{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,9,9]],"date-time":"2026-09-09T15:33:38Z","timestamp":1788968018008,"version":"build-2803163510"},"reference-count":30,"publisher":"Springer Science and Business Media LLC","issue":"1","license":[{"start":{"date-parts":[[2025,9,27]],"date-time":"2025-09-27T00:00:00Z","timestamp":1758931200000},"content-version":"tdm","delay-in-days":0,"URL":"https:\/\/www.springernature.com\/gp\/researchers\/text-and-data-mining"},{"start":{"date-parts":[[2025,9,27]],"date-time":"2025-09-27T00:00:00Z","timestamp":1758931200000},"content-version":"vor","delay-in-days":0,"URL":"https:\/\/www.springernature.com\/gp\/researchers\/text-and-data-mining"}],"content-domain":{"domain":["link.springer.com"],"crossmark-restriction":false},"short-container-title":["J Robotic Surg"],"DOI":"10.1007\/s11701-025-02827-y","type":"journal-article","created":{"date-parts":[[2025,9,27]],"date-time":"2025-09-27T07:23:31Z","timestamp":1758957811000},"update-policy":"https:\/\/doi.org\/10.1007\/springer_crossmark_policy","source":"Crossref","is-referenced-by-count":3,"title":["Large uterus as a surgical challenge in robot-assisted vNOTES hysterectomy: a retrospective propensity score-matched analysis"],"prefix":"10.1007","volume":"19","author":[{"given":"Qiannan","family":"Yang","sequence":"first","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Ariana","family":"Izaddoost","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Daniel","family":"Lovell","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Xiaoming","family":"Guan","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"297","published-online":{"date-parts":[[2025,9,27]]},"reference":[{"issue":"1","key":"2827_CR1","doi-asserted-by":"publisher","first-page":"73","DOI":"10.1016\/j.bpobgyn.2005.09.007","volume":"20","author":"RD Clayton","year":"2006","unstructured":"Clayton RD (2006) Hysterectomy. Best Pract Res Clin Obstet Gynaecol 20(1):73\u201387. https:\/\/doi.org\/10.1016\/j.bpobgyn.2005.09.007","journal-title":"Best Pract Res Clin Obstet Gynaecol"},{"key":"2827_CR2","doi-asserted-by":"publisher","unstructured":"Committee Opinion No 701: Choosing the route of hysterectomy for benign disease. Obstet Gynecol. 2017;129(6):e155-e159. https:\/\/doi.org\/10.1097\/AOG.0000000000002112","DOI":"10.1097\/AOG.0000000000002112"},{"key":"2827_CR3","doi-asserted-by":"publisher","DOI":"10.1155\/2022\/6034113","volume":"2022","author":"S Panda","year":"2022","unstructured":"Panda S, Das A, Das R et al (2022) Analysis of different routes of hysterectomy based on a prospective algorithm and their complications in a tertiary care institute. Minim Invasive Surg 2022:6034113. https:\/\/doi.org\/10.1155\/2022\/6034113","journal-title":"Minim Invasive Surg"},{"issue":"3","key":"2827_CR4","doi-asserted-by":"publisher","first-page":"391","DOI":"10.1097\/GRF.0b013e31822b4998","volume":"54","author":"TN Payne","year":"2011","unstructured":"Payne TN, Pitter MC (2011) Robotic-assisted surgery for the community gynecologist: can it be adopted? Clin Obstet Gynecol 54(3):391\u2013411. https:\/\/doi.org\/10.1097\/GRF.0b013e31822b4998","journal-title":"Clin Obstet Gynecol"},{"issue":"13","key":"2827_CR5","doi-asserted-by":"publisher","DOI":"10.1097\/MD.0000000000037551","volume":"103","author":"LL Zhang","year":"2024","unstructured":"Zhang LL, Wang YS, Bai LP, Zheng A (2024) Comparison of hysterectomy cases performed by transvaginal natural orifice transluminal endoscopic surgery: a paired sample cross-sectional study. Medicine (Baltimore) 103(13):e37551. https:\/\/doi.org\/10.1097\/MD.0000000000037551","journal-title":"Medicine (Baltimore)"},{"issue":"1","key":"2827_CR6","doi-asserted-by":"publisher","first-page":"105","DOI":"10.1111\/1471-0528.15504","volume":"126","author":"J Baekelandt","year":"2018","unstructured":"Baekelandt J, De Mulder P, Le Roy I et al (2018) Hysterectomy by transvaginal natural orifice transluminal endoscopic surgery versus laparoscopy as a day-care procedure: a randomised controlled trial. Intern J Obstet Gynaecol 126(1):105\u2013113. https:\/\/doi.org\/10.1111\/1471-0528.15504","journal-title":"Intern J Obstet Gynaecol"},{"issue":"1","key":"2827_CR7","doi-asserted-by":"publisher","first-page":"100","DOI":"10.1007\/s00464-014-3639-y","volume":"29","author":"CJ Wang","year":"2015","unstructured":"Wang CJ, Huang HY, Huang CY, Su H (2015) Hysterectomy via transvaginal natural orifice transluminal endoscopic surgery for nonprolapsed uteri. Surg Endosc 29(1):100\u2013107. https:\/\/doi.org\/10.1007\/s00464-014-3639-y","journal-title":"Surg Endosc"},{"key":"2827_CR8","doi-asserted-by":"publisher","DOI":"10.1080\/01443615.2025.2458842","author":"S Wylie","year":"2025","unstructured":"Wylie S, Mutema E, Yoong W (2025) Vaginal natural orifice transluminal endoscopic surgery (vNOTES): a new chapter in vaginal surgical innovation. J Obstet Gynaecol. https:\/\/doi.org\/10.1080\/01443615.2025.2458842","journal-title":"J Obstet Gynaecol"},{"issue":"1","key":"2827_CR9","doi-asserted-by":"publisher","DOI":"10.1007\/s11701-025-02593-x","volume":"19","author":"Q Yang","year":"2025","unstructured":"Yang Q, Kohn J, Guan X (2025) Robotic single port versus robotic multiple port transvaginal orifice transluminal endoscopic surgery hysterectomy: a comparison of surgical outcomes. J Robot Surg 19(1):410. https:\/\/doi.org\/10.1007\/s11701-025-02593-x","journal-title":"J Robot Surg"},{"issue":"6","key":"2827_CR10","doi-asserted-by":"publisher","first-page":"842","DOI":"10.1016\/j.tjog.2018.10.013","volume":"57","author":"T Temtanakitpaisan","year":"2018","unstructured":"Temtanakitpaisan T, Wu KY, Huang CY, Jaiswal A, Yen CF, Lee CL (2018) The outcomes of transvaginal NOTES hysterectomy in various uterine sizes. Taiwan J Obstet Gynecol 57(6):842\u2013845. https:\/\/doi.org\/10.1016\/j.tjog.2018.10.013","journal-title":"Taiwan J Obstet Gynecol"},{"key":"2827_CR11","doi-asserted-by":"publisher","first-page":"262","DOI":"10.1016\/j.ejogrb.2018.10.058","volume":"231","author":"A Chrysostomou","year":"2018","unstructured":"Chrysostomou A, Djokovic D, Edridge W, van Herendael BJ (2018) Evidence-based guidelines for vaginal hysterectomy of the International Society for Gynecologic Endoscopy (ISGE). Eur J Obstet Gynecol Reprod Biol 231:262\u2013267. https:\/\/doi.org\/10.1016\/j.ejogrb.2018.10.058","journal-title":"Eur J Obstet Gynecol Reprod Biol"},{"key":"2827_CR12","doi-asserted-by":"publisher","DOI":"10.1016\/j.ejogrb.2025.113952","volume":"310","author":"RCA Tan","year":"2025","unstructured":"Tan RCA, Jie Ying KO, Ng QJ, Qi M, Lee JM, Bhutia K (2025) Vnotes hysterectomy for patients with large uteri: initial experience in the largest tertiary centre in Singapore. Eur J Obstet Gynecol Reprod Biol 310:113952. https:\/\/doi.org\/10.1016\/j.ejogrb.2025.113952","journal-title":"Eur J Obstet Gynecol Reprod Biol"},{"issue":"3","key":"2827_CR13","doi-asserted-by":"publisher","first-page":"e56602","DOI":"10.7759\/cureus.56602","volume":"16","author":"N Higuchi","year":"2024","unstructured":"Higuchi N, Kanno K, Ochi Y et al (2024) Effect of Uterine Weight on the Surgical Outcomes of Robot-Assisted Hysterectomy in Benign Indications. Cureus. 16(3):e56602. https:\/\/doi.org\/10.7759\/cureus.56602","journal-title":"Cureus."},{"key":"2827_CR14","doi-asserted-by":"publisher","first-page":"1","DOI":"10.1016\/j.isurg.2022.06.002","volume":"4","author":"B Thigpen","year":"2022","unstructured":"Thigpen B, Sun J, Guan X (2022) Robotic transvaginal NOTES: a step-by-step approach to surgical technique. Intelli Surg 4:1\u20138. https:\/\/doi.org\/10.1016\/j.isurg.2022.06.002","journal-title":"Intelli Surg"},{"issue":"1","key":"2827_CR15","doi-asserted-by":"publisher","DOI":"10.1007\/s11701-025-02653-2","volume":"19","author":"X Guan","year":"2025","unstructured":"Guan X, Yang Q, Lovell DY, Zhang C (2025) Application of \u201c4-P\u201d port anchoring in transvaginal natural orifice transluminal endoscopic surgery (vNOTES): technique and initial feasibility. J Robot Surg 19(1):473. https:\/\/doi.org\/10.1007\/s11701-025-02653-2","journal-title":"J Robot Surg"},{"issue":"9","key":"2827_CR16","doi-asserted-by":"publisher","first-page":"755","DOI":"10.1089\/lap.2014.0640","volume":"25","author":"F Montella","year":"2015","unstructured":"Montella F, Cosma S, Riboni F, Dealberti D, Benedetto C, Abate S (2015) A safe and simple laparoscopic cold knife section technique for bulky uterus removal. J Laparoendosc Adv Surg Tech A 25(9):755\u2013759. https:\/\/doi.org\/10.1089\/lap.2014.0640","journal-title":"J Laparoendosc Adv Surg Tech A"},{"issue":"3","key":"2827_CR17","doi-asserted-by":"publisher","first-page":"276","DOI":"10.4103\/jmas.jmas_125_24","volume":"21","author":"A Bahadur","year":"2025","unstructured":"Bahadur A, Sharma S, Heda A, Chawla L, Mundhra R (2025) Impact of uterine weight on surgical outcomes in robotic hysterectomy: an ambispective analysis. J Minim Access Surg 21(3):276\u2013281. https:\/\/doi.org\/10.4103\/jmas.jmas_125_24","journal-title":"J Minim Access Surg"},{"issue":"5","key":"2827_CR18","doi-asserted-by":"publisher","first-page":"559","DOI":"10.1016\/j.jmig.2007.04.013","volume":"14","author":"A Fiaccavento","year":"2007","unstructured":"Fiaccavento A, Landi S, Barbieri F et al (2007) Total laparoscopic hysterectomy in cases of very large uteri: a retrospective comparative study. J Minim Invasive Gynecol 14(5):559\u2013563. https:\/\/doi.org\/10.1016\/j.jmig.2007.04.013","journal-title":"J Minim Invasive Gynecol"},{"key":"2827_CR19","unstructured":"US department of health and human services. safety communications > laparoscopic uterine power morcellation in hysterectomy and myomectomy: FDA Safety Communication. Available from: https:\/\/wayback.archive-it.org\/7993\/20170406071822\/https:\/\/www.fda.gov\/MedicalDevices\/Safety\/AlertsandNotices\/ucm393576.htm. April 17, 2014; Accessed on: May 25, 2019"},{"issue":"7","key":"2827_CR20","doi-asserted-by":"publisher","first-page":"1288","DOI":"10.1016\/j.jmig.2018.12.008","volume":"26","author":"Y Aoki","year":"2019","unstructured":"Aoki Y, Kanao H, Kikuchi I et al (2019) Comparison of the technical feasibility and safety of three contained morcellation techniques: a pilot study in an animal model. J Minim Invasive Gynecol 26(7):1288\u20131296. https:\/\/doi.org\/10.1016\/j.jmig.2018.12.008","journal-title":"J Minim Invasive Gynecol"},{"key":"2827_CR21","doi-asserted-by":"publisher","first-page":"126","DOI":"10.1016\/j.ejogrb.2016.04.012","volume":"201","author":"Y Aoki","year":"2016","unstructured":"Aoki Y, Matsuura M, Matsuno T, Yamamoto T (2016) Single-site in-bag morcellation achieved via direct puncture of the pneumoperitoneum cap, a cordless electric morcellator, and a 5-mm flexible scope. Eur J Obstet Gynecol Reprod Biol 201:126\u2013130. https:\/\/doi.org\/10.1016\/j.ejogrb.2016.04.012","journal-title":"Eur J Obstet Gynecol Reprod Biol"},{"issue":"4","key":"2827_CR22","doi-asserted-by":"publisher","first-page":"918","DOI":"10.1080\/08941939.2021.1958111","volume":"35","author":"C Kaya","year":"2022","unstructured":"Kaya C, Y\u0131ld\u0131z \u015e, Alay \u0130 et al (2022) Comparison of surgical outcomes of total laparoscopic hysterectomy and vNOTES hysterectomy for undescended-enlarged uteri. J Invest Surg 35(4):918\u2013923. https:\/\/doi.org\/10.1080\/08941939.2021.1958111","journal-title":"J Invest Surg"},{"issue":"11","key":"2827_CR23","doi-asserted-by":"publisher","first-page":"877","DOI":"10.1016\/j.jmig.2023.06.019","volume":"30","author":"N Kheirbek","year":"2023","unstructured":"Kheirbek N, Delporte V, El Hajj H et al (2023) Comparing vNOTES hysterectomy with laparoscopic hysterectomy for large uteri. J Minim Invasive Gynecol 30(11):877\u2013883. https:\/\/doi.org\/10.1016\/j.jmig.2023.06.019","journal-title":"J Minim Invasive Gynecol"},{"issue":"1","key":"2827_CR24","doi-asserted-by":"publisher","DOI":"10.1186\/s12893-020-00897-3","volume":"20","author":"X Wang","year":"2020","unstructured":"Wang X, Li J, Hua K, Chen Y (2020) Transvaginal natural orifice transluminal endoscopic surgery (vNOTES) hysterectomy for uterus weighing \u22651 kg. BMC Surg 20(1):234. https:\/\/doi.org\/10.1186\/s12893-020-00897-3","journal-title":"BMC Surg"},{"issue":"7","key":"2827_CR25","doi-asserted-by":"publisher","first-page":"1351","DOI":"10.1016\/j.jmig.2020.10.003","volume":"28","author":"K Nulens","year":"2021","unstructured":"Nulens K, Bosteels J, De Rop C, Baekelandt J (2021) VNOTES hysterectomy for large uteri: a retrospective cohort study of 114 patients. J Minim Invasive Gynecol 28(7):1351\u20131356. https:\/\/doi.org\/10.1016\/j.jmig.2020.10.003","journal-title":"J Minim Invasive Gynecol"},{"issue":"6","key":"2827_CR26","doi-asserted-by":"publisher","first-page":"1088","DOI":"10.1016\/j.jmig.2015.05.015","volume":"22","author":"J Baekelandt","year":"2015","unstructured":"Baekelandt J (2015) Total vaginal NOTES hysterectomy: a new approach to hysterectomy. J Minim Invasive Gynecol 22(6):1088\u20131094. https:\/\/doi.org\/10.1016\/j.jmig.2015.05.015","journal-title":"J Minim Invasive Gynecol"},{"issue":"8","key":"2827_CR27","doi-asserted-by":"publisher","DOI":"10.1136\/bmjopen-2016-011546","volume":"6","author":"J Baekelandt","year":"2016","unstructured":"Baekelandt J, De Mulder PA, Le Roy I et al (2016) Halon-hysterectomy by transabdominal laparoscopy or natural orifice transluminal endoscopic surgery: a randomised controlled trial (study protocol). BMJ Open 6(8):e011546. https:\/\/doi.org\/10.1136\/bmjopen-2016-011546","journal-title":"BMJ Open"},{"issue":"3","key":"2827_CR28","doi-asserted-by":"publisher","DOI":"10.1002\/rcs.2636","volume":"20","author":"LE Delgadillo Chabolla","year":"2024","unstructured":"Delgadillo Chabolla LE, Alpuing Radilla LA, Koythong T et al (2024) Exploring the feasibility of indocyanine green fluorescence for intraoperative ureteral visualisation in robotic transvaginal natural orifice transluminal endoscopy surgery during endometriosis resection. Int J Med Robot 20(3):e2636. https:\/\/doi.org\/10.1002\/rcs.2636","journal-title":"Int J Med Robot"},{"issue":"6","key":"2827_CR29","doi-asserted-by":"publisher","first-page":"496","DOI":"10.1016\/j.jmig.2024.03.006","volume":"31","author":"G Xu","year":"2024","unstructured":"Xu G, Lovell DY, Guan X (2024) Robot-assisted vaginal natural orifice transluminal endoscopic surgery (RvNOTES) with total hysterectomy for management of stage IV endometriosis with\/without complete cul-de-sac obliteration: 23-case pilot feasibility study. J Minim Invasive Gynecol 31(6):496\u2013503. https:\/\/doi.org\/10.1016\/j.jmig.2024.03.006","journal-title":"J Minim Invasive Gynecol"},{"issue":"6","key":"2827_CR30","doi-asserted-by":"publisher","first-page":"474","DOI":"10.1016\/j.jmig.2024.03.002","volume":"31","author":"DY Lovell","year":"2024","unstructured":"Lovell DY, Guan X (2024) Robot-assisted vaginal natural orifice transluminal endoscopic surgery for frozen pelvis. J Minim Invasive Gynecol 31(6):474. https:\/\/doi.org\/10.1016\/j.jmig.2024.03.002","journal-title":"J Minim Invasive Gynecol"}],"container-title":["Journal of Robotic Surgery"],"original-title":[],"language":"en","link":[{"URL":"https:\/\/link.springer.com\/content\/pdf\/10.1007\/s11701-025-02827-y.pdf","content-type":"application\/pdf","content-version":"vor","intended-application":"text-mining"},{"URL":"https:\/\/link.springer.com\/article\/10.1007\/s11701-025-02827-y","content-type":"text\/html","content-version":"vor","intended-application":"text-mining"},{"URL":"https:\/\/link.springer.com\/content\/pdf\/10.1007\/s11701-025-02827-y.pdf","content-type":"application\/pdf","content-version":"vor","intended-application":"similarity-checking"}],"deposited":{"date-parts":[[2026,1,4]],"date-time":"2026-01-04T01:21:16Z","timestamp":1767489676000},"score":1,"resource":{"primary":{"URL":"https:\/\/link.springer.com\/10.1007\/s11701-025-02827-y"}},"subtitle":[],"short-title":[],"issued":{"date-parts":[[2025,9,27]]},"references-count":30,"journal-issue":{"issue":"1","published-online":{"date-parts":[[2025,12]]}},"alternative-id":["2827"],"URL":"https:\/\/doi.org\/10.1007\/s11701-025-02827-y","relation":{},"ISSN":["1863-2491"],"issn-type":[{"value":"1863-2491","type":"electronic"}],"subject":[],"published":{"date-parts":[[2025,9,27]]},"assertion":[{"value":"11 August 2025","order":1,"name":"received","label":"Received","group":{"name":"ArticleHistory","label":"Article History"}},{"value":"18 September 2025","order":2,"name":"accepted","label":"Accepted","group":{"name":"ArticleHistory","label":"Article History"}},{"value":"27 September 2025","order":3,"name":"first_online","label":"First Online","group":{"name":"ArticleHistory","label":"Article History"}},{"order":1,"name":"Ethics","group":{"name":"EthicsHeading","label":"Declarations"}},{"value":"The authors declare no competing interests.","order":2,"name":"Ethics","group":{"name":"EthicsHeading","label":"Conflicts of interest"}},{"value":"The Institutional Review Board of Baylor College of Medicine approved the study protocol on March 8, 2022 (IRB No. H-51429). Given the retrospective design of the study, the requirement for informed consent was waived.","order":3,"name":"Ethics","group":{"name":"EthicsHeading","label":"Ethical approval"}}],"article-number":"639"}}