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Updated: Apr 27, 2026
Laparoscopic Extracorporeal Knot-Tying for Uterine Vessel Occlusion during Hysterectomy with Cervical Cerclage in Large Uteri
Published on: September 12, 2025
Learning curve analysis of intracorporeal cuff suturing during robotic single-site total hysterectomy
Ali Akdemir1, Burak Zeybek1, Banu Ozgurel2
1Department of Obstetrics and Gynecology, Ege University School of Medicine, Izmir, Turkey.
Study Objective:
To analyze the learning curve of intracorporeal cuff suturing during robotic single-site total hysterectomy.
Design:
Retrospective study (Canadian Task Force classification II-1).
Setting:
University hospital.
Patients:
Twenty-four patients with benign indications for hysterectomy.
Interventions:
Twenty-four patients who underwent robotic single-site total hysterectomy to treat benign indications were included in the study. Surgical procedures were performed by a single surgeon with extensive experience in laparoscopy, using the single-site platform of the da Vinci Surgical System. All vaginal cuffs were closed intracorporeally using semi-rigid single-site instruments.
Measurements And Main Results:
An exponential learning curve technique was used to analyze the learning curve. The overall mean (SD) vaginal cuff closure time was 23.2 (7) minutes. Learning curve analysis revealed a decrease in vaginal closure time after 14 procedures.
Conclusions:
An experienced robotic surgeon requires approximately 14 procedures to achieve proficiency in intracorporeal cuff suturing during robotic single-site total hysterectomy. Novel instruments that create perfect triangulation are needed to overcome the current challenges of suturing and to shorten operative time.
