Comparison of Surgical Outcomes of da Vinci Surgical Systems X and Xi: A Single-center Study

Comparison of Surgical Outcomes of da Vinci Surgical Systems X and Xi: A Single-center Study | Research Square window.SnipcartSettings = { analytics: { enabled: false } }; (function() { var accessVector = localStorage.getItem('access_vector') || ''; window.dataLayer = window.dataLayer || []; if (accessVector) { window.dataLayer.push({ user: { profile: { profileInfo: { snid: accessVector } } } }); } })(); (function(w,d,s,l,i){w[l]=w[l]||[];w[l].push({'gtm.start':new Date().getTime(),event:'gtm.js'});var f=d.getElementsByTagName(s)[0],j=d.createElement(s),dl=l!='dataLayer'?'&l='+l:'';j.async=true;j.src='https://www.googletagmanager.com/gtm.js?id='+i+dl;f.parentNode.insertBefore(j,f);})(window,document,'script','dataLayer','GTM-K279D39R'); Browse Preprints In Review Journals COVID-19 Preprints AJE Video Bytes Research Tools Research Promotion AJE Professional Editing AJE Rubriq About Preprint Platform In Review Editorial Policies Our Team Advisory Board Help Center Sign In Submit a Preprint Cite Share Download PDF Research Article Comparison of Surgical Outcomes of da Vinci Surgical Systems X and Xi: A Single-center Study Hiroki Nagata, Hiroaki Komatsu, Koji Yamamoto, Masayo Okawa, Kohei Hikino, and 8 more This is a preprint; it has not been peer reviewed by a journal. https://doi.org/ 10.21203/rs.3.rs-4152339/v1 This work is licensed under a CC BY 4.0 License Status: Published Journal Publication published 30 Jun, 2024 Read the published version in Asian Journal of Endoscopic Surgery → Version 1 posted You are reading this latest preprint version Abstract Background: The da Vinci surgical systems (X and Xi) are fourth-generation systems marketed by Intuitive Inc. The X system is less expensive compared with the Xi system. This study compared the surgical outcomes of patients who underwent hysterectomy using the X and Xi systems. Methods: Data of 172 patients who underwent robot-assisted total hysterectomies by four surgeons between April 2019 and March 2023 were retrospectively analyzed in a single-center study. The patients were divided into two groups based on the system used for the surgery. Approval was granted by the Institutional Review Board of the Tottori University Hospital (22A134). All patients provided opt-out consent in accordance with institutional guidelines. Results: The operative and console times in group X were shorter than those in group Xi after propensity score matching for age, body mass index, nulliparity, previous history of abdominal or pelvic surgery, pre-operative diagnosis, and surgical approach. No statistical differences were observed in a subgroup analysis of patients who underwent robot-assisted total laparoscopic hysterectomy without lymphadenectomy. Conclusion: Perioperative outcomes for the X and Xi da Vinci surgical systems were equivalent. The cost-effective X system may allow the widespread use of robotic surgeries. Hysterectomy Robotic surgery Treatment outcome Cost effectiveness Figures Figure 1 Figure 2 Introduction Robot-assisted gynecological surgery was approved by the U.S. Food and Drug Administration in 2005 [1]. Robot-assisted hysterectomy is associated with reduced hospital stay, fewer complication and fewer blood transfusions than open surgery [2]. Furthermore, robot-assisted hysterectomy has an early learning curve [3]. Since its approval, various improvements have been made to the robots and new models have been released. The da Vinci Xi (Xi) is a fourth-generation surgical system that includes a greater endoscope, thinner arms, and an automated patient-side cart [4]. For radical prostatectomy, the docking and operation times of the Xi system are shorter than those of the da Vinci Si system [5]. Da Vinci X (X) is a fourth-generation system that was released 3 years after the Xi system and is more affordable [6]. The robotic arms of the X system are fixed to the patient-side cart. Therefore, access to target organs is sometimes impaired. However, the X and Xi systems use the same vision cart and surgeon console, and the instruments are interchangeable. No previous studies have compared the Xi and X systems for hysterectomy. Robot-assisted hysterectomy using the Xi and X systems was introduced at our institution in 2018. This study compared the perioperative outcomes of patients who underwent robot-assisted hysterectomy with the da Vinci Xi and X systems. Methods The clinical records of 172 patients who underwent robot-assisted total hysterectomies by four surgeons at Tottori University Hospital between April 2019 and July 2023 were retrospectively reviewed. The patients who underwent sacrocolpopexy were excluded. The patients were divided into two groups based on the robotic system used for the surgery. The choice of the surgical system (X or Xi) was determined by the surgical department rather than the operating surgeon. Patient data, including age, body mass index (BMI), history of abdominal or pelvic surgery, parity, operative time, blood loss, uterine weight, frequency of perioperative adverse events (included Clavien-Dindo class II or higher), length of hospital stay, surgical approach (robot-assisted total laparoscopic hysterectomy [RATLH] or robot-assisted modified radical hysterectomy [RAmRH] and pelvic lymphadenectomy or not), and success rate of vaginal tissue removal were collected. The operative time was divided into pre-console time (defined as the time from the skin incision to the start of the console), console time, and post-console time (defined as the time from the end of the console to the end of the operation). RATLH and RAmRH were conducted with the patient in an 18–20° head-down position. A closed or opened first-puncture approach was used, and the pneumoperitoneum pressure was set at 8–12 mmHg CO 2 . Five port sites were used ( Fig. 1 ). An automated setup function directed towards the pelvic floor was used when the Xi system was used. As the X system does not include a positioning function, the surgeons manually and subjectively adjusted the arms prior to docking ( Fig. 2 ). During the operation, Maryland bipolar forceps, monopolar curved scissors, and a large needle driver were used. Furthermore, Cadiere forceps were used with the X system and Synchro Seal was used with Xi system. The second assistant used a Vagi pipe (Hakko Medical, Chikuma, Japan). The primary surgeons were certified by the Japan Society of Gynecologic and Obstetric Endoscopy and Minimally Invasive Therapy [7]. Propensity scores were used to control for potential covariate imbalances and create maximally non-biased groups. Propensity score matching involved the use of a logistic regression model based on six covariates: age, BMI, nulliparity, history of abdominal or pelvic surgery, pre-operative diagnosis, and surgical approach. The success of the matching was assessed for each variable using a standardized difference. A successful balance was inferred if the residual imbalance for all confounders was ≤10%. Pearson's chi-square test and the Mann–Whitney U test were used to compare the categorical and continuous variables, respectively. Statistical significance was set at P < 0.05. All statistical analyses were conducted using SPSS Statistics for Windows (version 28, IBM Corp., Armonk, NY, USA). This study was performed in line with the principles of the Declaration of Helsinki. Approval was granted by the Institutional Review Board of the Tottori University Hospital (22A134). All patients provided opt-out consent in accordance with institutional guidelines. Results A total of 172 patients underwent robot-assisted hysterectomy, including 95 (55.2%) and 77 (44.2%) for whom the X and Xi system was used, respectively (Table 1). After propensity score matching, 73 patients were included in each group. The demographic data and surgical approach used were not significantly different between the groups. RATLH was performed in approximately 70% of the patients in both groups. The mean number of harvested lymph nodes was 25.6 (± 9.9) with X and 28.9 (± 11.3) with Xi. The uterine weight and success rate of vaginal removal did not differ between the groups. No emergency conversion to open surgery was reported in either group. The operative and console times were insignificantly shorter in group X than in group Xi (Table 2). There were no differences between the groups when the data of patients who underwent RATLH without lymphadenectomy were compared (Table 3). Despite the small sample size, no inferior aspects were identified in group X over group Xi in patients with BMI > 30 or uterine weight > 300 g (Online Resource 1 and 2). Discussion To the best of our knowledge, this is the first study comparing the perioperative data of the X and Xi surgical systems for hysterectomy. Interestingly, the X system was not inferior to the Xi system and both systems were successfully used to perform hysterectomies. The operative and console times were shorter in group X than in group Xi, although the differences were insignificant. The surgeons reported similar frequencies of arm collisions in both groups. A previous study reported that the pre-console time was significantly shorter, and the operative time tended to be shorter during total hysterectomy when the Xi system was used than with the Si system [ 8 ]. The X and Xi systems have been compared for other types of surgery. During robotic thyroidectomy surgery, the Xi system required a shorter operative time than the X system [ 9 ]. As the robotic arms of the X system are fixed to the patient-side cart, access to the patient’s head is impaired. However, Bergmann et al. [ 10 ] reported no serious adverse events associated with either system during rectal surgery. Therefore, the use of the two systems is expected to result in comparable outcomes since hysterectomy is a pelvic surgery. Advanced equipment, such as Synchro Seal, and the automated setup function of the Xi system may have accounted for the longer times in group X in this study. Like the da Vinci Si system, the X system does not include an automated setup function. Furthermore, improvements to the operation fluency of the Xi system have resulted in a shorter operation time than that of the Si system [ 5 ]. Although a longer pre-operative time was expected in group X, there was no significant difference between the two groups in this study. Arm adjustments by the surgeons may have contributed to similar results between the two groups. Rama et al. [ 11 ] previously reported comparable docking times for the Si and Xi systems, suggesting the impact of the targeting process in the Xi system. Although the number of arm collisions was not reported in the current study, the surgeons did not report a difference in the frequency of collisions. The intraoperative blood loss for robot-assisted hysterectomy has been reported as 77–119 mL and the adverse event rate as 2–13% [ 2 , 12 , 13 ], which are comparable to the results of the current study. The similar outcomes between both groups in this study may be attributed to the use of the same surgeon console and instruments. This study has some limitations. First, the retrospective and single institution design have inherent limitations. Second, the long-term outcomes were not investigated. Although a detailed assessment was not performed, no notable adverse events were reported during the outpatient follow-up for 2 months in that study. Arms et al. [ 14 ] compared the long-term (4-month) satisfaction of women who underwent robot-assisted total hysterectomy. In addition, different surgeons may use different surgical techniques that may affect the study results. To summarize, the perioperative outcomes of hysterectomy did not differ when the da Vinci X and Xi systems were used. Therefore, the less expensive X system resulted in adequate outcomes. These results may contribute to the widespread use of robotic surgery. Declarations Funding No funds, grants, or other support was received. Competing interest The authors have no relevant financial or non-financial interests to disclose. Ethics approval This study was performed in line with the principles of the Declaration of Helsinki. Approval was granted by the Institutional Review Board of the Tottori University Hospital (22A134). All patients provided opt-out consent in accordance with institutional guidelines. Data availability The data that support the findings of this study are available on request from the corresponding author. The data are not publicly available as they could compromise the privacy of research participants. Authors’ contributions All authors contributed to the study conception and design. Material preparation, data collection and analysis were performed by [Hiroaki Komatsu and Hiroki Nagata]. The first draft of the manuscript was written by [Hiroki Nagata] and all authors commented on previous versions of the manuscript. All authors read and approved the final manuscript. References Sinha R, Sanjay M, Rupa B, Kumari S (2015) Robotic surgery in gynecology. J Minim Access Surg 11:50–59. https://doi.org/10.4103/0972-9941.147690 O’Neill M, Moran PS, Teljeur C et al (2013) Robot-assisted hysterectomy compared to open and laparoscopic approaches: systematic review and meta-analysis. Arch Gynecol Obstet 287:907–918. https://doi.org/10.1007/s00404-012-2681-z Iida Y, Komatsu H, Kudoh A et al (2023) The learning curve of introduced robotic-assisted hysterectomy versus skilled laparoscopic hysterectomy for benign gynecologic diseases. J Obstet Gynaecol Res 49:2494–2500. https://doi.org/10.1111/jog.15741 Da Vinci Xi robotic surgical system. Intuitive. https://www.intuitive.com/en-us/products-and-services/da-vinci/xi . Accessed 22 October 2023 Lei KY, Xie WJ, Fu SQ, Ma M, Sun T (2021) A comparison of the da VINCI Xi vs. da Vinci Si surgical systems for radical prostatectomy. BMC Surg 21:409. https://doi.org/10.1186/s12893-021-01406-w Da Vinci X. Robotic surgical system. Intuitive. https://www.intuitive.com/en-us/products-and-services/da-vinci/x . Accessed 22 October 2023 Komatsu H, Hiraike O, Fukuhara R et al (2023) Is there a need for a technical certification system for gynecological robotic surgery? Questionnaire survey of members of the Japan Society of Gynecologic and Obstetric Endoscopy and Minimally Invasive Therapy. J Robot Surg 17:1125–1131. https://doi.org/10.1007/s11701-022-01520-8 Giannini A, Malacarne E, Sergiampietri C et al (2021) Comparison of perioperative outcomes and technical features using da VINCI Si and Xi robotic platforms for early stages of endometrial cancer. J Robot Surg 15:195–201. https://doi.org/10.1007/s11701-020-01091-6 Shin HR, Lee K, Yu HW et al (2021) Comparison of perioperative outcomes using the da Vinci S, Si, X, and Xi robotic platforms for BABA robotic thyroidectomy. Medicina (Kaunas) 57:1130. https://doi.org/10.3390/medicina57101130 Bergmann J, Lehmann-Dorl B, Witt L, Aselmann H (2022) Using the da VINCI X® - system for esophageal surgery. JSLS 26:e2022. https://doi.org/10.4293/JSLS.2022.00018 Alhossaini RM, Altamran AA, Choi S et al (2019) Similar operative outcomes between the da VINCI Xi® and da VINCI Si® systems in robotic gastrectomy for gastric cancer. J Gastric Cancer 19:165–172. https://doi.org/10.5230/jgc.2019.19.e13 Payne TN, Dauterive FR (2008) A comparison of total laparoscopic hysterectomy to robotically assisted hysterectomy: surgical outcomes in a community practice. J Minim Invasive Gynecol 15:286–291. https://doi.org/10.1016/j.jmig.2008.01.008 Seamon LG, Cohn DE, Henretta MS et al (2009) Minimally invasive comprehensive surgical staging for endometrial cancer: robotics or laparoscopy? Gynecol Oncol. 113:36–41. https://doi.org/10.1016/j.ygyno.2008.12.005 Arms RG, Sun CC, Burzawa JK et al (2015) Improvement in quality of life after robotic surgery results in patient satisfaction. Gynecol Oncol 138:727–730. https://doi.org/10.1016/j.ygyno.2015.07.013 Tables Table 1. Patient characteristics and surgical approach Before propensity score matching After propensity score matching X system (n = 95) Xi system (n = 77) p-value X system (n = 73) Xi system (n = 73) p-value Sdiff Age (years) 54.5 (± 13.3) 52.4 (± 12.4) 0.417 52.7 (± 12.7) 53.1 (±12.3) 0.559 0.035 BMI (kg/m 2 ) 24.3 (± 5.4) 25.0 (± 7.3) 0.838 24.1 (± 5.1) 24.3 (± 6.4) 0.597 0.021 Nulliparity 23 (24.2%) 22 (28.6%) 0.601 18 (24.7%) 19 (26.0%) 1.000 0.031 Previous abdominal surgery 37 (38.9%) 36 (46.8%) 0.353 31 (42.5%) 33 (45.2%) 0.868 0.055 Benign tumor 50 (52.6%) 43 (55.8%) 0.759 41 (56.2%) 40 (54.8%) 1.000 0.028 RATLH 67 (70.5%) 54 (70.1%) 1.000 50 (68.5%) 51 (69.9%) 1.000 0.030 RAmRH 28 (29.5%) 23 (29.9%) - 23 (31.5%) 22 (30.1%) - - Lymphadenectomy 24 (25.3%) 19 (24.7%) 1.000 20 (27.4%) 18 (24.7) 0.851 0.062 Abbreviations Sdiff: Standardized difference, RATLH: Robot assisted total hysterectomy, RAmRH: Robot assisted modified radical hysterectomy, BMI: body mass index Data are presented as means (±standard deviation) or as n (%). Table 2. Surgical results of all patients X system (n = 73) Xi system (n = 73) p-value Operative time (min) 147.2 (±43.0) 162.3 (±53.0) 0.129 Pre-console time (min) 19.7 (±7.0) 20.0 (±7.2) 0.712 Console time (min) 111.9 (±40.3) 126.6 (±46.3) 0.074 Post-console time (min) 15.6 (±9.3) 15.4 (±10.1) 0.687 Blood loss (mL) 40.2 (±79.6) 46.8 (±77.6) 0.359 Length of hospital stay (day) 4.7 (±1.0) 6.3 (±10.1) 0.113 Complications 7 (9.6%) 7 (9.6%) 1.000 Uterine weight (g) 181.5 (±146.9) 168.7 (±120.2) 0.704 Uterine removal via the vagina 71 (97.3%) 69 (95.9%) 0.681 Data are presented as means (±standard deviation) or as n (%). Table 3. Surgical results of patients who underwent RATLH without lymphadenectomy X system (n = 50) Xi system (n = 48) p-value Operative time (min) 126.6 (±29.5) 138.2 (±38.5) 0.201 Pre-console time (min) 20.2 (±7.5) 19.3 (±4.4) 0.901 Console time (min) 92.9 (±27.0) 105.5 (±34.7) 0.089 Post-console time (min) 13.4 (±6.1) 13.5 (±5.6) 0.780 Blood loss (mL) 36.4 (±71.7) 42.9 (±74.9) 0.341 Length of hospital stay (days) 4.3 (±0.647) 6.7 (±12.4) 0.089 Complications 5 (10.0%) 3 (6.3%) 0.715 Uterine weight 171.8 (±114.3) 181.7 (±133.4) 0.926 Uterine removal via the vagina 50 (100%) 45 (93.8%) 0.114 RATLH: Robot assisted total laparoscopic hysterectomy Data are presented as means (±Standard Deviation) or as n (%). Additional Declarations No competing interests reported. Supplementary Files Supplementaryfile.docx Supplementary information Supplementary Table 1. Surgical results of patients who underwent RATLH without lymphadenectomy (BMI >30 kg/m 2 only) Supplementary Table 2. Surgical results of patients who underwent RATLH without lymphadenectomy (uterine >300 g only) Cite Share Download PDF Status: Published Journal Publication published 30 Jun, 2024 Read the published version in Asian Journal of Endoscopic Surgery → Version 1 posted You are reading this latest preprint version Research Square lets you share your work early, gain feedback from the community, and start making changes to your manuscript prior to peer review in a journal. As a division of Research Square Company, we’re committed to making research communication faster, fairer, and more useful. We do this by developing innovative software and high quality services for the global research community. Our growing team is made up of researchers and industry professionals working together to solve the most critical problems facing scientific publishing. Also discoverable on Platform About Our Team In Review Editorial Policies Advisory Board Help Center Resources Author Services Accessibility API Access RSS feed Manage Cookie Preferences © Research Square 2026 | ISSN 2693-5015 (online) Privacy Policy Terms of Service Do Not Sell My Personal Information {"props":{"pageProps":{"initialData":{"identity":"rs-4152339","acceptedTermsAndConditions":true,"allowDirectSubmit":true,"archivedVersions":[],"articleType":"Research Article","associatedPublications":[],"authors":[{"id":284783687,"identity":"6ac8bc68-5f8f-491b-b1d3-6a5fe16a3454","order_by":0,"name":"Hiroki Nagata","email":"","orcid":"","institution":"Tottori University School of Medicine","correspondingAuthor":false,"prefix":"","firstName":"Hiroki","middleName":"","lastName":"Nagata","suffix":""},{"id":284783688,"identity":"90756787-1e7f-43f3-935f-5134c6388d72","order_by":1,"name":"Hiroaki Komatsu","email":"data:image/png;base64,iVBORw0KGgoAAAANSUhEUgAAAZAAAAAyAQMAAABI0h/eAAAABlBMVEX///8AAABVwtN+AAAACXBIWXMAAA7EAAAOxAGVKw4bAAAA80lEQVRIie3PPQrCMBiA4ZSAiw2uKQXPUCcVj+Lk5JS9g0qmOqi7gz9XUAJxTQm0i8VVcPEACoJLwQ62FcWlBjfBvMOXDN9DCAA63Q+GnxcnG6abDgipmogX2WbE+IYgL5sKYg1HneslkaAOyp3jedFvV4YpiV1eSGwzYtj3JGhSxGpzHpKpNKgx3h4KSRWTFfapBI5A3EY8IDQl0PA+EhaLJCebG5oFZKkiNiYci9LjFYhoj6xUxBpHvBF5XdORiFmzQJB1SvxPf8HhhO3dpFV1wsn6cuoNyGIn/WPsFpNnJoD5KfMplPtvDb5Z1ul0uj/pDhqxXngOJW+UAAAAAElFTkSuQmCC","orcid":"","institution":"Tottori University School of Medicine","correspondingAuthor":true,"prefix":"","firstName":"Hiroaki","middleName":"","lastName":"Komatsu","suffix":""},{"id":284783689,"identity":"bf548e23-78e4-46be-9846-29a649d52e3a","order_by":2,"name":"Koji Yamamoto","email":"","orcid":"","institution":"Tottori University School of Medicine","correspondingAuthor":false,"prefix":"","firstName":"Koji","middleName":"","lastName":"Yamamoto","suffix":""},{"id":284783690,"identity":"325beae8-83b4-4c63-a064-634ee37813e5","order_by":3,"name":"Masayo Okawa","email":"","orcid":"","institution":"Tottori University School of Medicine","correspondingAuthor":false,"prefix":"","firstName":"Masayo","middleName":"","lastName":"Okawa","suffix":""},{"id":284783691,"identity":"e31b5a59-167b-4dc8-8c35-bec86bf679c4","order_by":4,"name":"Kohei Hikino","email":"","orcid":"","institution":"Tottori University School of Medicine","correspondingAuthor":false,"prefix":"","firstName":"Kohei","middleName":"","lastName":"Hikino","suffix":""},{"id":284783692,"identity":"745aa00c-d45a-4da8-9ef5-2fa2c5a61f91","order_by":5,"name":"Yuki Iida","email":"","orcid":"","institution":"Tottori University School of Medicine","correspondingAuthor":false,"prefix":"","firstName":"Yuki","middleName":"","lastName":"Iida","suffix":""},{"id":284783693,"identity":"c28f53ec-10be-4281-be7f-b846ad1e847a","order_by":6,"name":"Ikumi Wada","email":"","orcid":"","institution":"Tottori University School of Medicine","correspondingAuthor":false,"prefix":"","firstName":"Ikumi","middleName":"","lastName":"Wada","suffix":""},{"id":284783694,"identity":"c9461e88-ff31-4e2c-9652-9a5d855f2c9a","order_by":7,"name":"AI Ikebuchi","email":"","orcid":"","institution":"Tottori University School of Medicine","correspondingAuthor":false,"prefix":"","firstName":"AI","middleName":"","lastName":"Ikebuchi","suffix":""},{"id":284783695,"identity":"6a73af36-5821-48ba-bf32-a09639855ebe","order_by":8,"name":"Mayumi Sawada","email":"","orcid":"","institution":"Tottori University School of Medicine","correspondingAuthor":false,"prefix":"","firstName":"Mayumi","middleName":"","lastName":"Sawada","suffix":""},{"id":284783696,"identity":"ef2aade2-1bd5-4781-a8e0-08d9791b3195","order_by":9,"name":"Yukihiro Azuma","email":"","orcid":"","institution":"Tottori University School of Medicine","correspondingAuthor":false,"prefix":"","firstName":"Yukihiro","middleName":"","lastName":"Azuma","suffix":""},{"id":284783697,"identity":"b7c26cb0-580c-4586-a829-32e827d395d5","order_by":10,"name":"Shinya Sato","email":"","orcid":"","institution":"Tottori University School of Medicine","correspondingAuthor":false,"prefix":"","firstName":"Shinya","middleName":"","lastName":"Sato","suffix":""},{"id":284783698,"identity":"31466305-965b-46bf-a943-f5c757fe1987","order_by":11,"name":"Tasuku Harada","email":"","orcid":"","institution":"Tottori University School of Medicine","correspondingAuthor":false,"prefix":"","firstName":"Tasuku","middleName":"","lastName":"Harada","suffix":""},{"id":284783699,"identity":"c34d280a-aa75-4ce4-bb5a-b84e77f98964","order_by":12,"name":"Fuminori Taniguchi","email":"","orcid":"","institution":"Tottori University School of Medicine","correspondingAuthor":false,"prefix":"","firstName":"Fuminori","middleName":"","lastName":"Taniguchi","suffix":""}],"badges":[],"createdAt":"2024-03-23 01:29:20","currentVersionCode":1,"declarations":"","doi":"10.21203/rs.3.rs-4152339/v1","doiUrl":"https://doi.org/10.21203/rs.3.rs-4152339/v1","draftVersion":[],"editorialEvents":[{"content":"https://doi.org/10.1111/ases.13358","type":"published","date":"2024-07-01T00:31:35+00:00"}],"editorialNote":"","failedWorkflow":false,"files":[{"id":53751048,"identity":"a938d7d6-0673-48cc-9c80-b03ab05136c6","added_by":"auto","created_at":"2024-03-29 18:43:04","extension":"png","order_by":1,"title":"Figure 1","display":"","copyAsset":false,"role":"figure","size":92492,"visible":true,"origin":"","legend":"\u003cp\u003ePort site placement\u003c/p\u003e","description":"","filename":"1.png","url":"https://assets-eu.researchsquare.com/files/rs-4152339/v1/62b363d018c3d15af771ea52.png"},{"id":53752455,"identity":"ac906ad9-b904-4787-aa13-bcaf91ddb2d8","added_by":"auto","created_at":"2024-03-29 18:51:04","extension":"png","order_by":2,"title":"Figure 2","display":"","copyAsset":false,"role":"figure","size":1343057,"visible":true,"origin":"","legend":"\u003cp\u003eArm preparation for X\u003c/p\u003e\n\u003cp\u003eThe surgeons adjusted the arms manually before docking. Left: before adjustment; Right: after adjustment.\u003c/p\u003e","description":"","filename":"2.png","url":"https://assets-eu.researchsquare.com/files/rs-4152339/v1/4f7161c525b86fbe0112437e.png"},{"id":60035943,"identity":"c754e552-7f4f-4fe2-ad92-a4f93d9f0dd0","added_by":"auto","created_at":"2024-07-11 00:31:40","extension":"pdf","order_by":0,"title":"","display":"","copyAsset":false,"role":"manuscript-pdf","size":2014910,"visible":true,"origin":"","legend":"","description":"","filename":"manuscript.pdf","url":"https://assets-eu.researchsquare.com/files/rs-4152339/v1/3c3e86e9-975b-4730-9dbb-9679bf928a3f.pdf"},{"id":53751049,"identity":"105f25c0-f1f2-4eab-a752-aaac575fb74a","added_by":"auto","created_at":"2024-03-29 18:43:04","extension":"docx","order_by":1,"title":"","display":"","copyAsset":false,"role":"supplement","size":25151,"visible":true,"origin":"","legend":"\u003cp\u003eSupplementary information\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eSupplementary Table 1. \u003c/strong\u003eSurgical results of patients who underwent RATLH without lymphadenectomy (BMI \u0026gt;30 kg/m\u003csup\u003e2\u003c/sup\u003e only)\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eSupplementary Table 2. \u003c/strong\u003eSurgical results of patients who underwent RATLH without lymphadenectomy (uterine \u0026gt;300 g only)\u003c/p\u003e","description":"","filename":"Supplementaryfile.docx","url":"https://assets-eu.researchsquare.com/files/rs-4152339/v1/2a2728c1fa7c778874564d89.docx"}],"financialInterests":"No competing interests reported.","formattedTitle":"Comparison of Surgical Outcomes of da Vinci Surgical Systems X and Xi: A Single-center Study","fulltext":[{"header":"Introduction","content":"\u003cp\u003eRobot-assisted gynecological surgery was approved by the U.S. Food and Drug Administration in 2005 [1]. Robot-assisted hysterectomy is associated with reduced hospital stay, fewer\u0026nbsp;complication\u0026nbsp;and fewer blood transfusions than open surgery [2]. Furthermore, robot-assisted hysterectomy has an early learning curve [3]. Since its approval, various improvements have been made to the robots and new models have been released. The da Vinci Xi (Xi) is a fourth-generation surgical system that includes a greater endoscope, thinner arms, and an automated patient-side cart [4]. For radical prostatectomy, the docking and operation times of the Xi system are shorter than those of the da Vinci Si system [5].\u003c/p\u003e\n\u003cp\u003eDa Vinci X (X) is a fourth-generation system that was released 3 years after the Xi system and is more affordable [6]. The robotic arms of the X system are fixed to the patient-side cart. Therefore, access to target organs is sometimes impaired. However, the X and Xi systems use the same vision cart\u0026nbsp;and surgeon console, and the instruments are interchangeable.\u003c/p\u003e\n\u003cp\u003eNo previous studies have compared the Xi and X systems for hysterectomy. Robot-assisted hysterectomy using the Xi and X systems was introduced at our institution in 2018. This study compared the perioperative outcomes of patients who underwent robot-assisted hysterectomy with the da Vinci Xi and X systems.\u003c/p\u003e"},{"header":"Methods","content":"\u003cp\u003eThe clinical records of 172 patients who underwent robot-assisted total hysterectomies by four surgeons at Tottori University Hospital between April 2019 and July 2023 were retrospectively reviewed. The patients who underwent sacrocolpopexy were excluded. The patients were divided into two groups based on the robotic system used for the surgery. The choice of the surgical system (X or Xi) was determined by the surgical department rather than the operating surgeon. Patient data, including age, body mass index (BMI), history of abdominal or pelvic surgery, parity, operative time, blood loss, uterine weight, frequency of perioperative adverse events (included Clavien-Dindo class II or higher), length of hospital stay, surgical approach (robot-assisted total laparoscopic hysterectomy [RATLH] or robot-assisted modified radical hysterectomy [RAmRH] and pelvic lymphadenectomy or not), and success rate of vaginal tissue removal were collected. The operative time was divided into pre-console time (defined as the time from the skin incision to the start of the console), console time, and post-console time (defined as the time from the end of the console to the end of the operation).\u003c/p\u003e\n\u003cp\u003eRATLH and RAmRH were conducted with the patient in an 18\u0026ndash;20\u0026deg; head-down position. A closed or opened first-puncture approach was used, and the pneumoperitoneum pressure was set at 8\u0026ndash;12 mmHg CO\u003csub\u003e2\u003c/sub\u003e. Five port sites were used (\u003cstrong\u003eFig. 1\u003c/strong\u003e). An automated setup function directed towards the pelvic floor was used when the Xi system was used. As the X system does not include a positioning function, the surgeons manually and subjectively adjusted the arms prior to docking (\u003cstrong\u003eFig. 2\u003c/strong\u003e). During the operation, Maryland bipolar forceps, monopolar curved scissors, and a large needle driver were used. Furthermore, Cadiere forceps were used with the X system and Synchro Seal was used with Xi system. The second assistant used a Vagi pipe (Hakko Medical, Chikuma, Japan). The primary surgeons were certified by the Japan Society of Gynecologic and Obstetric Endoscopy and Minimally Invasive Therapy [7].\u003c/p\u003e\n\u003cp\u003ePropensity scores were used to control for potential covariate imbalances and create maximally non-biased groups. Propensity score matching involved the use of a logistic regression model based on six covariates: age, BMI, nulliparity, history of abdominal or pelvic surgery, pre-operative diagnosis, and surgical approach. The success of the matching was assessed for each variable using a standardized difference. A successful balance was inferred if the residual imbalance for all confounders was \u0026le;10%.\u003c/p\u003e\n\u003cp\u003ePearson\u0026apos;s chi-square test and the Mann\u0026ndash;Whitney U test were used to compare the categorical and continuous variables, respectively. Statistical significance was set at P \u0026lt; 0.05. All statistical analyses were conducted using SPSS Statistics for Windows (version 28, IBM Corp., Armonk, NY, USA). This study was performed in line with the principles of the Declaration of Helsinki. Approval was granted by the Institutional Review Board of the Tottori University Hospital (22A134). All patients provided opt-out consent in accordance with institutional guidelines.\u003c/p\u003e"},{"header":"Results","content":"\u003cp\u003eA total of 172 patients underwent robot-assisted hysterectomy, including 95 (55.2%) and 77 (44.2%) for whom the X and Xi system was used, respectively (Table 1). After propensity score matching, 73 patients were included in each group. The demographic data and surgical approach used were not significantly different between the groups. RATLH was performed in approximately 70% of the patients in both groups. The mean number of harvested lymph nodes was 25.6 (\u0026plusmn; 9.9) with X and 28.9 (\u0026plusmn;\u0026nbsp;11.3) with Xi.\u0026nbsp;The uterine weight and success rate of vaginal removal did not differ between the groups. No emergency conversion to open surgery was reported in either group.\u003c/p\u003e\n\u003cp\u003eThe operative and console times were insignificantly shorter in group X than in group Xi (Table 2). There were no differences between the groups when the data of patients who underwent RATLH without lymphadenectomy were compared (Table 3). Despite the small sample size, no inferior aspects were identified in group X over group Xi in patients with BMI \u0026gt; 30 or uterine weight \u0026gt; 300 g (Online Resource 1 and 2).\u003c/p\u003e"},{"header":"Discussion","content":"\u003cp\u003eTo the best of our knowledge, this is the first study comparing the perioperative data of the X and Xi surgical systems for hysterectomy. Interestingly, the X system was not inferior to the Xi system and both systems were successfully used to perform hysterectomies. The operative and console times were shorter in group X than in group Xi, although the differences were insignificant. The surgeons reported similar frequencies of arm collisions in both groups.\u003c/p\u003e \u003cp\u003eA previous study reported that the pre-console time was significantly shorter, and the operative time tended to be shorter during total hysterectomy when the Xi system was used than with the Si system [\u003cspan citationid=\"CR8\" class=\"CitationRef\"\u003e8\u003c/span\u003e]. The X and Xi systems have been compared for other types of surgery. During robotic thyroidectomy surgery, the Xi system required a shorter operative time than the X system [\u003cspan citationid=\"CR9\" class=\"CitationRef\"\u003e9\u003c/span\u003e]. As the robotic arms of the X system are fixed to the patient-side cart, access to the patient\u0026rsquo;s head is impaired. However, Bergmann et al. [\u003cspan citationid=\"CR10\" class=\"CitationRef\"\u003e10\u003c/span\u003e] reported no serious adverse events associated with either system during rectal surgery. Therefore, the use of the two systems is expected to result in comparable outcomes since hysterectomy is a pelvic surgery. Advanced equipment, such as Synchro Seal, and the automated setup function of the Xi system may have accounted for the longer times in group X in this study.\u003c/p\u003e \u003cp\u003eLike the da Vinci Si system, the X system does not include an automated setup function. Furthermore, improvements to the operation fluency of the Xi system have resulted in a shorter operation time than that of the Si system [\u003cspan citationid=\"CR5\" class=\"CitationRef\"\u003e5\u003c/span\u003e]. Although a longer pre-operative time was expected in group X, there was no significant difference between the two groups in this study. Arm adjustments by the surgeons may have contributed to similar results between the two groups. Rama et al. [\u003cspan citationid=\"CR11\" class=\"CitationRef\"\u003e11\u003c/span\u003e] previously reported comparable docking times for the Si and Xi systems, suggesting the impact of the targeting process in the Xi system. Although the number of arm collisions was not reported in the current study, the surgeons did not report a difference in the frequency of collisions.\u003c/p\u003e \u003cp\u003eThe intraoperative blood loss for robot-assisted hysterectomy has been reported as 77\u0026ndash;119 mL and the adverse event rate as 2\u0026ndash;13% [\u003cspan citationid=\"CR2\" class=\"CitationRef\"\u003e2\u003c/span\u003e, \u003cspan citationid=\"CR12\" class=\"CitationRef\"\u003e12\u003c/span\u003e, \u003cspan citationid=\"CR13\" class=\"CitationRef\"\u003e13\u003c/span\u003e], which are comparable to the results of the current study. The similar outcomes between both groups in this study may be attributed to the use of the same surgeon console and instruments.\u003c/p\u003e \u003cp\u003eThis study has some limitations. First, the retrospective and single institution design have inherent limitations. Second, the long-term outcomes were not investigated. Although a detailed assessment was not performed, no notable adverse events were reported during the outpatient follow-up for 2 months in that study. Arms et al. [\u003cspan citationid=\"CR14\" class=\"CitationRef\"\u003e14\u003c/span\u003e] compared the long-term (4-month) satisfaction of women who underwent robot-assisted total hysterectomy. In addition, different surgeons may use different surgical techniques that may affect the study results.\u003c/p\u003e \u003cp\u003eTo summarize, the perioperative outcomes of hysterectomy did not differ when the da Vinci X and Xi systems were used. Therefore, the less expensive X system resulted in adequate outcomes. These results may contribute to the widespread use of robotic surgery.\u003c/p\u003e"},{"header":"Declarations","content":"\u003cp\u003eFunding\u0026nbsp;\u003c/p\u003e\n\u003cp\u003eNo funds, grants, or other support was received.\u0026nbsp;\u003c/p\u003e\n\u003cp\u003eCompeting interest\u003c/p\u003e\n\u003cp\u003eThe authors have no relevant financial or non-financial interests to disclose.\u0026nbsp;\u003c/p\u003e\n\u003cp\u003eEthics approval\u003c/p\u003e\n\u003cp\u003eThis study was performed in line with the principles of the Declaration of Helsinki. Approval was granted by the Institutional Review Board of the Tottori University Hospital (22A134). All patients provided opt-out consent in accordance with institutional guidelines.\u0026nbsp;\u003c/p\u003e\n\u003cp\u003eData availability\u003c/p\u003e\n\u003cp\u003eThe data that support the findings of this study are available on request from the corresponding author. The data are not publicly available as they could compromise the privacy of research participants.\u0026nbsp;\u003c/p\u003e\n\u003cp\u003eAuthors\u0026rsquo; contributions\u003c/p\u003e\n\u003cp\u003eAll authors contributed to the study conception and design. Material preparation, data collection and analysis were performed by [Hiroaki Komatsu and Hiroki Nagata]. The first draft of the manuscript was written by [Hiroki Nagata] and all authors commented on previous versions of the manuscript. All authors read and approved the final manuscript.\u003c/p\u003e"},{"header":"References","content":"\u003col\u003e\u003cli\u003e\u003cspan\u003eSinha R, Sanjay M, Rupa B, Kumari S (2015) Robotic surgery in gynecology. J Minim Access Surg 11:50\u0026ndash;59. \u003cspan class=\"ExternalRef\"\u003e\u003cspan class=\"RefSource\"\u003ehttps://doi.org/10.4103/0972-9941.147690\u003c/span\u003e\u003cspan address=\"10.4103/0972-9941.147690\" targettype=\"DOI\" class=\"RefTarget\"\u003e\u003c/span\u003e\u003c/span\u003e\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003eO\u0026rsquo;Neill M, Moran PS, Teljeur C et al (2013) Robot-assisted hysterectomy compared to open and laparoscopic approaches: systematic review and meta-analysis. Arch Gynecol Obstet 287:907\u0026ndash;918. \u003cspan class=\"ExternalRef\"\u003e\u003cspan class=\"RefSource\"\u003ehttps://doi.org/10.1007/s00404-012-2681-z\u003c/span\u003e\u003cspan address=\"10.1007/s00404-012-2681-z\" targettype=\"DOI\" class=\"RefTarget\"\u003e\u003c/span\u003e\u003c/span\u003e\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003eIida Y, Komatsu H, Kudoh A et al (2023) The learning curve of introduced robotic-assisted hysterectomy versus skilled laparoscopic hysterectomy for benign gynecologic diseases. J Obstet Gynaecol Res 49:2494\u0026ndash;2500. \u003cspan class=\"ExternalRef\"\u003e\u003cspan class=\"RefSource\"\u003ehttps://doi.org/10.1111/jog.15741\u003c/span\u003e\u003cspan address=\"10.1111/jog.15741\" targettype=\"DOI\" class=\"RefTarget\"\u003e\u003c/span\u003e\u003c/span\u003e\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003eDa Vinci Xi robotic surgical system. Intuitive. \u003cspan class=\"ExternalRef\"\u003e\u003cspan class=\"RefSource\"\u003ehttps://www.intuitive.com/en-us/products-and-services/da-vinci/xi\u003c/span\u003e\u003cspan address=\"https://www.intuitive.com/en-us/products-and-services/da-vinci/xi\" targettype=\"URL\" class=\"RefTarget\"\u003e\u003c/span\u003e\u003c/span\u003e. Accessed 22 October 2023\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003eLei KY, Xie WJ, Fu SQ, Ma M, Sun T (2021) A comparison of the da VINCI Xi vs. da Vinci Si surgical systems for radical prostatectomy. BMC Surg 21:409. \u003cspan class=\"ExternalRef\"\u003e\u003cspan class=\"RefSource\"\u003ehttps://doi.org/10.1186/s12893-021-01406-w\u003c/span\u003e\u003cspan address=\"10.1186/s12893-021-01406-w\" targettype=\"DOI\" class=\"RefTarget\"\u003e\u003c/span\u003e\u003c/span\u003e\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003eDa Vinci X. Robotic surgical system. Intuitive. \u003cspan class=\"ExternalRef\"\u003e\u003cspan class=\"RefSource\"\u003ehttps://www.intuitive.com/en-us/products-and-services/da-vinci/x\u003c/span\u003e\u003cspan address=\"https://www.intuitive.com/en-us/products-and-services/da-vinci/x\" targettype=\"URL\" class=\"RefTarget\"\u003e\u003c/span\u003e\u003c/span\u003e. Accessed 22 October 2023\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003eKomatsu H, Hiraike O, Fukuhara R et al (2023) Is there a need for a technical certification system for gynecological robotic surgery? Questionnaire survey of members of the Japan Society of Gynecologic and Obstetric Endoscopy and Minimally Invasive Therapy. J Robot Surg 17:1125\u0026ndash;1131. \u003cspan class=\"ExternalRef\"\u003e\u003cspan class=\"RefSource\"\u003ehttps://doi.org/10.1007/s11701-022-01520-8\u003c/span\u003e\u003cspan address=\"10.1007/s11701-022-01520-8\" targettype=\"DOI\" class=\"RefTarget\"\u003e\u003c/span\u003e\u003c/span\u003e\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003eGiannini A, Malacarne E, Sergiampietri C et al (2021) Comparison of perioperative outcomes and technical features using da VINCI Si and Xi robotic platforms for early stages of endometrial cancer. J Robot Surg 15:195\u0026ndash;201. \u003cspan class=\"ExternalRef\"\u003e\u003cspan class=\"RefSource\"\u003ehttps://doi.org/10.1007/s11701-020-01091-6\u003c/span\u003e\u003cspan address=\"10.1007/s11701-020-01091-6\" targettype=\"DOI\" class=\"RefTarget\"\u003e\u003c/span\u003e\u003c/span\u003e\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003eShin HR, Lee K, Yu HW et al (2021) Comparison of perioperative outcomes using the da Vinci S, Si, X, and Xi robotic platforms for BABA robotic thyroidectomy. Medicina (Kaunas) 57:1130. \u003cspan class=\"ExternalRef\"\u003e\u003cspan class=\"RefSource\"\u003ehttps://doi.org/10.3390/medicina57101130\u003c/span\u003e\u003cspan address=\"10.3390/medicina57101130\" targettype=\"DOI\" class=\"RefTarget\"\u003e\u003c/span\u003e\u003c/span\u003e\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003eBergmann J, Lehmann-Dorl B, Witt L, Aselmann H (2022) Using the da VINCI X\u0026reg; - system for esophageal surgery. JSLS 26:e2022. \u003cspan class=\"ExternalRef\"\u003e\u003cspan class=\"RefSource\"\u003ehttps://doi.org/10.4293/JSLS.2022.00018\u003c/span\u003e\u003cspan address=\"10.4293/JSLS.2022.00018\" targettype=\"DOI\" class=\"RefTarget\"\u003e\u003c/span\u003e\u003c/span\u003e\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003eAlhossaini RM, Altamran AA, Choi S et al (2019) Similar operative outcomes between the da VINCI Xi\u0026reg; and da VINCI Si\u0026reg; systems in robotic gastrectomy for gastric cancer. J Gastric Cancer 19:165\u0026ndash;172. \u003cspan class=\"ExternalRef\"\u003e\u003cspan class=\"RefSource\"\u003ehttps://doi.org/10.5230/jgc.2019.19.e13\u003c/span\u003e\u003cspan address=\"10.5230/jgc.2019.19.e13\" targettype=\"DOI\" class=\"RefTarget\"\u003e\u003c/span\u003e\u003c/span\u003e\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003ePayne TN, Dauterive FR (2008) A comparison of total laparoscopic hysterectomy to robotically assisted hysterectomy: surgical outcomes in a community practice. J Minim Invasive Gynecol 15:286\u0026ndash;291. \u003cspan class=\"ExternalRef\"\u003e\u003cspan class=\"RefSource\"\u003ehttps://doi.org/10.1016/j.jmig.2008.01.008\u003c/span\u003e\u003cspan address=\"10.1016/j.jmig.2008.01.008\" targettype=\"DOI\" class=\"RefTarget\"\u003e\u003c/span\u003e\u003c/span\u003e\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003eSeamon LG, Cohn DE, Henretta MS et al (2009) Minimally invasive comprehensive surgical staging for endometrial cancer: robotics or laparoscopy? Gynecol Oncol. 113:36\u0026ndash;41. \u003cspan class=\"ExternalRef\"\u003e\u003cspan class=\"RefSource\"\u003ehttps://doi.org/10.1016/j.ygyno.2008.12.005\u003c/span\u003e\u003cspan address=\"10.1016/j.ygyno.2008.12.005\" targettype=\"DOI\" class=\"RefTarget\"\u003e\u003c/span\u003e\u003c/span\u003e\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003eArms RG, Sun CC, Burzawa JK et al (2015) Improvement in quality of life after robotic surgery results in patient satisfaction. Gynecol Oncol 138:727\u0026ndash;730. \u003cspan class=\"ExternalRef\"\u003e\u003cspan class=\"RefSource\"\u003ehttps://doi.org/10.1016/j.ygyno.2015.07.013\u003c/span\u003e\u003cspan address=\"10.1016/j.ygyno.2015.07.013\" targettype=\"DOI\" class=\"RefTarget\"\u003e\u003c/span\u003e\u003c/span\u003e\u003c/span\u003e\u003c/li\u003e\u003c/ol\u003e"},{"header":"Tables","content":"\u003cp\u003e\u003cstrong\u003eTable 1.\u0026nbsp;\u003c/strong\u003ePatient characteristics and surgical approach\u003c/p\u003e\n\u003ctable border=\"0\" cellspacing=\"0\" cellpadding=\"0\" width=\"683\"\u003e\n \u003ctbody\u003e\n \u003ctr\u003e\n \u003ctd width=\"18.887262079062957%\" valign=\"top\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"36.16398243045388%\" colspan=\"3\"\u003e\n \u003cp\u003eBefore propensity score matching\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"44.948755490483165%\" colspan=\"4\"\u003e\n \u003cp\u003eAfter propensity score matching\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd width=\"18.887262079062957%\" valign=\"top\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"14.494875549048317%\"\u003e\n \u003cp\u003eX system\u003c/p\u003e\n \u003cp\u003e(n = 95)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"14.494875549048317%\"\u003e\n \u003cp\u003eXi system\u003cbr\u003e\u0026nbsp;(n = 77)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"7.174231332357247%\"\u003e\n \u003cp\u003ep-value\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"14.494875549048317%\"\u003e\n \u003cp\u003eX system\u003c/p\u003e\n \u003cp\u003e(n = 73)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"14.494875549048317%\"\u003e\n \u003cp\u003eXi system\u003cbr\u003e\u0026nbsp;(n = 73)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"7.174231332357247%\"\u003e\n \u003cp\u003ep-value\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"8.784773060029282%\"\u003e\n \u003cp\u003eSdiff\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd width=\"18.887262079062957%\"\u003e\n \u003cp\u003eAge (years)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"14.494875549048317%\"\u003e\n \u003cp\u003e54.5\u0026nbsp;\u003c/p\u003e\n \u003cp\u003e(\u0026plusmn; 13.3)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"14.494875549048317%\"\u003e\n \u003cp\u003e52.4\u0026nbsp;\u003c/p\u003e\n \u003cp\u003e(\u0026plusmn; 12.4)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"7.174231332357247%\"\u003e\n \u003cp\u003e0.417\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"14.494875549048317%\"\u003e\n \u003cp\u003e52.7\u0026nbsp;\u003c/p\u003e\n \u003cp\u003e(\u0026plusmn; 12.7)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"14.494875549048317%\"\u003e\n \u003cp\u003e53.1\u0026nbsp;\u003c/p\u003e\n \u003cp\u003e(\u0026plusmn;12.3)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"7.174231332357247%\"\u003e\n \u003cp\u003e0.559\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"8.784773060029282%\"\u003e\n \u003cp\u003e0.035\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd width=\"18.887262079062957%\"\u003e\n \u003cp\u003eBMI (kg/m\u003csup\u003e2\u003c/sup\u003e)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"14.494875549048317%\"\u003e\n \u003cp\u003e24.3\u0026nbsp;\u003c/p\u003e\n \u003cp\u003e(\u0026plusmn; 5.4)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"14.494875549048317%\"\u003e\n \u003cp\u003e25.0\u0026nbsp;\u003c/p\u003e\n \u003cp\u003e(\u0026plusmn; 7.3)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"7.174231332357247%\"\u003e\n \u003cp\u003e0.838\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"14.494875549048317%\"\u003e\n \u003cp\u003e24.1\u0026nbsp;\u003c/p\u003e\n \u003cp\u003e(\u0026plusmn; 5.1)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"14.494875549048317%\"\u003e\n \u003cp\u003e24.3\u0026nbsp;\u003c/p\u003e\n \u003cp\u003e(\u0026plusmn; 6.4)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"7.174231332357247%\"\u003e\n \u003cp\u003e0.597\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"8.784773060029282%\"\u003e\n \u003cp\u003e0.021\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd width=\"18.887262079062957%\"\u003e\n \u003cp\u003eNulliparity\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"14.494875549048317%\"\u003e\n \u003cp\u003e23\u0026nbsp;\u003c/p\u003e\n \u003cp\u003e(24.2%)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"14.494875549048317%\"\u003e\n \u003cp\u003e22\u0026nbsp;\u003c/p\u003e\n \u003cp\u003e(28.6%)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"7.174231332357247%\"\u003e\n \u003cp\u003e0.601\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"14.494875549048317%\"\u003e\n \u003cp\u003e18\u0026nbsp;\u003c/p\u003e\n \u003cp\u003e(24.7%)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"14.494875549048317%\"\u003e\n \u003cp\u003e19\u0026nbsp;\u003c/p\u003e\n \u003cp\u003e(26.0%)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"7.174231332357247%\"\u003e\n \u003cp\u003e1.000\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"8.784773060029282%\"\u003e\n \u003cp\u003e0.031\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd width=\"18.887262079062957%\"\u003e\n \u003cp\u003ePrevious abdominal surgery\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"14.494875549048317%\"\u003e\n \u003cp\u003e37\u0026nbsp;\u003c/p\u003e\n \u003cp\u003e(38.9%)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"14.494875549048317%\"\u003e\n \u003cp\u003e36\u0026nbsp;\u003c/p\u003e\n \u003cp\u003e(46.8%)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"7.174231332357247%\"\u003e\n \u003cp\u003e0.353\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"14.494875549048317%\"\u003e\n \u003cp\u003e31\u0026nbsp;\u003c/p\u003e\n \u003cp\u003e(42.5%)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"14.494875549048317%\"\u003e\n \u003cp\u003e33\u0026nbsp;\u003c/p\u003e\n \u003cp\u003e(45.2%)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"7.174231332357247%\"\u003e\n \u003cp\u003e0.868\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"8.784773060029282%\"\u003e\n \u003cp\u003e0.055\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd width=\"18.887262079062957%\"\u003e\n \u003cp\u003eBenign tumor\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"14.494875549048317%\"\u003e\n \u003cp\u003e50\u0026nbsp;\u003c/p\u003e\n \u003cp\u003e(52.6%)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"14.494875549048317%\"\u003e\n \u003cp\u003e43\u0026nbsp;\u003c/p\u003e\n \u003cp\u003e(55.8%)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"7.174231332357247%\"\u003e\n \u003cp\u003e0.759\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"14.494875549048317%\"\u003e\n \u003cp\u003e41\u0026nbsp;\u003c/p\u003e\n \u003cp\u003e(56.2%)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"14.494875549048317%\"\u003e\n \u003cp\u003e40\u0026nbsp;\u003c/p\u003e\n \u003cp\u003e(54.8%)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"7.174231332357247%\"\u003e\n \u003cp\u003e1.000\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"8.784773060029282%\"\u003e\n \u003cp\u003e0.028\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd width=\"18.887262079062957%\"\u003e\n \u003cp\u003eRATLH\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"14.494875549048317%\"\u003e\n \u003cp\u003e67\u0026nbsp;\u003c/p\u003e\n \u003cp\u003e(70.5%)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"14.494875549048317%\"\u003e\n \u003cp\u003e54\u0026nbsp;\u003c/p\u003e\n \u003cp\u003e(70.1%)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"7.174231332357247%\"\u003e\n \u003cp\u003e1.000\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"14.494875549048317%\"\u003e\n \u003cp\u003e50\u0026nbsp;\u003c/p\u003e\n \u003cp\u003e(68.5%)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"14.494875549048317%\"\u003e\n \u003cp\u003e51\u0026nbsp;\u003c/p\u003e\n \u003cp\u003e(69.9%)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"7.174231332357247%\"\u003e\n \u003cp\u003e1.000\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"8.784773060029282%\"\u003e\n \u003cp\u003e0.030\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd width=\"18.887262079062957%\"\u003e\n \u003cp\u003eRAmRH\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"14.494875549048317%\"\u003e\n \u003cp\u003e28\u0026nbsp;\u003c/p\u003e\n \u003cp\u003e(29.5%)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"14.494875549048317%\"\u003e\n \u003cp\u003e23\u0026nbsp;\u003c/p\u003e\n \u003cp\u003e(29.9%)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"7.174231332357247%\"\u003e\n \u003cp\u003e-\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"14.494875549048317%\"\u003e\n \u003cp\u003e23\u0026nbsp;\u003c/p\u003e\n \u003cp\u003e(31.5%)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"14.494875549048317%\"\u003e\n \u003cp\u003e22\u0026nbsp;\u003c/p\u003e\n \u003cp\u003e(30.1%)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"7.174231332357247%\"\u003e\n \u003cp\u003e-\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"8.784773060029282%\"\u003e\n \u003cp\u003e-\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd width=\"18.887262079062957%\"\u003e\n \u003cp\u003eLymphadenectomy\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"14.494875549048317%\"\u003e\n \u003cp\u003e24\u0026nbsp;\u003c/p\u003e\n \u003cp\u003e(25.3%)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"14.494875549048317%\"\u003e\n \u003cp\u003e19\u0026nbsp;\u003c/p\u003e\n \u003cp\u003e(24.7%)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"7.174231332357247%\"\u003e\n \u003cp\u003e1.000\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"14.494875549048317%\"\u003e\n \u003cp\u003e20\u0026nbsp;\u003c/p\u003e\n \u003cp\u003e(27.4%)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"14.494875549048317%\"\u003e\n \u003cp\u003e18\u0026nbsp;\u003c/p\u003e\n \u003cp\u003e(24.7)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"7.174231332357247%\"\u003e\n \u003cp\u003e0.851\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"8.784773060029282%\"\u003e\n \u003cp\u003e0.062\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003c/tbody\u003e\n\u003c/table\u003e\n\u003cp\u003eAbbreviations\u003c/p\u003e\n\u003cp\u003eSdiff: Standardized difference, RATLH: Robot assisted total hysterectomy, RAmRH: Robot assisted modified radical hysterectomy, BMI: body mass index\u003c/p\u003e\n\u003cp\u003eData are presented as means (\u0026plusmn;standard deviation) or as n (%).\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eTable 2.\u0026nbsp;\u003c/strong\u003eSurgical results of all patients\u0026nbsp;\u003c/p\u003e\n\u003ctable border=\"0\" cellspacing=\"0\" cellpadding=\"0\" width=\"435\"\u003e\n \u003ctbody\u003e\n \u003ctr\u003e\n \u003ctd width=\"44.23963133640553%\" valign=\"top\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"20.046082949308754%\"\u003e\n \u003cp\u003eX system\u003c/p\u003e\n \u003cp\u003e(n = 73)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"20.046082949308754%\"\u003e\n \u003cp\u003eXi system\u003cbr\u003e\u0026nbsp;(n = 73)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"15.668202764976959%\"\u003e\n \u003cp\u003ep-value\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd width=\"44.23963133640553%\"\u003e\n \u003cp\u003eOperative time (min)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"20.046082949308754%\"\u003e\n \u003cp\u003e147.2\u0026nbsp;\u003c/p\u003e\n \u003cp\u003e(\u0026plusmn;43.0)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"20.046082949308754%\"\u003e\n \u003cp\u003e162.3\u0026nbsp;\u003c/p\u003e\n \u003cp\u003e(\u0026plusmn;53.0)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"15.668202764976959%\"\u003e\n \u003cp\u003e0.129\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd width=\"44.23963133640553%\"\u003e\n \u003cp\u003ePre-console time (min)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"20.046082949308754%\"\u003e\n \u003cp\u003e19.7\u0026nbsp;\u003c/p\u003e\n \u003cp\u003e(\u0026plusmn;7.0)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"20.046082949308754%\"\u003e\n \u003cp\u003e20.0\u0026nbsp;\u003c/p\u003e\n \u003cp\u003e(\u0026plusmn;7.2)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"15.668202764976959%\"\u003e\n \u003cp\u003e0.712\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd width=\"44.23963133640553%\"\u003e\n \u003cp\u003eConsole time (min)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"20.046082949308754%\"\u003e\n \u003cp\u003e111.9\u0026nbsp;\u003c/p\u003e\n \u003cp\u003e(\u0026plusmn;40.3)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"20.046082949308754%\"\u003e\n \u003cp\u003e126.6\u0026nbsp;\u003c/p\u003e\n \u003cp\u003e(\u0026plusmn;46.3)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"15.668202764976959%\"\u003e\n \u003cp\u003e0.074\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd width=\"44.23963133640553%\"\u003e\n \u003cp\u003ePost-console time (min)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"20.046082949308754%\"\u003e\n \u003cp\u003e15.6\u0026nbsp;\u003c/p\u003e\n \u003cp\u003e(\u0026plusmn;9.3)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"20.046082949308754%\"\u003e\n \u003cp\u003e15.4\u0026nbsp;\u003c/p\u003e\n \u003cp\u003e(\u0026plusmn;10.1)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"15.668202764976959%\"\u003e\n \u003cp\u003e0.687\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd width=\"44.23963133640553%\"\u003e\n \u003cp\u003eBlood loss (mL)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"20.046082949308754%\"\u003e\n \u003cp\u003e40.2\u0026nbsp;\u003c/p\u003e\n \u003cp\u003e(\u0026plusmn;79.6)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"20.046082949308754%\"\u003e\n \u003cp\u003e46.8\u0026nbsp;\u003c/p\u003e\n \u003cp\u003e(\u0026plusmn;77.6)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"15.668202764976959%\"\u003e\n \u003cp\u003e0.359\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd width=\"44.23963133640553%\"\u003e\n \u003cp\u003eLength of hospital stay (day)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"20.046082949308754%\"\u003e\n \u003cp\u003e4.7\u0026nbsp;\u003c/p\u003e\n \u003cp\u003e(\u0026plusmn;1.0)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"20.046082949308754%\"\u003e\n \u003cp\u003e6.3\u0026nbsp;\u003c/p\u003e\n \u003cp\u003e(\u0026plusmn;10.1)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"15.668202764976959%\"\u003e\n \u003cp\u003e0.113\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd width=\"44.23963133640553%\"\u003e\n \u003cp\u003eComplications\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"20.046082949308754%\"\u003e\n \u003cp\u003e7\u0026nbsp;\u003c/p\u003e\n \u003cp\u003e(9.6%)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"20.046082949308754%\"\u003e\n \u003cp\u003e7\u0026nbsp;\u003c/p\u003e\n \u003cp\u003e(9.6%)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"15.668202764976959%\"\u003e\n \u003cp\u003e1.000\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd width=\"44.23963133640553%\"\u003e\n \u003cp\u003eUterine weight (g)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"20.046082949308754%\"\u003e\n \u003cp\u003e181.5\u0026nbsp;\u003c/p\u003e\n \u003cp\u003e(\u0026plusmn;146.9)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"20.046082949308754%\"\u003e\n \u003cp\u003e168.7\u0026nbsp;\u003c/p\u003e\n \u003cp\u003e(\u0026plusmn;120.2)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"15.668202764976959%\"\u003e\n \u003cp\u003e0.704\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd width=\"44.23963133640553%\"\u003e\n \u003cp\u003eUterine removal via the vagina\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"20.046082949308754%\"\u003e\n \u003cp\u003e71\u0026nbsp;\u003c/p\u003e\n \u003cp\u003e(97.3%)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"20.046082949308754%\"\u003e\n \u003cp\u003e69\u0026nbsp;\u003c/p\u003e\n \u003cp\u003e(95.9%)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"15.668202764976959%\"\u003e\n \u003cp\u003e0.681\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003c/tbody\u003e\n\u003c/table\u003e\n\u003cp\u003e\u0026nbsp;Data are presented as means (\u0026plusmn;standard deviation) or as n (%).\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eTable 3.\u0026nbsp;\u003c/strong\u003eSurgical results of patients who underwent RATLH without lymphadenectomy\u0026nbsp;\u003c/p\u003e\n\u003ctable border=\"0\" cellspacing=\"0\" cellpadding=\"0\" width=\"435\"\u003e\n \u003ctbody\u003e\n \u003ctr\u003e\n \u003ctd width=\"39.1705069124424%\" valign=\"top\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"21.658986175115206%\"\u003e\n \u003cp\u003eX system\u003c/p\u003e\n \u003cp\u003e(n = 50)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"21.658986175115206%\"\u003e\n \u003cp\u003eXi system\u003cbr\u003e\u0026nbsp;(n = 48)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"17.51152073732719%\"\u003e\n \u003cp\u003ep-value\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd width=\"39.1705069124424%\"\u003e\n \u003cp\u003eOperative time (min)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"21.658986175115206%\"\u003e\n \u003cp\u003e126.6\u0026nbsp;\u003c/p\u003e\n \u003cp\u003e(\u0026plusmn;29.5)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"21.658986175115206%\"\u003e\n \u003cp\u003e138.2\u0026nbsp;\u003c/p\u003e\n \u003cp\u003e(\u0026plusmn;38.5)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"17.51152073732719%\"\u003e\n \u003cp\u003e0.201\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd width=\"39.1705069124424%\"\u003e\n \u003cp\u003ePre-console time (min)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"21.658986175115206%\"\u003e\n \u003cp\u003e20.2\u0026nbsp;\u003c/p\u003e\n \u003cp\u003e(\u0026plusmn;7.5)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"21.658986175115206%\"\u003e\n \u003cp\u003e19.3\u0026nbsp;\u003c/p\u003e\n \u003cp\u003e(\u0026plusmn;4.4)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"17.51152073732719%\"\u003e\n \u003cp\u003e0.901\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd width=\"39.1705069124424%\"\u003e\n \u003cp\u003eConsole time (min)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"21.658986175115206%\"\u003e\n \u003cp\u003e92.9\u0026nbsp;\u003c/p\u003e\n \u003cp\u003e(\u0026plusmn;27.0)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"21.658986175115206%\"\u003e\n \u003cp\u003e105.5\u0026nbsp;\u003c/p\u003e\n \u003cp\u003e(\u0026plusmn;34.7)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"17.51152073732719%\"\u003e\n \u003cp\u003e0.089\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd width=\"39.1705069124424%\"\u003e\n \u003cp\u003ePost-console time (min)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"21.658986175115206%\"\u003e\n \u003cp\u003e13.4\u0026nbsp;\u003c/p\u003e\n \u003cp\u003e(\u0026plusmn;6.1)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"21.658986175115206%\"\u003e\n \u003cp\u003e13.5\u0026nbsp;\u003c/p\u003e\n \u003cp\u003e(\u0026plusmn;5.6)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"17.51152073732719%\"\u003e\n \u003cp\u003e0.780\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd width=\"39.1705069124424%\"\u003e\n \u003cp\u003eBlood loss (mL)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"21.658986175115206%\"\u003e\n \u003cp\u003e36.4\u0026nbsp;\u003c/p\u003e\n \u003cp\u003e(\u0026plusmn;71.7)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"21.658986175115206%\"\u003e\n \u003cp\u003e42.9\u0026nbsp;\u003c/p\u003e\n \u003cp\u003e(\u0026plusmn;74.9)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"17.51152073732719%\"\u003e\n \u003cp\u003e0.341\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd width=\"39.1705069124424%\"\u003e\n \u003cp\u003eLength of hospital stay (days)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"21.658986175115206%\"\u003e\n \u003cp\u003e4.3\u0026nbsp;\u003c/p\u003e\n \u003cp\u003e(\u0026plusmn;0.647)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"21.658986175115206%\"\u003e\n \u003cp\u003e6.7\u0026nbsp;\u003c/p\u003e\n \u003cp\u003e(\u0026plusmn;12.4)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"17.51152073732719%\"\u003e\n \u003cp\u003e0.089\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd width=\"39.1705069124424%\"\u003e\n \u003cp\u003eComplications\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"21.658986175115206%\"\u003e\n \u003cp\u003e5\u0026nbsp;\u003c/p\u003e\n \u003cp\u003e(10.0%)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"21.658986175115206%\"\u003e\n \u003cp\u003e3\u0026nbsp;\u003c/p\u003e\n \u003cp\u003e(6.3%)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"17.51152073732719%\"\u003e\n \u003cp\u003e0.715\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd width=\"39.1705069124424%\"\u003e\n \u003cp\u003eUterine weight\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"21.658986175115206%\"\u003e\n \u003cp\u003e171.8\u0026nbsp;\u003c/p\u003e\n \u003cp\u003e(\u0026plusmn;114.3)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"21.658986175115206%\"\u003e\n \u003cp\u003e181.7\u0026nbsp;\u003c/p\u003e\n \u003cp\u003e(\u0026plusmn;133.4)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"17.51152073732719%\"\u003e\n \u003cp\u003e0.926\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd width=\"39.1705069124424%\"\u003e\n \u003cp\u003eUterine removal via the vagina\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"21.658986175115206%\"\u003e\n \u003cp\u003e50\u0026nbsp;\u003c/p\u003e\n \u003cp\u003e(100%)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"21.658986175115206%\"\u003e\n \u003cp\u003e45\u0026nbsp;\u003c/p\u003e\n \u003cp\u003e(93.8%)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"17.51152073732719%\"\u003e\n \u003cp\u003e0.114\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003c/tbody\u003e\n\u003c/table\u003e\n\u003cp\u003eRATLH: Robot assisted total\u0026nbsp;laparoscopic\u0026nbsp;\u0026nbsp;hysterectomy\u003c/p\u003e\n\u003cp\u003eData are presented as means (\u0026plusmn;Standard Deviation) or as n (%).\u003c/p\u003e"}],"fulltextSource":"","fullText":"","funders":[],"hasAdminPriorityOnWorkflow":false,"hasManuscriptDocX":true,"hasOptedInToPreprint":true,"hasPassedJournalQc":"","hasAnyPriority":false,"hideJournal":false,"highlight":"","institution":"","isAcceptedByJournal":true,"isAuthorSuppliedPdf":false,"isDeskRejected":"","isHiddenFromSearch":false,"isInQc":false,"isInWorkflow":false,"isPdf":false,"isPdfUpToDate":true,"isWithdrawnOrRetracted":false,"journal":{"display":true,"email":"[email protected]","identity":"researchsquare","isNatureJournal":false,"hasQc":true,"allowDirectSubmit":true,"externalIdentity":"","sideBox":"","snPcode":"","submissionUrl":"/submission","title":"Research Square","twitterHandle":"researchsquare","acdcEnabled":true,"dfaEnabled":false,"editorialSystem":"","reportingPortfolio":"","inReviewEnabled":false,"inReviewRevisionsEnabled":true},"keywords":"Hysterectomy, Robotic surgery, Treatment outcome, Cost effectiveness","lastPublishedDoi":"10.21203/rs.3.rs-4152339/v1","lastPublishedDoiUrl":"https://doi.org/10.21203/rs.3.rs-4152339/v1","license":{"name":"CC BY 4.0","url":"https://creativecommons.org/licenses/by/4.0/"},"manuscriptAbstract":"\u003cp\u003e\u003cstrong\u003eBackground: \u003c/strong\u003eThe da Vinci surgical systems (X and Xi) are fourth-generation systems marketed by Intuitive Inc. The X system is less expensive compared with the Xi system. This study compared the surgical outcomes of patients who underwent hysterectomy using the X and Xi systems.\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eMethods: \u003c/strong\u003eData of 172 patients who underwent robot-assisted total hysterectomies by four surgeons between April 2019 and March 2023 were retrospectively analyzed in a single-center study. The patients were divided into two groups based on the system used for the surgery. Approval was granted by the Institutional Review Board of the Tottori University Hospital (22A134). All patients provided opt-out consent in accordance with institutional guidelines.\u003cstrong\u003e\u0026nbsp;\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eResults: \u003c/strong\u003eThe operative and console times in group X were shorter than those in group Xi after propensity score matching for age, body mass index, nulliparity, previous history of abdominal or pelvic surgery, pre-operative diagnosis, and surgical approach. No statistical differences were observed in a subgroup analysis of patients who underwent robot-assisted total laparoscopic hysterectomy without lymphadenectomy.\u0026nbsp;\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eConclusion: \u003c/strong\u003ePerioperative outcomes for the X and Xi da Vinci surgical systems were equivalent. The cost-effective X system may allow the widespread use of robotic surgeries.\u003c/p\u003e","manuscriptTitle":"Comparison of Surgical Outcomes of da Vinci Surgical Systems X and Xi: A Single-center Study","msid":"","msnumber":"","nonDraftVersions":[{"code":1,"date":"2024-03-29 18:42:59","doi":"10.21203/rs.3.rs-4152339/v1","editorialEvents":[{"type":"communityComments","content":0}],"status":"published","journal":{"display":true,"email":"[email protected]","identity":"researchsquare","isNatureJournal":false,"hasQc":true,"allowDirectSubmit":true,"externalIdentity":"","sideBox":"","snPcode":"","submissionUrl":"/submission","title":"Research Square","twitterHandle":"researchsquare","acdcEnabled":true,"dfaEnabled":false,"editorialSystem":"","reportingPortfolio":"","inReviewEnabled":false,"inReviewRevisionsEnabled":true}}],"origin":"","ownerIdentity":"b81486dd-c507-4ce3-9297-d0cd447912b7","owner":[],"postedDate":"March 29th, 2024","published":true,"recentEditorialEvents":[],"rejectedJournal":[],"revision":"","amendment":"","status":"published-in-journal","subjectAreas":[],"tags":[],"updatedAt":"2024-07-11T00:31:35+00:00","versionOfRecord":{"articleIdentity":"rs-4152339","link":"https://doi.org/10.1111/ases.13358","journal":{"identity":"asian-journal-of-endoscopic-surgery","isVorOnly":true,"title":"Asian Journal of Endoscopic Surgery"},"publishedOn":"2024-07-01 00:31:35","publishedOnDateReadable":"July 1st, 2024"},"versionCreatedAt":"2024-03-29 18:42:59","video":"","vorDoi":"10.1111/ases.13358","vorDoiUrl":"https://doi.org/10.1111/ases.13358","workflowStages":[]},"version":"v1","identity":"rs-4152339","journalConfig":"researchsquare"},"__N_SSP":true},"page":"/article/[identity]/[[...version]]","query":{"redirect":"/article/rs-4152339","identity":"rs-4152339","version":["v1"]},"buildId":"qtupq5eGEP_6zYnWcrvyt","isFallback":false,"isExperimentalCompile":false,"dynamicIds":[84888],"gssp":true,"scriptLoader":[]}