Robotic-assisted hysterectomy using DEXTER^®: the first prospective multicentre study

Minimally invasive hysterectomy is increasingly performed robotically as new systems expand options and address limitations of traditional platforms, including financial, infrastructure, and workflow demands. The DEXTER^® Robotic Surgery System was designed to address some of these challenges.

To confirm perioperative and early postoperative safety, and evaluate the clinical performance of DEXTER in hysterectomy.

This prospective multicentre study included 34 patients who underwent robotic-assisted hysterectomy for benign or low-risk malignant diseases between November 2022 and November 2023. DEXTER was integrated into the surgical workflows of the four participating centres, which used their existing laparoscopic towers.

Primary outcomes were procedural conversions and Clavien-Dindo grade III-V events up to 30 days post-surgery.

Median patient age was 45.5 years; median body mass index was 26.0 kg/m². There were no conversions to laparotomy, intraoperative complications or transfusions, with a median estimated blood loss of 100 mL. Median skin-to-skin operative time was 125.5 min, including a median docking time of 5 minutes. Median length of hospitalisation was 2 days. Two Clavien-Dindo grade IIIb adverse events were recorded, neither of which was device-related. In 3 cases, the surgeons decided to finish the procedure laparoscopically.

Hysterectomy assisted with DEXTER can be safely performed even in the early learning phase. DEXTER facilitated an adaptable OR workflow allowing greater flexibility in procedural approaches. Further investigation with a larger cohort and a longer follow-up is required to evaluate long-term outcomes.

First prospective multicentre study to confirm robotic-assisted hysterectomy using DEXTER is a feasible and safe approach for treating benign and low-risk malignant conditions.