Two-Port Robotic-Assisted Hysterectomy: A Case Series Demonstrating Feasibility

BACKGROUND: Two-port robotic-assisted hysterectomy presents a minimally invasive alternative to traditional multi-port techniques. Although a limited number of cases have been documented in the literature [1,2], the improved articulation and precision of robotic instruments may facilitate effective surgery through just two access points. Potential benefits include reduced postoperative pain, lower hernia risk, and improved cosmetic outcomes without compromising surgical efficacy. OBJECTIVE: To demonstrate the feasibility and versatility of two-port robotic-assisted hysterectomy across different patient scenarios. METHODS: Three patients were carefully selected based on uterine size, underlying pathology, and surgical history; they were preoperatively counselled on the innovative aspects of the surgery, and informed consent was obtained accordingly. All patients were positioned in dorsal lithotomy with steep Trendelenburg (20 degrees). Pneumoperitoneum was established at 12 mmHg in all cases. In the first two cases, the camera port was placed at the umbilicus, with the instrument port in the suprapubic midline. In the third case, the camera was introduced through a left lateral port, with instruments inserted through the umbilicus. A nasogastric tube was inserted through the umbilical incision in all cases to provide suction and irrigation. In Case 2, coexisting endometriosis on the left pelvic sidewall was excised following ureterolysis, aided by vaginal traction. RESULTS: All three procedures were completed successfully without additional ports, with smooth recovery, rapid discharge and return to normal activities, excellent cosmetic results, and full symptom resolution. CONCLUSION: Two-port robotic-assisted hysterectomy is a feasible and effective approach for uncomplicated cases without significant pelvic distortion or complex comorbidity. This innovative technique represents a promising evolution in minimally invasive gynecologic surgery; however, current evidence is insufficient to establish superiority over conventional approaches. Further research is needed to assess its generalizability, long-term outcomes, and how it compares with established methods in terms of invasiveness and clinical results. VIDEO ABSTRACT.