Title: Video Vignette: Robotic Da Vinci SP Right Hemicolectomy via Vaginal Natural Orifice Transluminal Endoscopic Surgery (vNOTES)

 Title: Video Vignette: Robotic Da Vinci SP Right Hemicolectomy via Vaginal Natural Orifice Transluminal Endoscopic Surgery (vNOTES)

Sir,

Natural orifice transluminal endoscopic surgery (NOTES) minimizes abdominal wall trauma and optimizes cosmetic outcomes. We present a video vignette demonstrating a completely intracorporeal robotic right hemicolectomy performed via transvaginal NOTES (vNOTES) using the Da Vinci SP single-port platform.

A 59-year-old female presented with a cT1b adenocarcinoma of the distal ascending colon. The procedure was initiated transvaginally to establish peritoneal access and insert the single-port architecture. An additional abdominal port was utilized solely for external assistant viewing.

The video details the systematic robotic dissection and embryonic plane preservation. High vascular ligation was achieved by safely isolating, clipping, and dividing the middle colic artery and vein branches (MCA/MCV), the ileocolic artery and vein (ICA/ICV), and the gastrocolic trunk/right colic artery (GCT/RCA). Following complete medial-to-lateral colon mobilization, the terminal ileum and transverse colon were transected intracorporeally. Specimen extraction was performed entirely through the colpotomy site, avoiding any abdominal extraction incision. Finally, a fully intracorporeal side-to-side ileocolic anastomosis was constructed using continuous robotic suturing.

The patient’s postoperative course was uneventful, with minimal pain and early discharge. Final pathology confirmed a pT2N0 moderately differentiated adenocarcinoma with clear proximal and distal resection margins and 35 tumor-free lymph nodes (0/35).

This video demonstrates that the multi-jointed articulation and integrated camera of the Da Vinci SP system via a vNOTES approach provides excellent visualization and technical maneuverability for oncological central vascular ligation and intracorporeal anastomosis, serving as a feasible, completely scarless surgical option for selected female patients.