Comparison of robotic and conventional laparoendoscopic single-site hysterectomy for large uterus using da Vinci Xi system: A propensity score matching analysis

INTRODUCTION: The robotic surgical system equipped with enhanced visualization, flexible instruments, tremor filtration, and improved ergonomics can greatly address difficulties encountered in conventional laparoendoscopic single-site surgery. This study aimed to evaluate whether robotic laparoendoscopic single-site surgery performed by da Vinci Xi system was an optimal approach in performing benign hysterectomy for large uterus. METHODS: This was a single-center retrospective cohort study. Between May 2021 and September 2023, patients who underwent transumbilical single-site hysterectomy with or without da Vinci Xi system indicated for uterine myoma or adenomyosis with uterine weight exceeding 280 g were enrolled. After conducting propensity score matching to balance the baseline characteristics, perioperative outcomes were compared between the two groups. RESULTS: After 1:1 propensity score matching, 74 patients were included in each group. No patient required additional ports, conversion to laparotomy or multi-port laparoscopy. The robotic group showed significantly longer exhaust time (2.4 ± 0.7 vs 2.0 ± 0.7 days, p < 0.001) and lower postoperative complication rate (4.1 % vs 13.5 %, p = 0.042) compared to the conventional group. No significant differences were found in operative time (183.6 ± 53.6 vs 178.2 ± 55.4 min, p = 0.546), blood loss (100.0 vs 50.0 mL, p = 0.296) and intraoperative complication (1.4 % vs 0, p = 1.000) even though the robotic group had heavier uterine weights (412.5 vs 394.0 g) and a higher rate of severe adhesion (33.8 % vs 17.6 %). CONCLUSION: Robotic and conventional laparoendoscopic single-site hysterectomy for large uterus were both feasible and safe with satisfying surgical outcomes. However, the laparoendoscopic single-site surgery was easier to be mastered and more likely to handle challenging conditions with assistance of da Vinci Xi system.