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

Area of Science:

• Minimally Invasive Surgery
• Robotic Surgery
• Gynecologic Surgery

Background:

• The da Vinci Xi surgical system offers upgrades for minimally invasive procedures.
• Robotic surgery is increasingly used in gynecology.

Purpose of the Study:

• To evaluate the preliminary feasibility and safety of robotic laparoendoscopic single-site (R-LESS) gynecologic surgery using the da Vinci Xi system.
• To assess surgical outcomes and identify factors influencing operative time and blood loss.

Main Methods:

• Retrospective review of 35 female patients undergoing R-LESS gynecologic surgery for benign indications between June 2016 and January 2017.
• Analysis of operative times, complication rates, and blood loss.
• Comparison of early (first 12) versus later (subsequent 12) R-LESS hysterectomy cases.
• Logistic regression analysis to assess the association between BMI and surgical parameters.

Main Results:

• Median console time for hysterectomy was 41 minutes; median vaginal cuff closure time was 18 minutes.
• Conversion to multiport surgery occurred in 5.7% of cases; one major intraoperative complication (2.9%) was recorded.
• No patients required blood transfusion.
• A statistically significant decrease in surgical times and estimated blood loss was observed when comparing early and later R-LESS hysterectomy cases, suggesting a learning curve effect.
• No significant association was found between BMI and port entry time, console time, cuff closure time, operative time, or estimated blood loss.

Conclusions:

• The da Vinci Xi system demonstrates feasibility and safety for R-LESS gynecologic surgery in select patients.
• A learning curve effect was observed, with improved surgical efficiency in later cases.
• Further multi-center studies are warranted to fully establish the role of the da Vinci Xi system in single-site gynecologic procedures.