目的 探讨单孔机器人辅助经阴道自然腔道内镜手术（RSP-vNOTES）与传统经阴道自然腔道内镜手术（T-vNOTES）行全子宫切除术的临床效果。方法 采用回顾性队列研究方法，收集2024年1月至2025年7月于南京医科大学第二附属医院90例vNOTES全子宫切除术患者资料，采用倾向性评分匹配法对RSP-vNOTES组与T-vNOTES组患者进行匹配，共30对60例纳入研究。研究分析两组患者手术效果、住院总费用与术者主观工作负荷的差异。结果 两组患者在手术时长、术后24 h疼痛评分、术后首次肛门排气时间、Clavien-Dindo（CD）分级Ⅰ~Ⅱ级并发症发生率、住院时间方面差异均无统计学意义（P>0.05）。对比T-vNOTES组，RSP-vNOTES组术中出血量、术中补液量均更少（P<0.05），手术关键步骤操作时长更短（P<0.05），但住院总费用更高（P<0.05）；RSP-vNOTES组术者脑力需求、体力需求、业绩水平评分、努力程度评分均更低（P<0.05）。结论 对于有经验的术者，RSP-vNOTES与T-vNOTES全子宫切除术安全可行。较T-vNOTES，RSP-vNOTES全子宫切除不增加手术时长，在子宫切除关键手术操作步骤上可能更具效率，术中出血量与补液量更少，能够减轻术者部分工作负荷，提高操作舒适度。

Objective To compare the clinical effect of single-port robot-assisted vNOTES （RSP-vNOTES） with that of traditional vNOTES （T-vNOTES） in total hysterectomy. Methods The data of 90 patients who underwent vNOTES total hysterectomy in the Second Affiliated Hospital of Nanjing Medical University from January 2024 to July 2025 were retrospectively analyzed. Propensity score matching was used to match patients in the RSP-vNOTES group and the T-vNOTES group，resulting in 30 pairs （60 patients） included in the study.Compare and analyze the differences in surgical effects，total hospitalization cost and the operator’s subjective intensity of workload between the two groups of patients. Results There were no significant differences in the total operation time，postoperative 24 h pain score，first postoperative flatus time，CD gradeⅠ~Ⅱcomplication rate，or hospital stay between the two groups（P>0.05）. Compared with the T-vNOTES group，the RSP-vNOTES group had less intraoperative blood loss， less intraoperative fluid infusion （P<0.05），and less operating time of critical surgical steps（P<0.05），but higher total cost of hospitalization （P<0.05）. Compared with the T-vNOTES group，the RSP-vNOTES group had lower mental need，lower physical need，lower score in performance level and lower score in effort level （P<0.05）. Conclusions For experienced surgeons，both RSP-vNOTES total hysterectomy and T-vNOTES total hysterectomy are safe and feasible. Compared with T-vNOTES，RSP-vNOTES total hysterectomy does not increase the length of operation，and may be more efficient in the critical surgical steps of hysterectomy； it has less intraoperative blood loss and fluid infusion，less workload of the operator ，and can improve the comfort of the operation.