovascular and cerebrovascular diseases, coagulation dysfunction, and incomplete data were excluded. The operation was performed by the same physician with experience in T-vNOTES and RSP-vNOTES surgeries. All patients gave informed consent and signed the informed consent form for the operation. This study was approved by the hospital's medical ethics committee（2023043）. Table 1 Comparison of basic information between the two groups of patients project Observation Group (30 cases) Control group (60 cases) t/ χ 2 test P Age (years) 52.83±9.41 49.87±7.91 1.547 0.119 Body mass Index (Kg/m²) 25.10±3.88 25.94±4.05 0.932 0.354 History of abdominal surgery (examples) 12 20 0.533 0.639 Uterine volume (cm³) 162.83±201.30 147.63±232.93 0.305 0.761 diagnosis；myoma of uterus 8 25 4.869 0.088 adenomyosis 7 19 Other benign uterine diseases 15 16 1.2 Surgical Procedure The control group underwent T-vNOTES total hysterectomy supplemented with salpingectomy, lysis of pelvic adhesions, and other procedures based on lesion type. Surgical methods and steps adhered to the International Expert Consensus on the Safe Implementation of Transvaginal Natural Orifice Transluminal Endoscopic Surgery (2021) [2] and the Chinese Expert Consensus on Transvaginal Natural Orifice Transluminal Endoscopic Surgery in Gynaecology (China, 2023) [3] , and the Expert Consensus on Transvaginal Total Hysterectomy (2024 Edition) [4] . In the observation group, all procedures were performed under the assistance of the Sharp Single-Port Laparoscopic Surgery Robot System-vNOTES, with surgical specimens retrieved transvaginally. Both groups received postoperative antimicrobial prophylaxis, with oral intake permitted 6 hours postoperatively in the absence of complications. 1. 3 Observation Indicators Compare the differences between the two groups of patients in terms of surgical effect, subjective feeling of the operator, and workload intensity of the operator's surgical operation. The surgical effect indicators include the length of surgery, intraoperative bleeding, surgical triangle display, intraoperative rehydration volume, 24h postoperative pain, the time of the first postoperative defecation, the incidence of surgical complications, and hospital stay, in which the pain was assessed using the Visual Analogue Scale/Score (VAS), with a score of 0 for no pain, and a score of 10 for severe pain, and the observation group's surgical. The duration was the loading time add surgical operation time. The subjective perception of the operator was assessed by the attending surgeon after surgery by filling out a subjective perception scale, which included binocular focusing discrepancy, visual depth of field, coordination of visual field and angle of view manipulation, pixel stability, colour resolution, and rapid update rate of the screen. The scale was measured by the five-point Likert Scale, with scores from 1 to 5 indicating strongly disagree, disagree, undecided, agree, and strongly agree, respectively. The workload intensity of the operator's surgical operation was assessed using the nationalaeronautics and space administration task load index (NASA-TLX) [5] , which contains six scales: cerebral demand, physical demand, time demand, task completion, effort, frustration, and the degree of frustration. The scale consists of 6 items, including brain demand, physical demand, time demand, task completion, effort, and frustration, and each item is scored by a straight line from 0 to 20, with 0 indicating very low and 20 indicating very high. 1. 4 Statistical Methods Statistical software used was SPSS 22.0. For categorical data between two groups, the chi-square test was applied. For continuous data, the t-test was employed. P < 0.05 was considered statistically significant. Results 2.1 Comparison of Surgical Outcomes Between Two Patient Groups The maximum uterine volume resected in the control group was 699.23 cm³, whereas that in the observation group was 919.93 cm³. The observation group demonstrated a surgical triangle, which was absent in the control group. The observation group exhibited shorter operative duration ( P < 0.05), lower intraoperative blood loss, and reduced intraoperative fluid administration compared to the control group (both P 0.05). One patient in the control group underwent conversion to open surgery due to severe pelvic adhesions; all other patients completed the procedure uneventfully. No postoperative complications or reoperations occurred. See Table 2. Table 2 Comparison of surgical outcomes between the two groups of patients（ ±s） project Observation Group (30 cases) Control group (60 cases) t P Duration of surgery（min） 129.50±29.52 151.08±46.36 2.322 0.023 Intraoperative haemorrhage（ml） 71.00±84.50 128.83±140.40 2.073 0.041 Intraoperative rehydration volume（ml） 1183.34±427.57 1419.26±185.97 3.651 <0.001 24h postoperative VAS score 2.97±1.10 3.22±1.15 0.986 0.327 Time to first postoperative bowel movement（d） 3.03±0.89 2.78±0.55 1.635 0.106 transluminal transumbilical unicorn surgery 0 1 0.506 0.477 Length of postoperative stay（d） 5.10±1.67 5.13±1.17 0.110 0.913 Total hospitalisation costs（RMB） 36744.04±12321.28 23734.15±4196.69 7.398 <0.001 2.2 Comparison of Subjective Perceptions Between Two Groups of Operators Operators in the observation group scored higher than those in the control group for binocular focus disparity, visual depth perception, coordination between field of view and viewing angle control, pixel stability, colour resolution, and rapid image refresh rate (all P < 0.05), as shown in Table 3. Table 3 Comparison of subjective feelings between the two groups（ ±s，score） project Observation group (30 cases) Control group (60 cases) t P Binocular Focusing Difference 4.67±0.47 3.09±0.40 32.764 <0.001 visual depth 4.74±0.44 3.14±0.43 33.028 <0.001 Field of view and viewpoint manipulation coordination 4.77±0.42 3.08±0.34 40.033 <0.001 Pixel stability 4.12±0.33 4.02±0.31 2.779 0.006 Colour resolution 4.21±0.41 4.07±0.26 3.679 <0.001 Rapid screen update rate 4.30±0.46 4.12±0.32 4.122 <0.001 2.3 Comparison of workload intensity between the two groups of operators The scores of mental demand, physical demand, task completion, and effort of the observation group were lower than those of the control group (all P0.05), as shown in Table 4. Table 4 Comparison of workload intensity between two groups of operators（ ±s，score） project Observation group (30 cases) Control group (70 cases) t P mental needs 2.98±0.66 5.03±0.99 18.748 <0.001 stamina requirement 3.30±0.83 5.22±0.90 18.289 <0.001 time requirement 3.10±0.66 3.16±0.57 0.838 0.403 Mandate fulfilment 1.68±0.59 2.64±0.55 14.372 <0.001 degree of effort 3.05±0.79 5.24±0.63 22.255 <0.001 degree of frustration 1.80±0.58 1.87±0.63 0.934 0.351 Discussion NOTES refers to the "natural cavity" in surgery, such as the stomach, rectum, urethra, vagina, etc. to enter the abdominal cavity to reach the target surgical site for surgical operations, which can eliminate or hide the surgical scar, reduce surgical trauma, reduce the amount of postoperative analgesic drugs, and promote the postoperative recovery, and it is the direction of the development of clinical surgery. Vagina is the natural cavity that connects the female abdominal cavity to the outside world, and compared with the transrectal and gastric routes of NOTES, it has a short distance to the surface of the body, good elasticity and dilatation, large operating space, fast healing of the incision, and low risk of infection and leakage, which makes it the most commonly used route of NOTES in clinical practice, especially in the field of gynaecology. In 2012, Lee et al [6] reported 10 cases of adnexal resection by T-vNOTES for the first time, 9 of which were successful, 1 of which was due to a severe injury. Nine of them were successful and one was converted to open surgery due to preoperative misdiagnosis. In 2021, Badiglian et al [7] reported that T-vNOTES hysterectomy, salpingectomy, and salpingo-oophorectomy In terms of surgical indications, complications, conversion to surgery, blood transfusion, reoperation, severe intestinal obstruction, vomiting, postoperative infection rate, hospital stay, and readmission rate within 6 weeks, the indicators were comparable to those of the standard laparoscopic surgery group (all P >0.05). A 2020 clinical controlled study by Chen Keyao et al [8] showed that T-vNOTES hysterectomy had advantages over transumbilical laparoscopy and traditional transabdominal laparoscopy in terms of time to first postoperative anal defecation and postoperative 24h VAS score (all P <0.05); Zhang Chunhua et al [9] showed that T vNOTES for the treatment of benign gynaecological diseases, there existed advantages in postoperative time to get out of bed, time to recover intestinal function, postoperative pain level, hospital stay, and cosmetic scores compared with transumbilical route surgery (all P <0.05). T-vNOTES is safe and feasible to treat most gynaecological diseases, and has certain advantages over traditional laparoscopy, but there are limitations due to the influence of equipment, instruments and operating experience, such as no assistant assistance, weakening of visual depth, loss of surgical triangles, and prolonged surgical operation easily leads to fatigue of the surgeon, hand tremor, etc, which reduces the feasibility of complex surgical operations, and has an impact on the surgeon's learning and operation training. This reduces the feasibility of complex surgical operations, affects surgeons' learning and operation training, and hinders the development of vNOTES. The successful development of surgical robotic system breaks through the limitations of traditional endoscopic surgery, its three-dimensional high-definition imaging, tremor elimination function, flexible wrist instruments, motion scaling ratio adjustment function, etc. to make surgical operations easier, more flexible, more accurate, better able to perform the anastomosis, knot tying and other complex actions, and its assisted surgical operation has become a landmark milestone in the history of minimally invasive surgery. In 2021, Koythong [10] compared the data of 39 patients who underwent Da Vinci Xi robot-assisted vNOTES hysterectomy with 76 patients who underwent T-vNOTES hysterectomy. The results showed that there were no statistically significant differences between the two groups in terms of operation time, blood loss, hospital stay, and the degree of pain at 1 week, 2 weeks, and 3 weeks after the operation (all P >0.05); among the patients of the T-vNOTES group, the mid-construction transumbilical single-port laparoscopic operation was performed in 1 case, and there were no cases of relayed open surgery in the R-vNOTES group. In 2025, Yang et al [11] retrospectively analyzed 298 cases of gynecological diseases treated with R-vNOTES, including endometriosis, chronic pelvic pain, abnormal uterine bleeding, uterine fibroids, etc. The median total operation time was 138 minutes, the median estimated intraoperative blood loss was 50 ml, and 3 cases were converted to laparoscopic surgery. One case was converted to robot-assisted single-port plus single-port laparoscopic surgery, and two cases were converted to robot-assisted multi-port surgery. The intraoperative complication rate was 2.1%, and the postoperative complication rate was 15.44%. The above research results indicate that R-vNOTES is feasible for treating various gynecological conditions with less trauma, and it can help surgeons with insufficient experience in single-port laparoscopic surgery to learn and master the vNOTES technique more quickly. The traditional multi-hole surgical robot system still has the following limitations, such as only two mechanical arms, one straight camera, multi-arm collision, complex preoperative positioning, and the surgical system not conforming to ergonomic design, etc. Therefore, the multi-hole surgical robot system is regarded as a transitional stage of the single-hole surgical robot system. The SP surgical robot system features an integrated and compact layout, with technical advantages such as single incision, high-definition 3D image guidance, wide movement range, highly flexible serpentine arm, good master-slave control experience, and strong load capacity. It can complete complex surgical operations in limited and narrow Spaces, expanding the surgical indications. In 2023, Guan et al [12] successfully utilized the Da Vinci SP surgical robot system to assist vNOTES in completing a hysterectomy. The patient was discharged on the same day after the operation, and no surgical complications occurred. In 2024, Guan et al [13] reported 4 cases of RSP-vNOTES simple total hysterectomy and 18 cases of RSP-vNOTES endometriosis resection. The BMI of the patients ranged from 20.2 to 48.4 kg/m2, and the total hysterectomy time ranged from 24.0 to 170.0min. The intraoperative blood loss ranged from 25.0 to 50.0mL. Complications included one case of cellulitis at the vaginal stump and one case of urinary tract infection, demonstrating the feasibility and success of SP system-assisted vNOTES in the treatment of gynecological diseases. In 2023, Zhang Chunhua [14] and Liu Yang et al [15] in China used the EDGE SP1000 surgical robot system to assist vNOTES in completing the treatment of 2 hysterectomies and 20 benign gynecological diseases respectively, and no surgical complications occurred. The safety and feasibility of RSP-vNOTES hysterectomy were further verified. The results of this study showed that the observation group showed the surgical triangle, and the control group did not show the surgical triangle; the length of surgery in the observation group was shorter than that in the control group ( P <0.05), and the amount of intraoperative haemorrhage and intraoperative rehydration was less than that in the control group ( P <0.05); there was no statistical significance for differences in the pain condition in the postoperative period of 24h, the time of the first bowel movement after the operation and the length of hospital stay between the two groups (all P >0.05). Except for one case in the control group, who was transferred to open surgery due to severe pelvic adhesions, all patients in both groups successfully completed the surgery, and no postoperative complications occurred, which suggests that total hysterectomy with RSP-vNOTES is less traumatic and more accurate than that of T-vNOTES patients. Because the high-definition three-dimensional imaging of the SP surgical system can better display the surgical field and the "surgical triangle", the third arm can better expose the target surgical site, the operating space is larger and more delicate, and the safety is higher, so the RSP-vNOTES has a greater advantage over the T-vNOTES for complex surgeries. For example, the uterine volume in this group of RSP-vNOTES patients was 919.93cm 3 , and 12 patients had a history of cesarean section, adnexal surgery, appendicitis and other abdominal and pelvic surgeries, and all of the patients successfully completed the surgery without increasing the length of the operation, the amount of intraoperative bleeding, the amount of rehydration and the incidence of surgical complications. In addition, the scores of binocular focusing difference, visual depth, coordination of visual field and perspective manipulation, pixel stability, colour resolution, and rapid update rate of the screen were higher in the observation group than in the control group (all P <0.05), and the scores of workload intensity in terms of cerebral demand, physical demand, task completion, and effort were lower than those in the control group (all P <0.05), which suggests that RSP-vNOTES can improve the performance of the patients' workloads more than T-vNOTES, which can improve the performance of the patients' workloads more than T-vNOTES. vNOTES can improve the subjective feeling of the operator's operation, reduce the intensity of workload, and improve the comfort of the operator.In 2025, Guan et al [16] implemented the "4P"' port anchoring surgical technique in R-vNOTES, which provided a feasible and effective method for the fixation of the inner annular port and enhanced the accessibility of the operation, and reduced the port displacement. accessibility, reduced the risk of complications related to port displacement and gas leakage, and represents a valuable advance in the evolution of laparoscopy and R-vNOTES. In summary, compared with T-vNOTES total hysterectomy, RSP-vNOTES has the advantages of shorter operation time, less intraoperative bleeding, fine operation, higher safety, and is more suitable for complex surgical operations; RSP-vNOTES operators have better subjective feelings of operation, and the intensity of the workload is lighter, which is conducive to shortening the time for operators to learn about vNOTES, increasing the comfort level of the operation, and making inexperienced The RSP-vNOTES can help operators to shorten the learning time of vNOTES, improve the operating comfort, and enable inexperienced physicians to master vNOTES surgery faster. However, the clinical prevalence of surgical robotic systems is still low, and the cost of treatment is relatively high, which makes the burden of medical treatment on patients and society heavy. In addition, this study is retrospective, with a small amount of data and potential selective bias, and the subjective feeling and workload intensity were assessed by the operator filling out the assessment form after surgery, which may have recall bias. Therefore, further large-sample, randomised, controlled data studies should be conducted to comprehensively assess the effectiveness, safety and long-term effects of the RSP-vNOTES in gynaecological diseases. Declarations Author Contribution Chunhua Zhang and Xiaojie Hu contributed equally to this work and share first authorship. Chunhua Zhang and Xiaojie Hu wrote the main manuscript text. Qian Huang, Yunxia Chen, and Ranxin Zhang collected and analyzed the clinical data. Yaxiong Xu prepared Table 1–4. Xiaoming Guan conceived and supervised the study, and critically revised the manuscript. All authors reviewed and approved the final version of the manuscript. Data Availability The sequence data supporting the findings of this study are stored in the medical record system of the Second Affiliated Hospital of Nanjing Medical University. Due to patient privacy considerations, the data are not publicly available but can be accessed upon reasonable request. References Guan X, Yang Q, Lovell DY. Assessing Feasibility and Outcomes of Robotic Single Port Transvaginal NOTES(RSP-vNOTES) Hysterectomy: A Case Series[J]. Journal of Minimally Invasive Gynecology,2024,13 (12):1041–1049. Kapurubandara S, Lowenstein L, Salvay H, et al. Consensus on safe implementation of vaginal natural orifice transluminal endoscopic surgery (vNOTES)[J]. European journal of obstetrics, gynecology, and reproductive biology,2021,263 (Suppl C):216–222. 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. 中国妇幼保健协会妇科阴式手术专业委员会. 经阴道全子宫切除术专家共识(2024年版)[J]. 中国实用妇科与产科杂志,2024,40 (3):321–328. Elek RN, Haidegger T. Non-Technical Skill Assessment and Mental Load Evaluation in Robot-Assisted Minimally Invasive Surgery[J]. Sensors (Basel, Switzerland,2021,21 (8):2666. Lee C-L, Wu K-Y, Su H, et al. Transvaginal Natural-Orifice Transluminal Endoscopic Surgery (NOTES) in Adnexal Procedures[J]. Journal of Minimally Invasive Gynecology,2012,19 (4):: 509–513. Badiglian-Filho L, Faloppa CC, Menezes ANdO, et al. Vaginally assisted NOTES hysterectomy with adnexectomy (vNOTES) compared with conventional laparoscopy. A retrospective observational cohort study[J]. International journal of gynaecology and obstetrics: the official organ of the International Federation of Gynaecology and Obstetrics,2021,153 (2):351–356. 陈珂瑶, 孙力, 李华, 等. 经阴道自然腔道内镜全子宫切除手术的临床对比分析[J]. 中华腔镜外科杂志(电子版),2020,13 (2):96–102. Zhang C, Duan K, Fang F, et al. Comparison of Transvaginal and Transumbilical Laparoscopic Single-Site Surgery for Ovarian Cysts[J]. Journal of the Society of Laparoendoscopic Surgeons,2021,25 (2) Koythong T, Thigpen B, Sunkara S, et al. Outcomes of Hysterectomy via Robot-assisted versus Traditional Transvaginal Natural Orifice Transluminal Endoscopic Surgery[J]. Journal of minimally invasive gynecology,2021,28 (12):2028–2035. 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, Switzerland),2025,13 (7) 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. Guan X, Yang Q, Lovell D, et al. Feasibility and Outcomes of Robot-Assisted Single Port Vaginal Notes (RSP-vNOTES) Hysterectomy: A Retrospective Study[J]. Journal of Minimally Invasive Gynecology,2024,31 (11Suppl):S104. 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,2024:30–35. 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]. 中华腔镜外科杂志(电子版),2024,17 (4):234–238. Guan X, Yang Q, Lovell Daniel Y, et al. Application of “4-P” port anchoring in transvaginal natural orifce transluminal endoscopic surgery (vNOTES): technique and initial feasibility[J]. Journal of Robotic Surgery,2025,19 (473) Additional Declarations No competing interests reported. Cite Share Download PDF Status: Posted Version 1 posted You are reading this latest preprint version Research Square lets you share your work early, gain feedback from the community, and start making changes to your manuscript prior to peer review in a journal. As a division of Research Square Company, we’re committed to making research communication faster, fairer, and more useful. We do this by developing innovative software and high quality services for the global research community. Our growing team is made up of researchers and industry professionals working together to solve the most critical problems facing scientific publishing. Also discoverable on Platform About Our Team In Review Editorial Policies Advisory Board Help Center Resources Author Services Accessibility API Access RSS feed Manage Cookie Preferences © Research Square 2026 | ISSN 2693-5015 (online) Privacy Policy Terms of Service Do Not Sell My Personal Information {"props":{"pageProps":{"initialData":{"identity":"rs-7917529","acceptedTermsAndConditions":true,"allowDirectSubmit":true,"archivedVersions":[],"articleType":"Research Article","associatedPublications":[],"authors":[{"id":540324688,"identity":"38e2e9ac-15ab-4566-ba15-ff036d506ef0","order_by":0,"name":"Xiaoming Guan","email":"data:image/png;base64,iVBORw0KGgoAAAANSUhEUgAAAZAAAAAyAQMAAABI0h/eAAAABlBMVEX///8AAABVwtN+AAAACXBIWXMAAA7EAAAOxAGVKw4bAAAAu0lEQVRIiWNgGAWjYDACZhBhwMDAL4HgEqlFcgbRWmDA4AaxWgyOMz98dKPgjt3m281PNzBUWCc2ENIi2cxmbJxj8Cx5251jZjcYzqQT1sLPzGAmnWNwONnsRg7bDca2w4S1sDGzfwNrMZ4B0vKPCC38zDxgW+wMJEBaGojQItnMUwz0y+EECZBfEo6lGxPUYnD++MbHOX8O2/PPbn5240ONtSxBLTAAcU8CscpBwJ4UxaNgFIyCUTDCAACo+D2eMKluJwAAAABJRU5ErkJggg==","orcid":"","institution":"Baylor College of Medicine","correspondingAuthor":true,"prefix":"","firstName":"Xiaoming","middleName":"","lastName":"Guan","suffix":""},{"id":540324690,"identity":"07b07aa9-d8ca-4a81-8c4f-7508713fadb2","order_by":1,"name":"Chunhua Zhang","email":"","orcid":"","institution":"The Second Affiliated Hospital of Nanjing Medical University","correspondingAuthor":false,"prefix":"","firstName":"Chunhua","middleName":"","lastName":"Zhang","suffix":""},{"id":540324694,"identity":"790d5369-f5b4-4c1b-a469-31cd9a100f07","order_by":2,"name":"Xiaojie Hu","email":"","orcid":"","institution":"The Second Affiliated Hospital of Nanjing Medical University","correspondingAuthor":false,"prefix":"","firstName":"Xiaojie","middleName":"","lastName":"Hu","suffix":""},{"id":540324695,"identity":"59d6e441-9e45-4019-ab36-e1bd087874c0","order_by":3,"name":"Qian Huang","email":"","orcid":"","institution":"The Second Affiliated Hospital of Nanjing Medical University","correspondingAuthor":false,"prefix":"","firstName":"Qian","middleName":"","lastName":"Huang","suffix":""},{"id":540324696,"identity":"660ce966-03b3-4d4e-baee-4c582684991b","order_by":4,"name":"Yunxia Chen","email":"","orcid":"","institution":"The Second Affiliated Hospital of Nanjing Medical University","correspondingAuthor":false,"prefix":"","firstName":"Yunxia","middleName":"","lastName":"Chen","suffix":""},{"id":540324699,"identity":"467ca69e-af53-4055-a641-8bb4e911d902","order_by":5,"name":"Ranxin Zhang","email":"","orcid":"","institution":"The Second Affiliated Hospital of Nanjing Medical University","correspondingAuthor":false,"prefix":"","firstName":"Ranxin","middleName":"","lastName":"Zhang","suffix":""},{"id":540324700,"identity":"8410daac-4ac0-4ce0-be65-4356260f5f46","order_by":6,"name":"Yaxiong Xu","email":"","orcid":"","institution":"The Second Affiliated Hospital of Nanjing Medical University","correspondingAuthor":false,"prefix":"","firstName":"Yaxiong","middleName":"","lastName":"Xu","suffix":""}],"badges":[],"createdAt":"2025-10-22 08:10:09","currentVersionCode":1,"declarations":"","doi":"10.21203/rs.3.rs-7917529/v1","doiUrl":"https://doi.org/10.21203/rs.3.rs-7917529/v1","draftVersion":[],"editorialEvents":[],"editorialNote":"","failedWorkflow":false,"files":[{"id":95375907,"identity":"b23c6824-58a1-44ba-8458-ee2dfb9bb8c8","added_by":"auto","created_at":"2025-11-07 10:49:02","extension":"docx","order_by":0,"title":"","display":"","copyAsset":false,"role":"acdc-reference","size":49993,"visible":true,"origin":"","legend":"","description":"","filename":"ComparativeAnalysisofSinglePortRoboticAssistedvNOTESandTraditionalvNOTESinTotalHysterectomy.docx","url":"https://assets-eu.researchsquare.com/files/rs-7917529/v1/813d31e1ce08ad0b05e015f2.docx"},{"id":95526578,"identity":"311fd4f3-ee5b-4fb4-b9d9-487eee1c9b8c","added_by":"auto","created_at":"2025-11-10 10:07:17","extension":"json","order_by":1,"title":"","display":"","copyAsset":false,"role":"acdc-reference","size":8957,"visible":true,"origin":"","legend":"","description":"","filename":"388f22d6b6eb4102ac64d55ed7b13bea.json","url":"https://assets-eu.researchsquare.com/files/rs-7917529/v1/b782d8bb97cc0eb876e14553.json"},{"id":95375901,"identity":"105d5866-7bf6-41e9-8cd0-6b5c808647d2","added_by":"auto","created_at":"2025-11-07 10:49:01","extension":"xml","order_by":2,"title":"","display":"","copyAsset":false,"role":"acdc-reference","size":75448,"visible":true,"origin":"","legend":"","description":"","filename":"388f22d6b6eb4102ac64d55ed7b13bea1enriched.xml","url":"https://assets-eu.researchsquare.com/files/rs-7917529/v1/335d97161bec99e15715a29f.xml"},{"id":95526067,"identity":"3bcbabfc-5f8b-401b-836a-22c7e4410196","added_by":"auto","created_at":"2025-11-10 10:06:11","extension":"jpeg","order_by":3,"title":"","display":"","copyAsset":false,"role":"acdc-reference","size":11551,"visible":true,"origin":"","legend":"","description":"","filename":"floatimage1.jpeg","url":"https://assets-eu.researchsquare.com/files/rs-7917529/v1/c097232d589b7738f5ccf2b9.jpeg"},{"id":95375902,"identity":"91cc0eaf-bd41-40b4-99e5-4548264efd0c","added_by":"auto","created_at":"2025-11-07 10:49:02","extension":"jpeg","order_by":4,"title":"","display":"","copyAsset":false,"role":"acdc-reference","size":11551,"visible":true,"origin":"","legend":"","description":"","filename":"floatimage1.jpeg","url":"https://assets-eu.researchsquare.com/files/rs-7917529/v1/d48897aac7d20766da39544e.jpeg"},{"id":95526749,"identity":"20fb1ffe-7b0e-4d53-aee3-140c70ed3bcb","added_by":"auto","created_at":"2025-11-10 10:07:46","extension":"jpeg","order_by":5,"title":"","display":"","copyAsset":false,"role":"acdc-reference","size":11551,"visible":true,"origin":"","legend":"","description":"","filename":"floatimage1.jpeg","url":"https://assets-eu.researchsquare.com/files/rs-7917529/v1/2a211d3b93624818d4073f1a.jpeg"},{"id":95375905,"identity":"807ea70e-4df4-4dfe-af76-c568efe3d890","added_by":"auto","created_at":"2025-11-07 10:49:02","extension":"png","order_by":6,"title":"","display":"","copyAsset":false,"role":"acdc-reference","size":6124,"visible":true,"origin":"","legend":"","description":"","filename":"Onlinefloatimage1.png","url":"https://assets-eu.researchsquare.com/files/rs-7917529/v1/b443739a27a449f1a49fd5fe.png"},{"id":95525926,"identity":"52d4e4f1-b7ad-45ff-9c4b-8d4dfb168496","added_by":"auto","created_at":"2025-11-10 10:05:53","extension":"png","order_by":7,"title":"","display":"","copyAsset":false,"role":"acdc-reference","size":6124,"visible":true,"origin":"","legend":"","description":"","filename":"Onlinefloatimage1.png","url":"https://assets-eu.researchsquare.com/files/rs-7917529/v1/2bbec20f6b251e1c9212fd08.png"},{"id":95375909,"identity":"e79992af-1ad6-4703-849a-7e60ed1371a8","added_by":"auto","created_at":"2025-11-07 10:49:02","extension":"png","order_by":8,"title":"","display":"","copyAsset":false,"role":"acdc-reference","size":6124,"visible":true,"origin":"","legend":"","description":"","filename":"Onlinefloatimage1.png","url":"https://assets-eu.researchsquare.com/files/rs-7917529/v1/48d178a5dad7afbccb887341.png"},{"id":95375910,"identity":"a476c582-4f97-467a-98d9-43e5f2de4305","added_by":"auto","created_at":"2025-11-07 10:49:02","extension":"xml","order_by":9,"title":"","display":"","copyAsset":false,"role":"acdc-reference","size":70023,"visible":true,"origin":"","legend":"","description":"","filename":"388f22d6b6eb4102ac64d55ed7b13bea1structuring.xml","url":"https://assets-eu.researchsquare.com/files/rs-7917529/v1/ec68df279aa295f33fcb07b3.xml"},{"id":95375911,"identity":"99f8194f-4efc-4fe4-b91a-76abb5d4f3ec","added_by":"auto","created_at":"2025-11-07 10:49:02","extension":"html","order_by":10,"title":"","display":"","copyAsset":false,"role":"acdc-reference","size":80331,"visible":true,"origin":"","legend":"","description":"","filename":"earlyproof.html","url":"https://assets-eu.researchsquare.com/files/rs-7917529/v1/2509595f5585cf0c138ff7f8.html"},{"id":95531070,"identity":"37521919-019d-4034-ac4c-8e57e0a9dc6b","added_by":"auto","created_at":"2025-11-10 10:22:35","extension":"pdf","order_by":0,"title":"","display":"","copyAsset":false,"role":"manuscript-pdf","size":552156,"visible":true,"origin":"","legend":"","description":"","filename":"manuscript.pdf","url":"https://assets-eu.researchsquare.com/files/rs-7917529/v1/1d64abc9-dc72-4676-beca-6df348a0eda4.pdf"}],"financialInterests":"No competing interests reported.","formattedTitle":"Comparative Analysis of Single-Port Robotic-Assisted vNOTES and Traditional vNOTES in Total Hysterectomy","fulltext":[{"header":"Introduction","content":"\u003cp\u003eHysterectomy is the most commonly used and effective method for treating benign uterine diseases such as uterine fibroids, adenomyosis, and atypical endometrial hyperplasia. Specific surgical procedures include transabdominal total hysterectomy, transvaginal total hysterectomy, laparoscopic transumbilical total hysterectomy, transvaginal natural orifice transluminal endoscopic surgery (v-NOTES) and so on. Among them, v-NOTES can not only give full play to the minimally invasive advantages of laparoscopy, avoiding the scar formed by the traditional laparoscopic abdominal wall skin incision and the related complications caused by trocar puncture, but also reduce postoperative pain and accelerate postoperative recovery, so that the patients can experience more humanistic care. Traditional vNOTES (T-vNOTES) have good safety and reliability and are increasingly widely used in the field of gynecological diseases. However, there are defects such as loss of \"surgical triangle\", mutual interference of surgical instruments, no assistant assistance and insufficient exposure of some target surgical sites. These defects increase the operation complexity, surgical risk and learning difficulty, which cause some gynaecologists not to dare to try it, and impede the popularity of v-NOTES. Surgical robotic system-assisted vNOTES (robotic vNOTES, R-vNOTES) improves visual field, reduces surgical difficulty, and enables breakthroughs in minimally invasive gynaecological surgery. Currently, more studies are conducted on multi-port R-vNOTES total hysterectomy, whose safety and feasibility are not inferior to that of traditional laparoscopic surgery, whereas the overall number of reports of new-generation single port (SP) robotic surgical system-assisted vNOTES (robotic single port vNOTES, RSP-vNOTES) total hysterectomy The number of cases is relatively small, and its surgical efficacy, safety, and surgical perception of the operator need to be further evaluated\u003csup\u003e[1]\u003c/sup\u003e. In our hospital, 30 cases of total hysterectomy using RSP-vNOTES were performed from January 2024 to July 2025, and good clinical results were achieved. This paper retrospectively analyses the clinical data of RSP-vNOTES and T-vNOTES total hysterectomy, in order to provide reference for the clinical promotion and application of RSP-vNOTES.\u003c/p\u003e\n\u003cp\u003e\u003cbr\u003e\u003c/p\u003e"},{"header":"Materials and Methods","content":"\u003cp\u003e\u003cstrong\u003e1.1\u003c/strong\u003e\u003cstrong\u003egeneral data\u0026nbsp;\u003c/strong\u003eFifty patients who underwent total hysterectomy with RSP-vNOTES in our hospital from January 2024 to July 2025 were selected as the observation group, and 100 patients who underwent total hysterectomy with T-vNOTES from January 2024 to July 2025 were selected as the control group. The comparison of basic data of the two groups of patients is shown in\u0026nbsp;Table 1. Among them, the volume of the uterus = long diameter (cm)\u0026nbsp;×\u0026nbsp;transverse diameter (cm)\u0026nbsp;×\u0026nbsp;anteroposterior diameter (cm)\u0026nbsp;×0.542. Inclusion criteria: All patients were married, pathologically diagnosed with benign uterine diseases, and had indications for vNOTES surgery; Patients with contraindications to surgical anesthesia, vaginal stenosis, combined severe cardiovascular and cerebrovascular diseases, coagulation dysfunction, and incomplete data were excluded. The operation was performed by the same physician with experience in T-vNOTES and RSP-vNOTES surgeries. All patients gave informed consent and signed the informed consent form for the operation. This study was approved by the hospital's medical ethics committee（2023043）.\u003c/p\u003e\n\u003cp\u003eTable\u0026nbsp;1 Comparison of basic information between the two groups of patients\u003c/p\u003e\n\u003ctable border=\"0\" cellspacing=\"0\" cellpadding=\"0\"\u003e\n \u003ctbody\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\"\u003e\n \u003cp\u003eproject\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\"\u003e\n \u003cp\u003eObservation Group (30 cases)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\"\u003e\n \u003cp\u003eControl group (60 cases)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\"\u003e\n \u003cp\u003e\u003cem\u003et/\u003c/em\u003e\u003cem\u003eχ\u003csup\u003e2\u0026nbsp;\u003c/sup\u003e\u003c/em\u003etest\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\"\u003e\n \u003cp\u003e\u003cem\u003eP\u003c/em\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\"\u003e\n \u003cp\u003eAge (years)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\"\u003e\n \u003cp\u003e52.83±9.41\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\"\u003e\n \u003cp\u003e49.87±7.91\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\"\u003e\n \u003cp\u003e1.547\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\"\u003e\n \u003cp\u003e0.119\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\"\u003e\n \u003cp\u003eBody mass Index\u0026nbsp;(Kg/m²)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\"\u003e\n \u003cp\u003e25.10±3.88\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\"\u003e\n \u003cp\u003e25.94±4.05\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\"\u003e\n \u003cp\u003e0.932\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\"\u003e\n \u003cp\u003e0.354\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\"\u003e\n \u003cp\u003eHistory\u0026nbsp;of abdominal surgery (examples)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\"\u003e\n \u003cp\u003e12\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\"\u003e\n \u003cp\u003e20\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\"\u003e\n \u003cp\u003e0.533\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\"\u003e\n \u003cp\u003e0.639\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\"\u003e\n \u003cp\u003eUterine volume\u0026nbsp;(cm³)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\"\u003e\n \u003cp\u003e162.83±201.30\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\"\u003e\n \u003cp\u003e147.63±232.93\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\"\u003e\n \u003cp\u003e0.305\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\"\u003e\n \u003cp\u003e0.761\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\"\u003e\n \u003cp\u003ediagnosis；myoma of uterus\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\"\u003e\n \u003cp\u003e8\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\"\u003e\n \u003cp\u003e25\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd rowspan=\"3\"\u003e\n \u003cp\u003e4.869\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd rowspan=\"3\"\u003e\n \u003cp\u003e0.088\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\"\u003e\n \u003cp\u003eadenomyosis\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\"\u003e\n \u003cp\u003e7\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\"\u003e\n \u003cp\u003e19\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\"\u003e\n \u003cp\u003eOther benign uterine diseases\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\"\u003e\n \u003cp\u003e15\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\"\u003e\n \u003cp\u003e16\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003c/tbody\u003e\n\u003c/table\u003e\n\u003cp\u003e\u003cstrong\u003e1.2\u003c/strong\u003e\u003cstrong\u003eSurgical Procedure\u0026nbsp;\u003c/strong\u003eThe control group underwent T-vNOTES total hysterectomy supplemented with salpingectomy, lysis of pelvic adhesions, and other procedures based on lesion type. Surgical methods and steps adhered to the International Expert Consensus on the Safe Implementation of Transvaginal Natural Orifice Transluminal Endoscopic Surgery (2021)\u0026nbsp;\u003csup\u003e[2]\u003c/sup\u003e and the Chinese Expert Consensus on Transvaginal Natural Orifice Transluminal Endoscopic Surgery in Gynaecology (China, 2023)\u0026nbsp;\u003csup\u003e[3]\u003c/sup\u003e, and the Expert Consensus on Transvaginal Total Hysterectomy (2024 Edition)\u0026nbsp;\u003csup\u003e[4]\u003c/sup\u003e\u003csup\u003e.\u003c/sup\u003e In the observation group, all procedures were performed under the assistance of the Sharp Single-Port Laparoscopic Surgery Robot System-vNOTES, with surgical specimens retrieved transvaginally. Both groups received postoperative antimicrobial prophylaxis, with oral intake permitted 6 hours postoperatively in the absence of complications.\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003e1.\u003c/strong\u003e\u003cstrong\u003e3\u003c/strong\u003e\u003cstrong\u003eObservation Indicators\u003c/strong\u003e Compare the differences between the two groups of patients in terms of surgical effect, subjective feeling of the operator, and workload intensity of the operator's surgical operation. The surgical effect indicators include the length of surgery, intraoperative bleeding, surgical triangle display, intraoperative rehydration volume, 24h postoperative pain, the time of the first postoperative defecation, the incidence of surgical complications, and hospital stay, in which the pain was assessed using the Visual Analogue Scale/Score (VAS), with a score of 0 for no pain, and a score of 10 for severe pain, and the observation group's surgical. The duration was the loading time add surgical operation time. The subjective perception of the operator was assessed by the attending surgeon after surgery by filling out a subjective perception scale, which included binocular focusing discrepancy, visual depth of field, coordination of visual field and angle of view manipulation, pixel stability, colour resolution, and rapid update rate of the screen. The scale was measured by the five-point Likert Scale, with scores from 1 to 5 indicating strongly disagree, disagree, undecided, agree, and strongly agree, respectively. The workload intensity of the operator's surgical operation was assessed using the nationalaeronautics and space administration task load index (NASA-TLX)\u0026nbsp;\u003csup\u003e[5]\u003c/sup\u003e, which contains six scales: cerebral demand, physical demand, time demand, task completion, effort, frustration, and the degree of frustration. The scale consists of 6 items, including brain demand, physical demand, time demand, task completion, effort, and frustration, and each item is scored by a straight line from 0 to 20, with 0 indicating very low and 20 indicating very high.\u0026nbsp;\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003e1.\u003c/strong\u003e\u003cstrong\u003e4 Statistical Methods\u0026nbsp;\u003c/strong\u003eStatistical software used was SPSS 22.0. For categorical data between two groups, the chi-square test was applied. For continuous data, the t-test was employed. \u003cem\u003eP\u003c/em\u003e \u0026lt; 0.05 was considered statistically significant.\u003c/p\u003e"},{"header":"Results","content":"\u003cp\u003e\u003cstrong\u003e2.1 Comparison of Surgical Outcomes Between Two Patient Groups\u003c/strong\u003e The maximum uterine volume resected in the control group was 699.23 cm\u0026sup3;, whereas that in the observation group was 919.93 cm\u0026sup3;. The observation group demonstrated a surgical triangle, which was absent in the control group. The observation group exhibited shorter operative duration (\u003cem\u003eP\u0026nbsp;\u003c/em\u003e\u0026lt; 0.05), lower intraoperative blood loss, and reduced intraoperative fluid administration compared to the control group (both \u003cem\u003eP\u003c/em\u003e \u0026lt; 0.05). There were no statistically significant differences between the two groups in terms of postoperative pain at 24 hours, time to first bowel movement, or length of hospital stay (all \u003cem\u003eP\u003c/em\u003e \u0026gt; 0.05). One patient in the control group underwent conversion to open surgery due to severe pelvic adhesions; all other patients completed the procedure uneventfully. No postoperative complications or reoperations occurred. See Table 2.\u003c/p\u003e\n\u003cp\u003eTable\u0026nbsp;2 Comparison of surgical outcomes between the two groups of patients（\u003cimg width=\"9\" height=\"13\" src=\"data:image/jpeg;base64,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\" alt=\"x\"\u003e\u0026plusmn;s）\u003c/p\u003e\n\u003ctable border=\"0\" cellspacing=\"0\" cellpadding=\"0\"\u003e\n \u003ctbody\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 170px;\"\u003e\n \u003cp\u003eproject\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 124px;\"\u003e\n \u003cp\u003eObservation Group (30 cases)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 121px;\"\u003e\n \u003cp\u003eControl group (60 cases)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 76px;\"\u003e\n \u003cp\u003e\u003cem\u003et\u003c/em\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 76px;\"\u003e\n \u003cp\u003e\u003cem\u003eP\u003c/em\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 170px;\"\u003e\n \u003cp\u003eDuration of surgery（min）\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 124px;\"\u003e\n \u003cp\u003e129.50\u0026plusmn;29.52\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 121px;\"\u003e\n \u003cp\u003e151.08\u0026plusmn;46.36\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 76px;\"\u003e\n \u003cp\u003e2.322\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 76px;\"\u003e\n \u003cp\u003e0.023\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 170px;\"\u003e\n \u003cp\u003eIntraoperative haemorrhage（ml）\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 124px;\"\u003e\n \u003cp\u003e71.00\u0026plusmn;84.50\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 121px;\"\u003e\n \u003cp\u003e128.83\u0026plusmn;140.40\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 76px;\"\u003e\n \u003cp\u003e2.073\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 76px;\"\u003e\n \u003cp\u003e0.041\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 170px;\"\u003e\n \u003cp\u003eIntraoperative rehydration volume（ml）\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 124px;\"\u003e\n \u003cp\u003e1183.34\u0026plusmn;427.57\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 121px;\"\u003e\n \u003cp\u003e1419.26\u0026plusmn;185.97\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 76px;\"\u003e\n \u003cp\u003e3.651\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 76px;\"\u003e\n \u003cp\u003e\u0026lt;0.001\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 170px;\"\u003e\n \u003cp\u003e24h postoperative VAS score\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 124px;\"\u003e\n \u003cp\u003e2.97\u0026plusmn;1.10\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 121px;\"\u003e\n \u003cp\u003e3.22\u0026plusmn;1.15\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 76px;\"\u003e\n \u003cp\u003e0.986\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 76px;\"\u003e\n \u003cp\u003e0.327\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 170px;\"\u003e\n \u003cp\u003eTime to first postoperative bowel movement（d）\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 124px;\"\u003e\n \u003cp\u003e3.03\u0026plusmn;0.89\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 121px;\"\u003e\n \u003cp\u003e2.78\u0026plusmn;0.55\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 76px;\"\u003e\n \u003cp\u003e1.635\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 76px;\"\u003e\n \u003cp\u003e0.106\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 170px;\"\u003e\n \u003cp\u003etransluminal transumbilical unicorn surgery\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 124px;\"\u003e\n \u003cp\u003e0\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 121px;\"\u003e\n \u003cp\u003e1\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 76px;\"\u003e\n \u003cp\u003e0.506\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 76px;\"\u003e\n \u003cp\u003e0.477\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 170px;\"\u003e\n \u003cp\u003eLength of postoperative stay（d）\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 124px;\"\u003e\n \u003cp\u003e5.10\u0026plusmn;1.67\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 121px;\"\u003e\n \u003cp\u003e5.13\u0026plusmn;1.17\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 76px;\"\u003e\n \u003cp\u003e0.110\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 76px;\"\u003e\n \u003cp\u003e0.913\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 170px;\"\u003e\n \u003cp\u003eTotal hospitalisation costs（RMB）\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 124px;\"\u003e\n \u003cp\u003e36744.04\u0026plusmn;12321.28\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 121px;\"\u003e\n \u003cp\u003e23734.15\u0026plusmn;4196.69\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 76px;\"\u003e\n \u003cp\u003e7.398\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 76px;\"\u003e\n \u003cp\u003e\u0026lt;0.001\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003c/tbody\u003e\n\u003c/table\u003e\n\u003cp\u003e\u003cstrong\u003e\u0026nbsp;\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003e2.2 Comparison of Subjective Perceptions Between Two Groups of Operators\u003c/strong\u003e Operators in the observation group scored higher than those in the control group for binocular focus disparity, visual depth perception, coordination between field of view and viewing angle control, pixel stability, colour resolution, and rapid image refresh rate (all\u003cem\u003e\u0026nbsp;P\u003c/em\u003e \u0026lt; 0.05), as shown in Table 3.\u003c/p\u003e\n\u003cp\u003e\u0026nbsp;\u003c/p\u003e\n\u003cp\u003eTable\u0026nbsp;3 Comparison of subjective feelings between the two groups（\u003cimg width=\"9\" height=\"13\" src=\"data:image/jpeg;base64,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\" alt=\"x\"\u003e\u0026plusmn;s，score）\u003c/p\u003e\n\u003ctable border=\"0\" cellspacing=\"0\" cellpadding=\"0\"\u003e\n \u003ctbody\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 163px;\"\u003e\n \u003cp\u003eproject\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 101px;\"\u003e\n \u003cp\u003eObservation group (30 cases)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 115px;\"\u003e\n \u003cp\u003eControl group (60 cases)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 88px;\"\u003e\n \u003cp\u003e\u003cem\u003et\u003c/em\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 101px;\"\u003e\n \u003cp\u003e\u003cem\u003eP\u003c/em\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 163px;\"\u003e\n \u003cp\u003eBinocular Focusing Difference\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 101px;\"\u003e\n \u003cp\u003e4.67\u0026plusmn;0.47\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 115px;\"\u003e\n \u003cp\u003e3.09\u0026plusmn;0.40\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 88px;\"\u003e\n \u003cp\u003e32.764\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 101px;\"\u003e\n \u003cp\u003e\u0026lt;0.001\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 163px;\"\u003e\n \u003cp\u003evisual depth\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 101px;\"\u003e\n \u003cp\u003e4.74\u0026plusmn;0.44\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 115px;\"\u003e\n \u003cp\u003e3.14\u0026plusmn;0.43\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 88px;\"\u003e\n \u003cp\u003e33.028\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 101px;\"\u003e\n \u003cp\u003e\u0026lt;0.001\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 163px;\"\u003e\n \u003cp\u003eField of view and viewpoint manipulation coordination\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 101px;\"\u003e\n \u003cp\u003e4.77\u0026plusmn;0.42\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 115px;\"\u003e\n \u003cp\u003e3.08\u0026plusmn;0.34\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 88px;\"\u003e\n \u003cp\u003e40.033\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 101px;\"\u003e\n \u003cp\u003e\u0026lt;0.001\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 163px;\"\u003e\n \u003cp\u003ePixel stability\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 101px;\"\u003e\n \u003cp\u003e4.12\u0026plusmn;0.33\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 115px;\"\u003e\n \u003cp\u003e4.02\u0026plusmn;0.31\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 88px;\"\u003e\n \u003cp\u003e2.779\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 101px;\"\u003e\n \u003cp\u003e0.006\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 163px;\"\u003e\n \u003cp\u003eColour resolution\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 101px;\"\u003e\n \u003cp\u003e4.21\u0026plusmn;0.41\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 115px;\"\u003e\n \u003cp\u003e4.07\u0026plusmn;0.26\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 88px;\"\u003e\n \u003cp\u003e3.679\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 101px;\"\u003e\n \u003cp\u003e\u0026lt;0.001\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 163px;\"\u003e\n \u003cp\u003eRapid screen update rate\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 101px;\"\u003e\n \u003cp\u003e4.30\u0026plusmn;0.46\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 115px;\"\u003e\n \u003cp\u003e4.12\u0026plusmn;0.32\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 88px;\"\u003e\n \u003cp\u003e4.122\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 101px;\"\u003e\n \u003cp\u003e\u0026lt;0.001\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003c/tbody\u003e\n\u003c/table\u003e\n\u003cp\u003e\u0026nbsp;\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003e2.3\u003c/strong\u003e \u003cstrong\u003eComparison of workload intensity between the two groups of operators\u003c/strong\u003e\u0026nbsp; The scores of mental demand, physical demand, task completion, and effort of the observation group were lower than those of the control group (all P\u0026lt;0.05); the scores of time demand and frustration were lower than those of the control group, but the differences were not statistically significant (all P\u0026gt;0.05), as shown in Table 4.\u003c/p\u003e\n\u003cp\u003eTable 4 Comparison of workload intensity between two groups of operators（\u003cimg width=\"9\" height=\"13\" src=\"data:image/jpeg;base64,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\" alt=\"x\"\u003e\u0026plusmn;s，score）\u003c/p\u003e\n\u003ctable border=\"0\" cellspacing=\"0\" cellpadding=\"0\"\u003e\n \u003ctbody\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 134px;\"\u003e\n \u003cp\u003eproject\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 101px;\"\u003e\n \u003cp\u003eObservation group (30 cases)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 114px;\"\u003e\n \u003cp\u003eControl group (70 cases)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 114px;\"\u003e\n \u003cp\u003e\u003cem\u003et\u003c/em\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 114px;\"\u003e\n \u003cp\u003e\u003cem\u003eP\u003c/em\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 134px;\"\u003e\n \u003cp\u003emental needs\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 101px;\"\u003e\n \u003cp\u003e2.98\u0026plusmn;0.66\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 114px;\"\u003e\n \u003cp\u003e5.03\u0026plusmn;0.99\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 114px;\"\u003e\n \u003cp\u003e18.748\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 114px;\"\u003e\n \u003cp\u003e\u0026lt;0.001\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 134px;\"\u003e\n \u003cp\u003estamina requirement\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 101px;\"\u003e\n \u003cp\u003e3.30\u0026plusmn;0.83\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 114px;\"\u003e\n \u003cp\u003e5.22\u0026plusmn;0.90\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 114px;\"\u003e\n \u003cp\u003e18.289\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 114px;\"\u003e\n \u003cp\u003e\u0026lt;0.001\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 134px;\"\u003e\n \u003cp\u003etime requirement\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 101px;\"\u003e\n \u003cp\u003e3.10\u0026plusmn;0.66\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 114px;\"\u003e\n \u003cp\u003e3.16\u0026plusmn;0.57\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 114px;\"\u003e\n \u003cp\u003e0.838\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 114px;\"\u003e\n \u003cp\u003e0.403\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 134px;\"\u003e\n \u003cp\u003eMandate fulfilment\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 101px;\"\u003e\n \u003cp\u003e1.68\u0026plusmn;0.59\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 114px;\"\u003e\n \u003cp\u003e2.64\u0026plusmn;0.55\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 114px;\"\u003e\n \u003cp\u003e14.372\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 114px;\"\u003e\n \u003cp\u003e\u0026lt;0.001\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 134px;\"\u003e\n \u003cp\u003edegree of effort\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 101px;\"\u003e\n \u003cp\u003e3.05\u0026plusmn;0.79\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 114px;\"\u003e\n \u003cp\u003e5.24\u0026plusmn;0.63\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 114px;\"\u003e\n \u003cp\u003e22.255\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 114px;\"\u003e\n \u003cp\u003e\u0026lt;0.001\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 134px;\"\u003e\n \u003cp\u003edegree of frustration\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 101px;\"\u003e\n \u003cp\u003e1.80\u0026plusmn;0.58\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 114px;\"\u003e\n \u003cp\u003e1.87\u0026plusmn;0.63\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 114px;\"\u003e\n \u003cp\u003e0.934\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 114px;\"\u003e\n \u003cp\u003e0.351\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003c/tbody\u003e\n\u003c/table\u003e\n\u003cp\u003e\u003cstrong\u003e\u0026nbsp;\u003c/strong\u003e\u003c/p\u003e"},{"header":"Discussion","content":"\u003cp\u003eNOTES refers to the \"natural cavity\" in surgery, such as the stomach, rectum, urethra, vagina, etc. to enter the abdominal cavity to reach the target surgical site for surgical operations, which can eliminate or hide the surgical scar, reduce surgical trauma, reduce the amount of postoperative analgesic drugs, and promote the postoperative recovery, and it is the direction of the development of clinical surgery. Vagina is the natural cavity that connects the female abdominal cavity to the outside world, and compared with the transrectal and gastric routes of NOTES, it has a short distance to the surface of the body, good elasticity and dilatation, large operating space, fast healing of the incision, and low risk of infection and leakage, which makes it the most commonly used route of NOTES in clinical practice, especially in the field of gynaecology. In 2012, Lee et al\u003csup\u003e[6]\u003c/sup\u003e reported 10 cases of adnexal resection by T-vNOTES for the first time, 9 of which were successful, 1 of which was due to a severe injury. Nine of them were successful and one was converted to open surgery due to preoperative misdiagnosis. In 2021, Badiglian et al\u003csup\u003e[7]\u003c/sup\u003ereported that T-vNOTES hysterectomy, salpingectomy, and salpingo-oophorectomy In terms of surgical indications, complications, conversion to surgery, blood transfusion, reoperation, severe intestinal obstruction, vomiting, postoperative infection rate, hospital stay, and readmission rate within 6 weeks, the indicators were comparable to those of the standard laparoscopic surgery group (all \u003cem\u003eP\u003c/em\u003e\u0026gt;0.05). A 2020 clinical controlled study by Chen Keyao et al\u003csup\u003e[8]\u003c/sup\u003e showed that T-vNOTES hysterectomy had advantages over transumbilical laparoscopy and traditional transabdominal laparoscopy in terms of time to first postoperative anal defecation and postoperative 24h VAS score (all \u003cem\u003eP\u003c/em\u003e\u0026lt;0.05); Zhang Chunhua et al\u003csup\u003e[9]\u003c/sup\u003eshowed that T vNOTES for the treatment of benign gynaecological diseases, there existed advantages in postoperative time to get out of bed, time to recover intestinal function, postoperative pain level, hospital stay, and cosmetic scores compared with transumbilical route surgery (all\u003cem\u003e\u0026nbsp;P\u003c/em\u003e\u0026lt;0.05).\u003c/p\u003e\n\u003cp\u003eT-vNOTES is safe and feasible to treat most gynaecological diseases, and has certain advantages over traditional laparoscopy, but there are limitations due to the influence of equipment, instruments and operating experience, such as no assistant assistance, weakening of visual depth, loss of surgical triangles, and prolonged surgical operation easily leads to fatigue of the surgeon, hand tremor, etc, which reduces the feasibility of complex surgical operations, and has an impact on the surgeon's learning and operation training. This reduces the feasibility of complex surgical operations, affects surgeons' learning and operation training, and hinders the development of vNOTES. The successful development of surgical robotic system breaks through the limitations of traditional endoscopic surgery, its three-dimensional high-definition imaging, tremor elimination function, flexible wrist instruments, motion scaling ratio adjustment function, etc. to make surgical operations easier, more flexible, more accurate, better able to perform the anastomosis, knot tying and other complex actions, and its assisted surgical operation has become a landmark milestone in the history of minimally invasive surgery. In 2021, Koythong\u003csup\u003e[10]\u003c/sup\u003e compared the data of 39 patients who underwent Da Vinci Xi robot-assisted vNOTES hysterectomy with 76 patients who underwent T-vNOTES hysterectomy. The results showed that there were no statistically significant differences between the two groups in terms of operation time, blood loss, hospital stay, and the degree of pain at 1 week, 2 weeks, and 3 weeks after the operation (all \u003cem\u003eP\u003c/em\u003e\u0026gt;0.05); among the patients of the T-vNOTES group, the mid-construction transumbilical single-port laparoscopic operation was performed in 1 case, and there were no cases of relayed open surgery in the R-vNOTES group. In 2025, Yang et al\u003csup\u003e[11]\u003c/sup\u003e retrospectively analyzed 298 cases of gynecological diseases treated with R-vNOTES, including endometriosis, chronic pelvic pain, abnormal uterine bleeding, uterine fibroids, etc. The median total operation time was 138 minutes, the median estimated intraoperative blood loss was 50 ml, and 3 cases were converted to laparoscopic surgery. One case was converted to robot-assisted single-port plus single-port laparoscopic surgery, and two cases were converted to robot-assisted multi-port surgery. The intraoperative complication rate was 2.1%, and the postoperative complication rate was 15.44%. The above research results indicate that R-vNOTES is feasible for treating various gynecological conditions with less trauma, and it can help surgeons with insufficient experience in single-port laparoscopic surgery to learn and master the vNOTES technique more quickly.\u003c/p\u003e\n\u003cp\u003e\u0026nbsp;The traditional multi-hole surgical robot system still has the following limitations, such as only two mechanical arms, one straight camera, multi-arm collision, complex preoperative positioning, and the surgical system not conforming to ergonomic design, etc. Therefore, the multi-hole surgical robot system is regarded as a transitional stage of the single-hole surgical robot system. The SP surgical robot system features an integrated and compact layout, with technical advantages such as single incision, high-definition 3D image guidance, wide movement range, highly flexible serpentine arm, good master-slave control experience, and strong load capacity. It can complete complex surgical operations in limited and narrow Spaces, expanding the surgical indications. In 2023, Guan et al\u003csup\u003e[12]\u003c/sup\u003e successfully utilized the Da Vinci SP surgical robot system to assist vNOTES in completing a hysterectomy. The patient was discharged on the same day after the operation, and no surgical complications occurred. In 2024, Guan et al\u003csup\u003e[13]\u003c/sup\u003e reported 4 cases of RSP-vNOTES simple total hysterectomy and 18 cases of RSP-vNOTES endometriosis resection. The BMI of the patients ranged from 20.2 to 48.4 kg/m2, and the total hysterectomy time ranged from 24.0 to 170.0min. The intraoperative blood loss ranged from 25.0 to 50.0mL. Complications included one case of cellulitis at the vaginal stump and one case of urinary tract infection, demonstrating the feasibility and success of SP system-assisted vNOTES in the treatment of gynecological diseases. In 2023, Zhang Chunhua\u003csup\u003e[14]\u003c/sup\u003e and Liu Yang et al\u003csup\u003e[15]\u003c/sup\u003e in China used the EDGE SP1000 surgical robot system to assist vNOTES in completing the treatment of 2 hysterectomies and 20 benign gynecological diseases respectively, and no surgical complications occurred. The safety and feasibility of RSP-vNOTES hysterectomy were further verified.\u003c/p\u003e\n\u003cp\u003eThe results of this study showed that the observation group showed the surgical triangle, and the control group did not show the surgical triangle; the length of surgery in the observation group was shorter than that in the control group (\u003cem\u003eP\u003c/em\u003e\u0026lt;0.05), and the amount of intraoperative haemorrhage and intraoperative rehydration was less than that in the control group (\u003cem\u003eP\u003c/em\u003e\u0026lt;0.05); there was no statistical significance for differences in the pain condition in the postoperative period of 24h, the time of the first bowel movement after the operation and the length of hospital stay between the two groups (all \u003cem\u003eP\u003c/em\u003e\u0026gt;0.05). Except for one case in the control group, who was transferred to open surgery due to severe pelvic adhesions, all patients in both groups successfully completed the surgery, and no postoperative complications occurred, which suggests that total hysterectomy with RSP-vNOTES is less traumatic and more accurate than that of T-vNOTES patients. Because the high-definition three-dimensional imaging of the SP surgical system can better display the surgical field and the \"surgical triangle\", the third arm can better expose the target surgical site, the operating space is larger and more delicate, and the safety is higher, so the RSP-vNOTES has a greater advantage over the T-vNOTES for complex surgeries. For example, the uterine volume in this group of RSP-vNOTES patients was 919.93cm\u003csup\u003e3\u003c/sup\u003e, and 12 patients had a history of cesarean section, adnexal surgery, appendicitis and other abdominal and pelvic surgeries, and all of the patients successfully completed the surgery without increasing the length of the operation, the amount of intraoperative bleeding, the amount of rehydration and the incidence of surgical complications. In addition, the scores of binocular focusing difference, visual depth, coordination of visual field and perspective manipulation, pixel stability, colour resolution, and rapid update rate of the screen were higher in the observation group than in the control group (all \u003cem\u003eP\u003c/em\u003e\u0026lt;0.05), and the scores of workload intensity in terms of cerebral demand, physical demand, task completion, and effort were lower than those in the control group (all \u003cem\u003eP\u003c/em\u003e\u0026lt;0.05), which suggests that RSP-vNOTES can improve the performance of the patients' workloads more than T-vNOTES, which can improve the performance of the patients' workloads more than T-vNOTES. vNOTES can improve the subjective feeling of the operator's operation, reduce the intensity of workload, and improve the comfort of the operator.In 2025, Guan et al\u003csup\u003e[16]\u003c/sup\u003e implemented the \"4P\"' port anchoring surgical technique in R-vNOTES, which provided a feasible and effective method for the fixation of the inner annular port and enhanced the accessibility of the operation, and reduced the port displacement. accessibility, reduced the risk of complications related to port displacement and gas leakage, and represents a valuable advance in the evolution of laparoscopy and R-vNOTES.\u003c/p\u003e\n\u003cp\u003eIn summary, compared with T-vNOTES total hysterectomy, RSP-vNOTES has the advantages of shorter operation time, less intraoperative bleeding, fine operation, higher safety, and is more suitable for complex surgical operations; RSP-vNOTES operators have better subjective feelings of operation, and the intensity of the workload is lighter, which is conducive to shortening the time for operators to learn about vNOTES, increasing the comfort level of the operation, and making inexperienced The RSP-vNOTES can help operators to shorten the learning time of vNOTES, improve the operating comfort, and enable inexperienced physicians to master vNOTES surgery faster. However, the clinical prevalence of surgical robotic systems is still low, and the cost of treatment is relatively high, which makes the burden of medical treatment on patients and society heavy. In addition, this study is retrospective, with a small amount of data and potential selective bias, and the subjective feeling and workload intensity were assessed by the operator filling out the assessment form after surgery, which may have recall bias. Therefore, further large-sample, randomised, controlled data studies should be conducted to comprehensively assess the effectiveness, safety and long-term effects of the RSP-vNOTES in gynaecological diseases.\u003c/p\u003e"},{"header":"Declarations","content":"\u003ch2\u003eAuthor Contribution\u003c/h2\u003e\u003cp\u003eChunhua Zhang and Xiaojie Hu contributed equally to this work and share first authorship. Chunhua Zhang and Xiaojie Hu wrote the main manuscript text. Qian Huang, Yunxia Chen, and Ranxin Zhang collected and analyzed the clinical data. Yaxiong Xu prepared Table 1\u0026ndash;4. Xiaoming Guan conceived and supervised the study, and critically revised the manuscript. All authors reviewed and approved the final version of the manuscript.\u003c/p\u003e\u003ch2\u003eData Availability\u003c/h2\u003e\u003cp\u003eThe sequence data supporting the findings of this study are stored in the medical record system of the Second Affiliated Hospital of Nanjing Medical University. Due to patient privacy considerations, the data are not publicly available but can be accessed upon reasonable request.\u003c/p\u003e"},{"header":"References","content":"\u003col\u003e\u003cli\u003e\u003cspan\u003eGuan X, Yang Q, Lovell DY. Assessing Feasibility and Outcomes of Robotic Single Port Transvaginal NOTES(RSP-vNOTES) Hysterectomy: A Case Series[J]. Journal of Minimally Invasive Gynecology,2024,13 (12):1041\u0026ndash;1049.\u003c/span\u003e\u003c/li\u003e\u003cli\u003e\u003cspan\u003eKapurubandara S, Lowenstein L, Salvay H, \u003cem\u003eet al.\u003c/em\u003e Consensus on safe implementation of vaginal natural orifice transluminal endoscopic surgery (vNOTES)[J]. European journal of obstetrics, gynecology, and reproductive biology,2021,263 (Suppl C):216\u0026ndash;222.\u003c/span\u003e\u003c/li\u003e\u003cli\u003e\u003cspan\u003e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\u0026ndash;490.\u003c/span\u003e\u003c/li\u003e\u003cli\u003e\u003cspan\u003e中国妇幼保健协会妇科阴式手术专业委员会. 经阴道全子宫切除术专家共识(2024年版)[J]. 中国实用妇科与产科杂志,2024,40 (3):321\u0026ndash;328.\u003c/span\u003e\u003c/li\u003e\u003cli\u003e\u003cspan\u003eElek RN, Haidegger T. Non-Technical Skill Assessment and Mental Load Evaluation in Robot-Assisted Minimally Invasive Surgery[J]. Sensors (Basel, Switzerland,2021,21 (8):2666.\u003c/span\u003e\u003c/li\u003e\u003cli\u003e\u003cspan\u003eLee C-L, Wu K-Y, Su H, \u003cem\u003eet al.\u003c/em\u003e Transvaginal Natural-Orifice Transluminal Endoscopic Surgery (NOTES) in Adnexal Procedures[J]. Journal of Minimally Invasive Gynecology,2012,19 (4):: 509\u0026ndash;513.\u003c/span\u003e\u003c/li\u003e\u003cli\u003e\u003cspan\u003eBadiglian-Filho L, Faloppa CC, Menezes ANdO, \u003cem\u003eet al.\u003c/em\u003e Vaginally assisted NOTES hysterectomy with adnexectomy (vNOTES) compared with conventional laparoscopy. A retrospective observational cohort study[J]. International journal of gynaecology and obstetrics: the official organ of the International Federation of Gynaecology and Obstetrics,2021,153 (2):351\u0026ndash;356.\u003c/span\u003e\u003c/li\u003e\u003cli\u003e\u003cspan\u003e陈珂瑶, 孙力, 李华, 等. 经阴道自然腔道内镜全子宫切除手术的临床对比分析[J]. 中华腔镜外科杂志(电子版),2020,13 (2):96\u0026ndash;102.\u003c/span\u003e\u003c/li\u003e\u003cli\u003e\u003cspan\u003eZhang C, Duan K, Fang F, \u003cem\u003eet al.\u003c/em\u003e Comparison of Transvaginal and Transumbilical Laparoscopic Single-Site Surgery for Ovarian Cysts[J]. Journal of the Society of Laparoendoscopic Surgeons,2021,25 (2)\u003c/span\u003e\u003c/li\u003e\u003cli\u003e\u003cspan\u003eKoythong T, Thigpen B, Sunkara S, \u003cem\u003eet al.\u003c/em\u003e Outcomes of Hysterectomy via Robot-assisted versus Traditional Transvaginal Natural Orifice Transluminal Endoscopic Surgery[J]. Journal of minimally invasive gynecology,2021,28 (12):2028\u0026ndash;2035.\u003c/span\u003e\u003c/li\u003e\u003cli\u003e\u003cspan\u003eYang Q, Lovell DY, Ma Y, \u003cem\u003eet al.\u003c/em\u003e The Feasibility and Safety of Robot-Assisted Vaginal Natural Orifice Transluminal Endoscopic Surgery (RA-vNOTES) for Gynecologic Disease: 298-Case Series[J]. Healthcare (Basel, Switzerland),2025,13 (7)\u003c/span\u003e\u003c/li\u003e\u003cli\u003e\u003cspan\u003eGuan 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\u0026ndash;6.\u003c/span\u003e\u003c/li\u003e\u003cli\u003e\u003cspan\u003eGuan X, Yang Q, Lovell D, \u003cem\u003eet al.\u003c/em\u003e Feasibility and Outcomes of Robot-Assisted Single Port Vaginal Notes (RSP-vNOTES) Hysterectomy: A Retrospective Study[J]. Journal of Minimally Invasive Gynecology,2024,31 (11Suppl):S104.\u003c/span\u003e\u003c/li\u003e\u003cli\u003e\u003cspan\u003eZhang C, Li Q, Fang F, \u003cem\u003eet al.\u003c/em\u003e Transvaginal NOTES hysterectomy with the Chinese robotic single port platform - Report of two cases[J]. Intelligent Surgery,2024:30\u0026ndash;35.\u003c/span\u003e\u003c/li\u003e\u003cli\u003e\u003cspan\u003e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]. 中华腔镜外科杂志(电子版),2024,17 (4):234\u0026ndash;238.\u003c/span\u003e\u003c/li\u003e\u003cli\u003e\u003cspan\u003eGuan X, Yang Q, Lovell Daniel Y, \u003cem\u003eet al.\u003c/em\u003e Application of \u0026ldquo;4-P\u0026rdquo; port anchoring in transvaginal natural orifce transluminal endoscopic surgery (vNOTES): technique and initial feasibility[J]. Journal of Robotic Surgery,2025,19 (473)\u003c/span\u003e\u003c/li\u003e\u003c/ol\u003e"}],"fulltextSource":"","fullText":"","funders":[],"hasAdminPriorityOnWorkflow":false,"hasManuscriptDocX":true,"hasOptedInToPreprint":true,"hasPassedJournalQc":"","hasAnyPriority":false,"hideJournal":true,"highlight":"","institution":"","isAcceptedByJournal":false,"isAuthorSuppliedPdf":false,"isDeskRejected":"","isHiddenFromSearch":false,"isInQc":false,"isInWorkflow":false,"isPdf":false,"isPdfUpToDate":true,"isWithdrawnOrRetracted":false,"journal":{"display":true,"email":"[email protected]","identity":"researchsquare","isNatureJournal":false,"hasQc":true,"allowDirectSubmit":true,"externalIdentity":"","sideBox":"","snPcode":"","submissionUrl":"/submission","title":"Research Square","twitterHandle":"researchsquare","acdcEnabled":true,"dfaEnabled":false,"editorialSystem":"","reportingPortfolio":"","inReviewEnabled":false,"inReviewRevisionsEnabled":true},"keywords":"Single-hole robot vNOTES, Total hysterectomy Surgical outcome, The subjective feelings of the surgeon, The intensity of surgical operation workload","lastPublishedDoi":"10.21203/rs.3.rs-7917529/v1","lastPublishedDoiUrl":"https://doi.org/10.21203/rs.3.rs-7917529/v1","license":{"name":"CC BY 4.0","url":"https://creativecommons.org/licenses/by/4.0/"},"manuscriptAbstract":"\u003ch2\u003eObjective\u003c/h2\u003e\u003cp\u003eTo explore the clinical effects of single-port robot-assisted vNOTES (RSP-vNOTES) and traditional vNOTES (T-vNOTES) in total hysterectomy.\u003c/p\u003e\u003ch2\u003eMethods\u003c/h2\u003e\u003cp\u003eThirty patients who underwent total hysterectomy using RSP-vNOTES in our hospital from January 2024 to July 2025 were selected as the observation group, and 60 patients who underwent total hysterectomy using T-vNOTES from January 2024 to July 2025 were selected as the control group. Compare the differences in surgical effects, subjective feelings of the surgeons, and the intensity of surgical operation workload between the two groups of patients.\u003c/p\u003e\u003ch2\u003eResult\u003c/h2\u003e\u003cp\u003eThe maximum uterine volume resected in the control group was 699.23cm\u0026sup3;, and that in the observation group was 919.93cm\u0026sup3;. The surgical triangle was shown in the observation group, while that in the control group was not. The operation time of the observation group was longer than that of the control group (\u003cem\u003eP\u003c/em\u003e\u0026thinsp;\u0026lt;\u0026thinsp;0.05), and the intraoperative blood loss and intraoperative fluid infusion volume were less than those of the control group (both \u003cem\u003eP\u003c/em\u003e\u0026thinsp;\u0026lt;\u0026thinsp;0.05). There was no statistically significant difference in pain conditions 24 hours after surgery, the time of first defecation after surgery, and hospital stay between the two groups of patients (all \u003cem\u003eP\u003c/em\u003e\u0026thinsp;\u0026gt;\u0026thinsp;0.05). One case in the control group was transferred to transumbilical single-port laparoscopic surgery due to severe pelvic adhesion, and the rest of the patients completed the surgery successfully without postoperative complications and any cases of secondary surgery. The scores of binocular focusing difference, visual depth perception, coordination of field and viewing Angle control, pixel stability, color resolution, and rapid image update rate of the surgeons in the observation group were higher than those in the control group (all \u003cem\u003eP\u003c/em\u003e\u0026thinsp;\u0026lt;\u0026thinsp;0.05). The scores of mental demand, physical demand, task completion and effort in the observation group were all lower than those in the control group (all \u003cem\u003eP\u003c/em\u003e\u0026thinsp;\u0026lt;\u0026thinsp;0.05). There was no statistically significant difference in the scores of time requirement and frustration degree (all \u003cem\u003eP\u003c/em\u003e\u0026thinsp;\u0026gt;\u0026thinsp;0.05).\u003c/p\u003e\u003ch2\u003eConclusion\u003c/h2\u003e\u003cp\u003eCompared with T-vNOTES for total hysterectomy, RSP-vNOTES causes less trauma to patients and has higher surgical accuracy. RSP-vNOTES has more advantages for complex surgical operations. RSP-vNOTES surgeons have a better subjective experience during operation, a lighter workload intensity, which is conducive to shortening the learning time of vNOTES for surgeons, improving the comfort of operation, and enabling less experienced physicians to master vNOTES surgery more quickly.\u003c/p\u003e","manuscriptTitle":"Comparative Analysis of Single-Port Robotic-Assisted vNOTES and Traditional vNOTES in Total Hysterectomy","msid":"","msnumber":"","nonDraftVersions":[{"code":1,"date":"2025-11-07 10:48:57","doi":"10.21203/rs.3.rs-7917529/v1","editorialEvents":[{"type":"communityComments","content":0}],"status":"published","journal":{"display":true,"email":"[email protected]","identity":"researchsquare","isNatureJournal":false,"hasQc":true,"allowDirectSubmit":true,"externalIdentity":"","sideBox":"","snPcode":"","submissionUrl":"/submission","title":"Research Square","twitterHandle":"researchsquare","acdcEnabled":true,"dfaEnabled":false,"editorialSystem":"","reportingPortfolio":"","inReviewEnabled":false,"inReviewRevisionsEnabled":true}}],"origin":"","ownerIdentity":"3d3480b7-df8e-4b63-832f-9502e46f0b2b","owner":[],"postedDate":"November 7th, 2025","published":true,"recentEditorialEvents":[],"rejectedJournal":[],"revision":"","amendment":"","status":"posted","subjectAreas":[],"tags":[],"updatedAt":"2025-11-09T19:23:24+00:00","versionOfRecord":[],"versionCreatedAt":"2025-11-07 10:48:57","video":"","vorDoi":"","vorDoiUrl":"","workflowStages":[]},"version":"v1","identity":"rs-7917529","journalConfig":"researchsquare"},"__N_SSP":true},"page":"/article/[identity]/[[...version]]","query":{"redirect":"/article/rs-7917529","identity":"rs-7917529","version":["v1"]},"buildId":"XKTyCvWXoU3ODBz1xrDgd","isFallback":false,"isExperimentalCompile":false,"dynamicIds":[84888],"gssp":true,"scriptLoader":[]}