Robotic laparoendoscopic single-site benign gynecologic surgery: a single-center experience

The da Vinci Xi surgical system was released with several upgrades and modifications compared to the previous robotic generations to facilitate minimal invasive surgery. Herein, we present our preliminary experience of robotic laparoendoscopic single-site gynecologic surgery performed for benign indications with the da Vinci Xi robotic system in a single center. Thirty-five female patients underwent robotic single-site surgery between June 2016 and January 2017. The median console time for hysterectomy with or without salpingo-oophorectomy was 41 min. The median intracorporeal vaginal cuff closure time was 18 min. Two cases (5.7%) were converted to robotic-assisted multiport surgery. There was one major intraoperative complication (2.9%). None of the patient required blood transfusion. When comparing our first 12 cases to subsequent 12 cases of R-LESS hysterectomy, there was a statistically significant decrease in surgical times and estimated blood loss. On logistic regression analysis, no association was detected between BMI and port entry time (OR 0.93, 95% CI 0.83-1.04, p = 0.23), console time (OR 0.98, 95% CI 0.94-1.02, p = 0.37), cuff closure time (OR 0.9, 95% CI 0.76-1.09, p = 0.33), operative time (OR 1, 95% CI 0.98-1.01, p = 0.97), and estimated blood loss (OR 0.98, 95% CI 0.96-1.01, p = 0.33). Our preliminary experience with robotic laparoendoscopic single-site surgery using the da Vinci Xi system has demonstrated feasibility and safety in select patients. Further studies with greater number of patients in multiple settings will help us to fully elucidate the role of da Vinci Xi surgical system in single-site gynecologic surgery.