Comparative analysis of nerve-sparing modified radical hysterectomy for deep endometriosis using the da Vinci SP versus Xi systems

This study compared surgical approaches and perioperative outcomes of nerve-sparing modified radical hysterectomy (NSmRH) for deep endometriosis (DE) using the da Vinci SP and Xi systems. This retrospective cohort study included consecutive patients who underwent robot-assisted NSmRH for DE at a single tertiary referral center between March 2020 and October 2025. Disease severity was evaluated using the revised American Society for Reproductive Medicine (rASRM) and #Enzian classifications, and perioperative outcomes—including operative time (OT), console time (CT), docking time (DT), estimated blood loss (EBL), and complications—were compared. The analysis included 100 patients: 32 in the SP group and 68 in the Xi group. Advanced disease was prevalent in both cohorts, with rASRM stage IV observed in 72% of the SP group and 70% of the Xi group. The distribution of #Enzian classifications was comparable between groups. Median OT and CT did not differ significantly between groups (OT: 159 [123–196] vs. 144 [122–164] min, p = 0.16; and CT: 144 [101–180] vs. 130 [108–153] min, p = 0.22), whereas DT was shorter in the SP group (1.8–2.0 vs. 2.0–3.0 min, p = 0.0036). EBL was significantly lower in the SP group (5 vs. 15 mL; p = 0.0015). No intraoperative injuries, severe postoperative complications, or voiding dysfunction were observed in either group. NSmRH for DE was performed safely using both SP and Xi systems. These findings indicate that the SP system represents a feasible alternative robotic platform for selected high-complexity nerve-sparing procedures in DE. Similar content being viewed by others Data availability The data supporting the findings of this study are not publicly available owing to sensitivity reasons and are available from the corresponding author upon reasonable request.

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We would like to thank Editage (www.editage.jp) for English language editing. Funding The authors declare that no funds, grants, or other support were received during the preparation of this manuscript. Author information Authors and Affiliations Contributions All authors contributed to the study conception, study design, and data collection. The study design, project management, data collection, data analysis, and manuscript drafting and editing were carried out by Kiyoshi Kanno. All authors reviewed and provided comments on previous versions of the manuscript. All authors have read and approved the final version of the manuscript. Corresponding author Ethics declarations Competing interests The authors declare no competing interests. Ethics approval This study was approved by the Institutional Review Board of the Kurashiki Medical Center (No. 861). Consent to Participate and Publish Written informed consent was obtained from all the participants included in this study. Additional information Publisher’s note Springer Nature remains neutral with regard to jurisdictional claims in published maps and institutional affiliations. Supplementary Information Below is the link to the electronic supplementary material. Supplementary Material 1 Rights and permissions Springer Nature or its licensor (e.g. a society or other partner) holds exclusive rights to this article under a publishing agreement with the author(s) or other rightsholder(s); author self-archiving of the accepted manuscript version of this article is solely governed by the terms of such publishing agreement and applicable law. About this article Cite this article Kanno, K., Kashiwabara, T., Iwata, T. et al. Comparative analysis of nerve-sparing modified radical hysterectomy for deep endometriosis using the da Vinci SP versus Xi systems. J Robotic Surg 20, 354 (2026). https://doi.org/10.1007/s11701-026-03274-z Received: Accepted: Published: Version of record: DOI: https://doi.org/10.1007/s11701-026-03274-z