Enhanced surgical efficiency with the next-generation da Vinci 5 system compared with da Vinci Xi: a retrospective...

The da Vinci 5 (DV5) system is the latest evolution in robotic surgery, featuring force feedback technology, improved ergonomics, and integrated workflow solutions. Comparative data on surgical efficiency compared with the established da Vinci Xi system are limited. We evaluated the perioperative outcomes and efficiency of the DV5 system for total laparoscopic hysterectomy (TLH). We retrospectively analyzed 124 patients who underwent robotic TLH for benign indications between January 2024 and May 2025 (DV5, n = 48; Xi, n = 76). The primary outcomes were operative efficiency metrics, namely docking, console, and total surgical time. Multivariable linear regression was used to estimate the platform effect after adjustment for age, body mass index, uterine weight, prior abdominal surgery, and adhesiolysis. Baseline characteristics, including uterine weight (424.2 ± 242.5 vs. 403.6 ± 265.8 g, P = 0.123), were comparable between groups. The DV5 group demonstrated significantly shorter operative times across all metrics: docking time (3.13 ± 1.21 vs. 3.74 ± 1.77 min, P = 0.025), console time (63.6 ± 35.2 vs. 86.6 ± 42.3 min, P = 0.001), and total surgical time (109.8 ± 48.0 vs. 153.2 ± 65.1 min, P < 0.001). After multivariable adjustment, DV5 remained independently associated with shorter total operative time (adjusted β = -43.8 min, 95% CI -63.4 to -24.3; P < 0.001). Clinical outcomes, including hemoglobin change and length of hospital stay, did not differ significantly between groups. The DV5 system improved surgical efficiency compared with the Xi system, with adjusted effect estimates closely matching the unadjusted comparisons. Technological advancements, including the E-200 generator, integrated smoke evacuation, and enhanced surgeon autonomy, facilitated a more streamlined surgical workflow. No significant differences in hemoglobin change, complications, or length of stay were detected; however, because the study was not powered for low-frequency safety endpoints, these findings should be interpreted as the absence of a detectable safety signal rather than as definitive proof of safety equivalence, and confirmation in larger prospective studies is warranted.