Safe Trocar Placement by Transvaginal Endoscopic Insertion in Robot-Assisted Surgery for Endometrial Cancer With Umbilical Incisional Hernia and Prior Mesh Repair: Two Case Reports.

We report two cases of endometrial cancer with umbilical incisional hernia or prior mesh repair, in which robot-assisted surgery was safely performed using transvaginal laparoscope insertion. Both patients had prior abdominal surgeries, and preoperative imaging raised concerns about adhesions or mesh near the umbilicus, making conventional trocar insertion risky. A laparoscope was inserted via the posterior vaginal fornix, allowing real-time intra-abdominal visualization and safe port placement under direct vision. In one case, mesh and adhesions were confirmed at the umbilicus. In the other, no adhesions were found within the hernia sac despite being suspected preoperatively, whereas dense adhesions were identified at Palmer's point, which could not be fully characterized by imaging alone. These cases highlight the limitations of relying solely on imaging and underscore the utility of intraoperative visual assessment. Transvaginal scope insertion offers a simple, reproducible method to enhance trocar safety. To our knowledge, no previous reports have described this technique used solely for observation in robot-assisted surgery for endometrial cancer.