Evaluation of the learning curve and safety outcomes in robotic assisted vaginal natural orifice transluminal endoscopic hysterectomy: A case series of 84 patients

Int J Med Robot. 2022 Jun;18(3):e2385. doi: 10.1002/rcs.2385. Epub 2022 Mar 8.


Background: To explore the learning curve and safety outcomes of robotic assisted transvaginal natural orifice transluminal endoscopic surgery (R-vNOTES) for hysterectomy in benign gynaecological diseases.

Methods: A retrospective chart review of all patients undergoing R-vNOTES hysterectomy for benign gynaecological disease from 2019 to 2021.

Setting: An academic tertiary care university hospital in Houston, TX, USA.

Results: 84 patients were identified that met the study requirements. The mean hysterectomy time was 77.27 ± 2.89 min. The median additional operation time was 63 (8-206) min. There were two conversions to robotic assisted single incision laparoscopy. Thirteen (15.48%) patients had an associated complication. Analysis of the learning curve suggests plateauing of hysterectomy time at approximately 10 cases and time for robot docking and port placement after 10-20 cases.

Conclusion: R-vNOTES is a safe and effective route for hysterectomy. For a surgeon with experience in laparoscopic single site surgery and abdominal robotic surgery, they need to perform 10 cases of R-vNOTES hysterectomy and 10-20 cases in port placement and robotic docking to achieve proficiency.

Keywords: benign disease; hysterectomy; learning curve; robotic; transvaginal natural orifice transluminal endoscopic surgery (vNOTES).

MeSH terms

  • Female
  • Humans
  • Hysterectomy
  • Laparoscopy*
  • Learning Curve
  • Natural Orifice Endoscopic Surgery*
  • Retrospective Studies
  • Robotic Surgical Procedures*
  • Vagina / surgery