A pilot investigation of robot-assisted total hysterectomy using the Toumai^® Laparoscopic Surgical Robot System

The objective of this study was to evaluate the technical feasibility, perioperative safety, and surgical workflow of the Toumai^® Laparoscopic Surgical Robot System in gynecology by reporting the first Robot-Assisted Total Hysterectomy (RATH) using this platform in Europe.

A total hysterectomy with bilateral salpingo-oophorectomy was performed on a patient with recurrent HPV-related CIN 3 at AZORG Hospital (Aalst, Belgium) in May 2025. The procedure was conducted by a surgeon with > 200 prior robotic hysterectomies. All surgical team members underwent formal system training. Preoperative, intraoperative, and postoperative data were collected, including operative times, complications, estimated blood loss, and hospital stay. The setup, port placement, and docking process were detailed to serve as a reference for future users.

The procedure was completed without intraoperative complications, conversions, or need for additional ports. Total operative time was 70 min: 6 min for port placement, 9 min for docking, 46 min of console time, and 9 min for closure. Estimated blood loss was 30 mL The patient was discharged on postoperative day one, and follow-up at 14 days was unremarkable. The surgical setup provided adequate ergonomics and workflow efficiency, with all robotic arms functioning without issue. Instrumentation was comparable to existing platforms.

In this first European experience, Toumai^® enabled a safe and efficient multi-port RATH with 70 min' total time and 30 mL blood loss, without complications or conversion. These feasibility data warrant a prospective series to assess reproducibility, learning curve, and cost-effectiveness.