Robotic and conventional laparoendoscopic single-site hysterectomy safe and feasible for large uterus: Study

A new study published in the European Journal of Obstetrics, Gynecology and Reproductive Biology found that for big uteruses, both robotic and traditional laparoendoscopic single-site hysterectomy were safe, practical, and produced satisfactory surgical results.

In the gynecological setting, minimally invasive surgery like the single-site method (laparoscopic or robotics-assisted) has shown several benefits in the management of both benign and malignant diseases. When compared to standard laparotomy surgery, this surgical technique has well-known advantages, including a smaller abdominal scar and a lower rate of wound complications, postoperative discomfort, and hospitalization.

Also, the single-site procedure reduces scarring from surgical incisions and abdominal stress, as well as the appearance of potential side effects (tissue, nerve, and artery damage), improving the cosmetic results following surgery.

The challenges of traditional laparoendoscopic single-site surgery can be significantly reduced by the robotic surgical system with improved ergonomics, tremor filtering, flexible tools, and greater visibility. Thus, to determine if robotic laparoendoscopic single-site surgery using the da Vinci Xi system was the best method for conducting benign hysterectomy on a big uterus, Yu Chen and team carried out this study.

This retrospective study included patients with uterine weights more than 280 g who had transumbilical single-site hysterectomy, with or without da Vinci Xi system, performed between May 2021 and September 2023 were included in the study. Perioperative outcomes were assessed between the two groups following propensity score matching to equalize the baseline characteristics.

Each group consisted of 74 patients after a 1:1 propensity score match. No patient needed more ports, a multi-port laparoscopy, or a conversion to a laparotomy. The robotic group had a considerably reduced postoperative complication rate (4.1 % vs 13.5%) and a significantly longer exhaust time (2.4 ± 0.7 vs 2.0 ± 0.7 days) when compared to the conventional group.

Even though the robotic group had bigger uterine weights (412.5 vs 394.0 g) and a greater percentage of severe adhesion (33.8 % vs 17.6 %), there were no significant differences in operating time (183.6 ± 53.6 vs 178.2 ± 55.4 min), blood loss (100.0 vs 50.0 mL), or intraoperative complications (1.4% vs 0%). Overall, for large uteruses, both robotic and traditional laparoendoscopic single-site hysterectomy were safe, practical, and produced satisfactory surgical results.

Reference:

Chen, Y., Zheng, Y., Yang, F., Wang, Q., Liu, J., Chen, S., & Yang, X. (2025). Comparison of robotic and conventional laparoendoscopic single-site hysterectomy for large uterus using da Vinci Xi system: A propensity score matching analysis. European Journal of Obstetrics, Gynecology, and Reproductive Biology, 307, 252–257. https://doi.org/10.1016/j.ejogrb.2025.02.036