Comparing approaches to benign hysterectomy using conventional multi-port and newer single-port robots: a propensity score matching analysis of surgical outcomes and literature review.

Abstract

To compare the surgical outcomes of robot-assisted hysterectomy (RAH) for benign diseases using da Vinci SP (SP) and da Vinci Xi (Xi). A retrospective study with propensity score matching (PSM) analysis. An urban general hospital in Japan. 346 patients who underwent RAH at a single institution between May 2023 and April 2024. A 1:1 PSM analysis was performed using age, body mass index, number of previous deliveries, history of abdominal surgery, uterine weight, and severe endometriosis as covariates. Variables extracted for analysis included operative time, docking time, console time, estimated blood loss (EBL), hemoglobin drop, postoperative hospital stay, major intraoperative complication rates, and postoperative complication rates (Clavien-Dindo classification ≥ Grade 3), conversion to laparotomy, and blood transfusion requirements. After PSM, 262 patients (131 in each group) were included in this study. The median (range) of operative time, docking time, console time, EBL, and postoperative hospital stay were 94 (39-191) vs. 77 (33-194) min (p < 0.001), 2 (1-8) vs. 2 (1-6) min (p=0.088), 66 (27-178) vs. 62 (25-144) min (p=0.003), 5 (5-650) vs. 5 (5-350) mL (p=0.394), and 4 (3-15) vs. 4 (3-9) days (p=0.688), respectively, for SP and Xi groups. No major intraoperative complications, blood transfusions, or conversions to laparotomy were observed in either group. Postoperative complications occurred in 3.1% and 1.5% of patients of SP and Xi groups, respectively (p=0.684). The learning curve for RAH using SP indicated proficiency after eight cases. SP can be a safe alternative robotic platform to Xi for RAH.