Clinical application and early experience of da Vinci Xi robotic single-site laparoscopic gynecologic surgery in mainland China: early experience from a retrospective consecutive cohort of 221 cases

Background: This study evaluated the clinical performance and learning curve of the da Vinci Xi robotic laparoendoscopic single-site surgery (R-LESS) in gynecology by analyzing a consecutive series of 221 cases from a single tertiary center in mainland China. Methods: We retrospectively analyzed the medical records of patients who underwent R-LESS using the fourth-generation da Vinci Xi system in the Department of Gynecology, Zhongnan Hospital of Wuhan University, between January 2020 and January 2022. Clinical characteristics, operative time, estimated blood loss (EBL), intraoperative and postoperative complications, postoperative 24-hour visual analog scale (VAS) pain scores, time to bowel recovery, postoperative length of stay (LOS), hospitalization costs, and learning curves were analyzed. Results: A total of 221 patients were included, including 189 benign cases and 32 malignant cases. Benign indications included uterine leiomyoma and adenomyosis (n = 70), cervical lesion (n = 20), endometrial lesions (n = 9), uterine prolapse (n = 6), hydatidiform mole (n = 2), and adnexal masses (n = 82). All malignant cases were endometrial cancer (FIGO stage IA: n = 19; IB: n = 7; II: n = 6). Surgical procedures included robotic single-site total hysterectomy (n = 67), myomectomy (n = 40), ovarian cystectomy (n = 82), and staging surgery for endometrial cancer (n = 32). All operations were successfully completed without conversion to multiport laparoscopy or laparotomy. Perioperative outcomes were as follows: (1) Total hysterectomy: operative time 115.95 ± 31.96 min, EBL 58.75 ± 22.48 mL, LOS 4.26 ± 0.93 days, 24-h VAS 1 (1–3); (2) myomectomy: operative time 113.17 ± 41.08 min, EBL 53.16 ± 22.63 mL, LOS 3.83 ± 0.99 days, 24-h VAS 1 (1–3); (3) ovarian cystectomy: operative time 85.16 ± 27.46 min, EBL 31.62 ± 19.14 mL, LOS 3.83 ± 1.15 days, 24-h VAS 1 (1–3); (4) malignant staging surgery: operative time 205.09 ± 56.05 min, EBL 111.50 ± 58.43 mL, LOS 5.75 ± 1.53 days. No intraoperative complications occurred. Postoperative complications were minimal, with one case of urinary retention after hysterectomy in the benign cohort and one infection after staging surgery in the malignant cohort. Learning curve analysis showed that proficiency was achieved after 12 cases for hysterectomy, 13 cases for adnexal mass surgery, 14 cases for myomectomy, and 17 cases for malignant staging surgery. Conclusions: This consecutive case series demonstrates that da Vinci Xi R-LESS is safe and feasible in gynecologic practice, with low blood loss, short hospital stay, and rapid postoperative recovery. Surgeons experienced in conventional laparoscopy can achieve proficiency within a relatively short learning curve.