Single-Port Versus Reduced-Port (1 + 1) Robotic Myomectomy and Hysterectomy

Background: We aimed to investigate the reduced-port (RP) robotic surgery as an alternative to the single-port (SP) robotic surgery by first comparing the surgical outcomes between the two groups. Methods: A total of 184 patients who underwent SP robotic myomectomy (SP-RM, n = 94), RP robotic myomectomy (RP-RM, n = 38), SP robotic hysterectomy (SP-RH, n = 33), or RP robotic hysterectomy (RP-RH, n = 19) from October 2020 to April 2022 were analyzed. An 8 mm skin incision 8-10 cm away from the umbilical incision was made for the RP robotic surgery. Results: Of the total of 184 patients, 166 (90.2%) underwent surgery for leiomyoma followed by adenomyosis (n = 10, 5.44%). None of the cases were converted to laparotomy or added additional ports during surgery. Demographic characteristics and surgical outcomes were comparable between RP-RM and SP-RM and between RP-H and SP-H, respectively. However, more leiomyoma were removed in the RP-RM group than the SP-RM group [median 4.2 (range 1-21) vs. median 2.7 (range 1-11), p = 0.009]. The total operating time was longer in the SP-RH group than the RP-RH group (159.8 ± 55.0 min vs. 113.6 ± 24.6 min, p = 0.001). Conclusions: RP robotic surgery is a feasible and effective surgical option for myomectomy and hysterectomy with cosmetic benefits compared to conventional multiport robotic surgery. In conclusion, for surgeons who cannot use the da Vinci SP, RP robotic surgery using the da Vinci^® Xi or Si systems may be an alternative option.