Introduction/Background Natural orifice transluminal endoscopy (NOTES) minimally invasive surgery improves cosmetic outcomes and reduces surgical injury. This in turn decreases the inflammatory and neuroendocrine responses resulting in less postoperative pain and quicker recovery.

Methodology Patients with stage I/IIA endometrial cancer are selected for this procedure.

The HominisTM Surgical System is used. The System consists of sterile: components: the Hominis ArmsTM and the GYNTrocar Kit, and non-sterile capital equipment: the ControlConsole and the Motor Units. The Arms are inserted transvaginally through the posterior fornix to the pelvic cavity, retroflexed towards the point of entry. This enables performing the procedure with a clear view and reaching various structures in the pelvic cavity. Each Arm corresponds to the respective hand of the surgeon as controlled by the right and left Joysticks. The surgeon controls the Hominis Arms through two Hominis motor units. the motor units house a motorized prismatic joint that enables controlled linear motion to insert and extract the Arms from the pelvic cavity. Blunt dissection is performed with vaginal total hysterectomy, bilateral salpingo-oophorectomy, pelvic lymphadenectomy, approximation, and electrosurgery, using monopolar and bipolar energy systems. The vaginal cuff is closed with Vicryl sutures.

Results The procedure is successfully performed. No conversion to standard multi-incision laparoscopy or laparotomy is necessary. Mean vaginal time is 19 minutes, mean docking time is 18 minutes, and mean console time is 35 minutes. The mean drop in hemoglobin level is 1.3 g/dl. Most patients score a low postoperative pain score (range 3- 6) .

Conclusion Robot-assisted natural orifice vaginal hysterectomy for early-stage endometrial cancer – Farghaly’s Technique is associated with minimal blood loss, short operative time and length of hospital stay, lower pain score, and low use of analgesics. Thus, it may be considered a reasonable alternative to the robot-assisted abdominal approach in medically compromised women.