Robotic single-site versus laparoendoscopic single-site hysterectomy: a propensity score matching study

The aim of this study was to compare the surgical outcomes of robotic single-site (RSS-H) and laparoendoscopic single-site total hysterectomy (LESS-H) and to evaluate the feasibility of RSS-H in patients with benign gynecologic disease.

The RSS-H was performed using the da Vinci single-site surgical platform, and the LESS-H using a single multi-channel port system at the umbilicus. Among 467 consecutive patients who had undergone total hysterectomy for benign gynecologic disease, surgical outcomes were compared between RSS-H group (n = 25) and LESS-H group (n = 442) after propensity score matching.

All operations were completed robotically and laparoscopically without conversion to laparotomy, respectively. The RSS-H group had longer operating times and less operative bleeding compared to the LESS-H group. While the LESS-H showed 1.4% of major complication rate, the RSS-H had no perioperative complication. Even after propensity score matching, the RSS-H still showed longer operating times (170.9 vs 94.1 min, p < 0.0001) and less operative bleeding (median estimated blood loss, 20 vs 50 ml, p = 0.009; mean hemoglobin drop, 1.6 vs 2.0 g/dl, p = 0.038) than the LESS-H.

The RSS-H could be a feasible and safe procedure in appropriately selected patients with benign gynecologic disease, and further experience and technical refinements will continue to improve operative results. Prospective randomized trials will permit the evaluation of the potential benefits of the RSS surgery as a minimally invasive surgical approach.