Single-Port surgical robot-assisted transvaginal natural orifice translumenal endoscopic surgery (v-NOTES) hysterectomy and double salpingectomy with pneumoperitoneum-free: surgical technique

Hysterectomy is a frequent gynecological surgical technique. With the extensive application of robot-assisted laparoscopic surgery, the feasibility of robot-assisted transvaginal natural orifice translumenal endoscopic surgery (v-NOTES) has been demonstrated in various benign gynecologic procedures, including hysterectomy, endometriosis excision, myomectomy, sacrocolpopexy, as well as oncologic surgery. But they are all multi-port straight-arm robots. We report a case of a patient who underwent Single-Port surgical robot-assisted v-NOTES hysterectomy with pneumoperitoneum-free technique to demonstrate its possible advantages over the straight-arm robot. The patient underwent hysterectomy and double salpingectomy because of grade 3 cervical intraepithelial neoplasia (CIN3) and high-grade squamous intraepithelial lesion (HSIL) at the cervical margin. The entire procedure of pneumoperitoneum-free hysterectomy using a Single-Port surgical robot is fully demonstrated in the video. During the operation, transvaginal surgical techniques and v-NOTES techniques were combined with Single-Port robot-assisted and pneumoperitoneum-free devices. The uterosacral main ligament, uterine vessels, broad ligament, inherent ligament of the ovary, round ligament and mesentery of the fallopian tube were treated in sequence. We share this surgical technique, hoping that more gynecologists will learn about this new method. It can effectively avoid the limitations caused by the vaginal anatomy in direct-arm robot surgery. This combination is still in the initial exploration stage and more prospective controlled clinical evaluations are needed before it is widely applied.