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

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. Similar content being viewed by others Data availability No datasets were generated or analysed during the current study.

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We would like to thank Editage (www.editage.jp) for their support in English-language editing. Funding The authors have not disclosed any funding. Author information Authors and Affiliations Contributions All authors contributed to the study conception and design. Material preparation, data collection and analysis were performed by Naofumi Higuchi and Kiyoshi Kanno. The first draft of the manuscript was written by Naofumi Higuchi and Kiyoshi Kanno, and all authors commented on previous versions of the manuscript. All authors read and approved of the final manuscript. Corresponding author Ethics declarations Conflict of interest The authors declare no competing interests. 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 file1 Online Resource 1 (Robot-assited hysterectomy using da Vinci SP) (MP4 184107 KB) 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 Higuchi, N., Kanno, K., Onji, H. et al. 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. J Robotic Surg 19, 320 (2025). https://doi.org/10.1007/s11701-025-02448-5 Received: Accepted: Published: Version of record: DOI: https://doi.org/10.1007/s11701-025-02448-5