Safety of Continuous Force Feedback in Robotic Hysterectomy and Myomectomy

United States labeling of the newest robotic surgical platform contraindicates the use of force feedback instruments during hysterectomy and myomectomy because of a theoretical, clinically unexamined bleeding risk. We describe real-world outcomes and quantified intraoperative force during continuous force feedback use throughout these procedures, including closure, in a setting where this restriction does not apply.

This single-surgeon observational cohort comprised 93 consecutive patients undergoing robotic hysterectomy or myomectomy between December 2024 and April 2026, classified into 3 groups: force feedback active throughout (43), the same instruments with the feature disabled (13), and conventional instruments (37). The primary outcome was a composite of vaginal cuff dehiscence, uterine wound disruption, or readmission or reintervention for bleeding within 30 days.

Baseline characteristics were comparable across groups. Mean intraoperative force in the active group was 2.1 newtons for hysterectomy and 2.2 newtons for myomectomy. The composite event occurred in 1 of 43 active-group patients (a readmission for bleeding) and in no patient in the other groups; no cuff dehiscence or uterine wound disruption occurred in any group. After adjustment for procedure, higher mean force was associated with shorter operative time.

Continuous force feedback through the closure phases of robotic hysterectomy and myomectomy was not associated with cuff dehiscence or uterine wound disruption, and mean operative force clustered near 2 newtons. These hypothesis-generating findings warrant larger studies before safety equivalence can be inferred.