Pioneering case: Robotic single port (SP) transvaginal NOTES (RSP-vNOTES) for hysterectomy in ten steps

Transvaginal Natural Orifice Transluminal Endoscopic Surgery (NOTES) has become popular since its inception in 2012, offering advantages by combining vaginal surgery principles with laparoscopic instruments for procedures like hysterectomy and myomectomy. The da Vinci Xi robotic system for transvaginal NOTES has been used successfully in over 300 cases, including advanced surgeries like sacrocolpopexy and endometriosis procedures. The new da Vinci SP platform, designed for single-port surgery, was employed in the first transvaginal NOTES hysterectomy on November 11, 2023, at Baylor College of Medicine. The surgical steps and outcomes of the procedure are detailed in this case report, showcasing the feasibility and success of utilizing the da Vinci SP system for transvaginal NOTES. The patient was discharged on the same day with an unremarkable post-operative course, and pathology results revealed adenomyosis and endometriosis after the comprehensive surgery.