Robotic Single-site Hysterectomy Research Articles

Feasibility and Surgical Outcomes of Hybrid Robotic Single-Site Hysterectomy Compared with Single-Port Access Total Laparoscopic Hysterectomy.

We compared surgical outcomes between single-port access total laparoscopic hysterectomy (SPA-TLH) and hybrid robotic single-site hysterectomy (RSSH), a new technique of combining the benefits of SPA-TLH with RSSH in this study. A total of 64 patients were retrospectively analyzed. They underwent either hybrid RSSH or SPA-TLH for benign gynecologic disease between December 2018 and August 2021. To assess the feasibility of hybrid RSSH, the clinical characteristics and surgical outcomes were compared between the hybrid RSSH group (n = 29) and the SPA-TLH group (n = 35). All of the surgeries were completed without requiring additional ports or conversion to laparotomy. The surgical outcomes including total operative time, uterine weight, estimated blood loss, hemoglobin changes, length of hospital stay, and postoperative pain scores were not significantly different between the two groups. The colpotomy time, including the detachment of the uterosacral and cardinal ligaments, was shorter in the hybrid RSSH group than in the SPA-TLH group (8.0 min vs. 14.0 min; p = 0.029). However, the vaginal cuff closure time was longer in the hybrid RSSH group than in the SPA-TLH group (15.0 min vs.10.0 min; p = 0.001). No difference was observed with regards to intraoperative and postoperative complications. Hybrid RSSH appears to be a feasible procedure for hysterectomy in patients with benign gynecologic diseases.

Robotic Single-Site Hysterectomy in Gynecologic Benign Pathology: A Systematic Review of the Literature.

Background and objectives: Total hysterectomy is one of the most common gynecologic surgical procedures and it is mainly performed for benign pathologies. The introduction of robotic single-site surgery (RSS) as an acceptable alternative to laparoendoscopic surgery combines the advantages of robotics with the aesthetic result of a single incision. This study aims to review the existing literature on a single-site robotic hysterectomy in patients with benign pathologies and verify its safety and feasibility. Materials and Methods: Following the recommendations in the preferred reporting items for systematic reviews and meta-analyses (PRISMA) statement, FP and AR systematically screened the PubMed, Embase, and Scopus databases. No temporal or geographical limitation was discriminatory. Studies containing data about feasibility and safety were included. Results: From 219, only eight studies met the inclusion criteria, and a total of 212 patients were included with a mean patient age of 45.42 years old (range 28-49.5 years old) and a mean BMI of 25.74 kg/m2 (range 22-28.5 kg/m2). The mean presurgical time, including port placement and docking time, was 15.56 (range 3-30) minutes. Mean console time was reported in six studies and is 83.21 min (range 25-180 min). The mean operative time is 136.6 min (range 60-294 min) and the mean blood loss is 43.68 mL (range 15-300 mL). Only two patients in the total analyzed had intraoperative complications and no conversion to LPT occurred. The median hospital stay was 1.71 days (range 0.96-3.5 days). The postoperative complication rate was estimated at 1.4% (vaginal bleeding). Conclusions: Our review supports the safety and feasibility of robotic single-site hysterectomy for benign gynecological diseases.

Surgical Outcomes Following Robotic Single-Site Versus Multiport Hysterectomy for Treatment of Endometrial Cancer: A Systematic Review and Meta-Analysis.

Robotic single-site hysterectomy (RSSH) has emerged as a novel surgical approach for the treatment of endometrial cancer and atypical endometrial hyperplasia (AEH). Current research regarding the benefits of RSSH compared to robotic multiport hysterectomy (RMPH) for these indications has been inconclusive. Our team sought to compare surgical outcomes between these two approaches ofrobotic hysterectomy via systematic review and meta-analysis to ensure optimal surgical practices. The Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) 2020 Checklist guided our review. MEDLINE, Clinicaltrials.gov, and Cochrane Library were searched, yielding 59 results. Articles were filtered by title and abstract and then reviewed in full for inclusion and exclusion criteria. Inclusion criteria required that (1) studies compared outcomes for RSSH and RMPH, (2) hysterectomy was indicated for endometrial cancer or hyperplasia with atypia, and (3) studies were available in English. Excluded studies (1) compared single-site and multiport laparoscopic approaches, (2) compared robotic approaches to laparoscopic or abdominal (open) techniques, and (3) employed hysterectomy for benign conditions. Publication bias was assessed using the Egger Regression Correlation analysis. Four studies complied with the selection criteria, comprising 138 patients in the RSSH group and 259 in the RMPH group. Similar outcomes were noted across all measures, including conversion rate (relative risk [RR] = 1.84 and confidence interval [CI] = 0.99-3.43), blood loss (Cohen's d = 1.05 and Z = 18.62), operating time (Cohen's d=0.29 and Z=4.38), and length of hospital stay (Cohen's d= 1.06 and Z= 3.86). Publication bias was deemed minimal as indicated by Egger regression values of less than 0.05. These findings suggest that either a surgical approach or AEH with the proper standard of care can provide patients with endometrial cancer.

Comparison between Robotic Single-Site and Laparoendoscopic Single-Site Hysterectomy: Multicentric Analysis of Surgical Outcomes.

We consecutively enrolled 278 women between 2012 and 2019 in this multicentre trial. The patients underwent robotic single-site hysterectomy (RSSH) or laparoendoscopic single-site hysterectomy (LESSH) procedures with or without salpingo-oophorectomy for benign indications. Surgical parameters and surgical outcomes were analysed. There was a statistical difference between the two surgical techniques for total operative time (p = 0.001), set-up time (p = 0.013), and anaesthesia time (p = 0.001). Significant differences in intraoperative blood loss were observed (p = 0.001), but no differences were shown for blood transfusion or intraoperative or postoperative complications in the two groups. LESSH outperformed RSSH in terms of surgical performance and clinical outcomes, with no differences in adverse events.

8683 Robotic Single-Site Versus Laparoscopic Single-Site Hysterectomy in Benign Gynecologic Disease: A Single Surgeon's Experience

<h3>Study Objective</h3> The purpose of this study is to evaluate the feasibility and safety of robotic single-site hysterectomy (RSSH), and to compare postoperative outcomes between RSSH and laparoscopic single-site hysterectomy (LSSH) for benign gynecological disease. <h3>Design</h3> A retrospective study was conducted of all cases of RSSH and LSSH performed from January 2018 to February 2021. <h3>Setting</h3> N/A. <h3>Patients or Participants</h3> Among 170 consecutive patients who had undergone total hysterectomy for benign gynecologic disease, surgical outcomes were compared between the RSSH group (n=92) and the LSSH group (n=78). <h3>Interventions</h3> RSSH was performed using the da Vinci Xi robotic system with Lab single®, and LSSH using a handmade globe port at the umbilicus. And all operations were performed by a single gynecologic oncologic surgeon. <h3>Measurements and Main Results</h3> All operations were completed with no additional port insertion or conversion to laparotomy. There were no significant differences in the characteristics of the patients between the 2 study groups. The uterus weight was 389 ± 190 in the RSSH group and 390 ± 225 in the LSSH group. Mean operation time was higher in the RSSH group than the LSSH group (85.3 ± 26.5 vs 73.6 ± 26.5 min, <i>p <</i> 0.0001). However, the postoperative pain score was lower in the RSSH group. The mean NRS score after 2 hours, 4 hours, 8 hours, and 12 hours was significantly lower than the LSSH group (<i>p <</i> 0.0001). Operative Mean hemoglobin drop (1.4 ± 0.9 vs 1.3 ± 1.0 g/dl, p = 0.122) and Mean postoperative day (3.1 ± 0.6 vs 3.1 ± 0.5 days, p = 0.943) did not significantly differ between two groups. <h3>Conclusion</h3> The RSSH using the da Vinci Xi system is feasible and safe in appropriately select patients with benign gynecologic disease. Additionally, prospective randomized clinical trials will be able to evaluate the potential benefits of Robotic single-site surgery.

Case report of lighted ureteral stent insertion with robotic single-site radical hysterectomy in early cervical cancer treatment

Case report of lighted ureteral stent insertion with robotic single-site radical hysterectomy in early cervical cancer treatment

Analysis of surgical outcomes and learning curve of surgical parameters for robotic hysterectomy: a comparison between multiport versus single-site

Introduction: The primary goal is to analyze the learning curve of surgical parameters (docking, operation and console time) between multiport and single-site robotic hysterectomy techniques, performed by expert laparoscopic surgeons. Material and methods: The trial is a retrospective analysis of 229 patients enrolled between 2010 and 2018 who underwent robotic hysterectomies with bilateral salpingo-oophorectomies (HBSO) for gynecological diseases. Results: Surgical parameters, learning curve and surgical outcomes were analyzed in order to evaluate the transition from multiport to single-site programs, performed by non-expert surgeons using the multiport technique. All surgical times (total, docking and console time) were shorter in the multiport robotic hysterectomy group, while the intraoperative complication rate was lower in the robotic single-site hysterectomy group (p = 0.007). The learning curve of operative, console and docking time significantly decreased more in the robotic-single site hysterectomy group, than in the multiport robotic hysterectomy group over time (p value < 0.001). Conclusions: The direct transition from the laparoscopy program to the single-site approach is feasible and effective in HBSO performed by expert laparoscopic surgeons. The learning curve of robotic single-site hysterectomy shows that the proficiency in this technique requires more cases than the multiport robotic hysterectomy cases and needs more time to fit the surgical step to the single-site platform.

Robotic single-site surgery in benign gynecologic diseases: Experiences and learning curve based on 626 robotic cases at a single institute.

The purpose of this study was to report on 626 cases of successful robotic single-site (RSS) surgeries to address various types of gynecologic disease and to evaluate the outcomes and learning curve inherent to RSS surgery in the gynecology field. A total of 626 cases of RSS surgeries were performed by 3 gynecologic surgeons at Ewha Womans University Medical Center, Robot Surgery Center from November 2014 to January 2018 were collected retrospectively. All of the patients' charts were reviewed, and the clinical characteristics and surgical variables were analyzed. Among the total of 626 cases, there were 220 cases of RSS myomectomy (RSSM), 182 cases of RSS hysterectomy (RSSH), 195 of RSS adnexectomy, 24 of RSS sacrocolpopexy (RSS SCP) and 5 were classified as other RSS surgeries. The patient's mean age was 38.98 ± 10.07 years. There was 3.99 ± 2.15 min of mean docking time and 117.78 ± 51.18 min of mean operating time. The surgical variables were analyzed annually. The total operating time was seen to decrease significantly according to each period. The docking time declined significantly and gradually after 1 year. We also analyzed each of the surgical types by time. The operating time of RSSH, RSSM, RSS adnexectomy and RSS SCP fell over time. The tendency found was for operating time to decline sharply following the first 10 cases. When we analyzed the data at annual intervals, the operating time was most significantly less and stable following the first year. There were a few intraoperative or perioperative complications in 16 cases (2.6%). Robotic single-site surgery is a feasible and safe procedure for treating various kinds of gynecologic diseases. The learning curve was approximately 10 cases of RSS surgery in gynecologic disease, having a greater amount of experience at performing RSS surgery was revealed to be key to achieving better surgical outcomes.

The robotic single-port platform for gynecologic surgery: a systematic review of the literature and meta-analysis.

Since the first robotic single-site hysterectomy was performed, the research focused on the use of robotic single-site surgery (RSSS) for all gynecological conditions. This review aims to examine the studies available in the literature on RSSS in gynecology both for benign and malignant indications. The systematic review was carried out in agreement with the preferred reporting items for systematic reviews and meta-analyses statement (PRISMA). All the articles were grouped into three sets based on the surgical indication (Group 1, 2, and 3 for benign, malignant, and mixed diseases, respectively). Two hundred and fifty total studies were analyzed, and 27 articles were included in the review. A total of 1065 patients were included in the analysis. Of these, 605 patients were included in group 1, 260 in group 2, and 200 in group 3. Ten (1.7%) patients with benign pathology, 16 (6.2%) patients with malignant disease, and 5 (2.5%) patients with both diseases developed major complications. Two (0.3%) patients in group 1, 3 (1.2%) patients in group 2 and 5 (2.5%) in group 3 were converted to a different type of surgery. No significant differences were found between groups for BMI (p = 0.235), operative time (p = 0.723), estimated blood loss (EBL) (p = 0.342), and hospital stay (p = 0.146). The complications and conversions incidence through pooled analysis showed a higher general conversion rate (p = 0.012) in group 3 (3.0%) and higher complications rate (p = 0.001) in group 2 (5.3%) compared to the other groups. RSSS seems to be a feasible and safe procedure for all gynecological surgical procedures. A long-term analysis would be necessary before considering the RSSS oncologically safe for patients with malignant disease.

1644 1. Clinical Study and Evaluation of the Robotic Single-Site Hysterectomy

Study Objective The study aimed to discuss the safety, feasibility and advantages of the Robotic Single-Site hysterectomy (RSSH) in gynecological field. Design Retrospective analysis of 179 cases of RSSH Setting Department of Obstetrics and Gynecology, College of Medicine, Robot Surgery Center, Ewha Womans University Patients or Participants 179 patients who had RSSH Interventions From December 2014 to January 2019, 179 cases of Robotic Single-Site Hysterectomy which was done by 3 gynecologic surgeons at Ewha Womans University Medical Center were retrospectively analyzed. Measurements and Main Results There were total 179 cases of the Robotic Single-Site hysterectomy. One hundred seventy cases had adenomyosis, or leiomyoma or those combined diseases. The mean ages was 47.24±6.02. The mean total operation time was 120.44±40.61 mins, with the mean docking time 3.47±1.79 mins. The mean estimated blood loss (EBL) was 177.12±184.82 ml and the mean hemoglobin change was 1.92±0.95 g/dl. The mean hospitalization period was 4.98±1.24 days. Only few intraoperative or perioperative complication in 7cases (0.039%) were noted. The conversion rate to laparotomy was zero. Conclusion The Robotic Single-Site hysterectomy is a safe, reliable and feasible surgical method in gynecology.

Robotic Single-Site Hysterectomy versus Robot-Assisted Multiport Hysterectomy in Benign Gynecologic Diseases: A Retrospective Comparison of Clinical and Surgical Outcomes

Robotic Single-Site Hysterectomy versus Robot-Assisted Multiport Hysterectomy in Benign Gynecologic Diseases: A Retrospective Comparison of Clinical and Surgical Outcomes

Tips on robotic single-site surgery suture technique: Screwing and clockwise direction suture technique for Robotic single-site surgery

ObjectivesUsing the da Vinci single-site platform, surgeons can perform more minimally invasive surgery. However, surgical challenges exist due to the limitations of single-site instrumental movements. To aid in the performance of successful robotic single-site hysterectomy, a new suturing technique using the current set of limited instruments is introduced in this study. Material & methodsNew vaginal cuff suturing techniques have been used in 55 robotic single-site hysterectomies in our institute over the past 2 years. A needle driver approach utilizing screwing and advancing the needle driver in the correct direction at an increasing angle from the transverse cuff margin with dragging and formation of an adequate loop of thread was used when suturing the vaginal cuff. ResultsUsing the new vaginal suturing techniques, easy and firm vaginal cuff closure with reduced operative time relative to previous hysterectomies was achieved. ConclusionThe new vaginal cuff suturing techniques may convince more surgeons to perform robotic single-site hysterectomies more frequently and with greater ease.

The Patient and Observer Scar Assessment Scale to Evaluate the Cosmetic Outcomes of the Robotic Single-Site Hysterectomy in Endometrial Cancer.

The objective of this study was to evaluate the cosmetic outcome of robotic single-site hysterectomy (RSSH) in early-stage endometrial cancer. We prospectively collected patient demographics, operative times, complications, pathologic results, and length of stay on all patients who underwent RSSH for early-stage endometrial cancer. The Patient and Observer Scar Assessment Scale (POSAS) was used for the evaluation of the cosmetic outcome. Forty-five patients were included in our study from January 2012 to October 2015. The median age of patients was 63 years (range, 35-84 years), and the median body mass index was 26.5 kg/m (range, 18-39 kg/m). No laparoscopic/laparotomic conversion was registered. The median docking time, console time, and total operative time were 7 minutes (range, 4-14 minutes), 46 minutes (range, 20-100 minutes), and 90 minutes (range, 45-150 minutes), respectively. The median blood loss was 50 mL (range, 10-150 mL). Nine patients underwent pelvic lymphadenectomy, and the median number of pelvic lymph nodes was 13 (range, 10-32). The median time to discharge was 3 days (range, 2-6 days). No intraoperative complications occurred, whereas we did observe 1 early postoperative complication. The oncological outcome was directly comparable to the literature. Patients reported low pain scores and high satisfaction in terms of postoperative scarring. The POSAS scores confirmed excellent cosmetic outcome of RSSH. Robotic single-site hysterectomy provided an efficient option for gynecologic oncologic surgery. The POSAS revealed high objective and patient-evaluated outcome, and patients were highly satisfied with the overall outcome of the appearance of their scars.

Robotic single site staging in endometrial cancer: A multi-institution study

ObjectiveTo evaluate the feasibility and the safety of robotic single site hysterectomy (RSSH) plus or less pelvic lymphadenectomy in FIGO stage I–II endometrial cancer. Materials and methodsWe prospectively collected patient demographics, operative times, complications, pathologic results, and length of stay on all patients who underwent RSSH plus or less pelvic lymphadenectomy for clinical FIGO stage I or occult stage II endometrial carcinoma. ResultsFrom January 2012 to February 2015, 125 patients were included in our study. The median age of the patients was 59 years (range, 35–84 years) and the median body mass index was 27 kg/m2 (range, 19–52 kg/m2). One patient was converted to vaginal surgery due to problems of hypercapnia. The median docking time, console time, and total operative time was 11 min (range, 4–40 min), 80 min (range, 20–240 min) and 122 min (range, 35–282 min), respectively. The median blood loss was 50 ml (range, 10–250 ml). No laparoscopic/laparotomic conversion was registered. Twenty one patients underwent pelvic lymphadenectomy (16.8%) and the median pelvic lymph nodes was 13 (range, 3–32). The median time to discharge was 2 days (range, 1–3 days). No intra-operative complications occurred, while we observed 10 (8%) early post-operative complications. ConclusionRSSH plus or less pelvic lymphadenectomy is technically feasible, safe and reproducible and could be the treatment of choice for patients affected by FIGO stage I–II endometrial cancer. However, randomized controlled trials are needed to confirm these results.

Robotic single site versus robotic multiport hysterectomy in early endometrial cancer: a case control study.

ObjectiveTo compare surgical outcomes and cost of robotic single-site hysterectomy (RSSH) versus robotic multiport hysterectomy (RMPH) in early stage endometrial cancer.MethodsThis is a retrospective case-control study, comparing perioperative outcomes and costs of RSSH and RMPH in early stage endometrial cancer patients. RSSH were matched 1:2 according to age, body mass index, comorbidity, the International Federation of Gynecology and Obstetric (FIGO) stage, type of radical surgery, histologic type, and grading. Mean hospital cost per discharge was calculated summarizing the cost of daily hospital room charges, operating room, cost of supplies and length of hospital stay.ResultsA total of 23 women who underwent RSSH were matched with 46 historic controls treated by RMPH in the same institute, with the same surgical team. No significant differences were found in terms of age, histologic type, stage, and grading. Operative time was similar: 102.5 minutes in RMPH and 110 in RSSH (p=0.889). Blood loss was lower in RSSH than in RMPH (respectively, 50 mL vs. 100 mL, p=0.001). Hospital stay was 3 days in RMPH and 2 days in RSSH (p=0.001). No intraoperative complications occurred in both groups. Early postoperative complications were 2.2% in RMPH and 4.3% in RSSH. Overall cost was higher in RMPH than in RSSH (respectively, $7,772.15 vs. $5,181.06).ConclusionOur retrospective study suggests the safety and feasibility of RSSH for staging early endometrial cancer without major differences from the RMPH in terms of surgical outcomes, but with lower hospital costs. Certainly, further studies are eagerly warranted to confirm our findings.

Single Incision Trans-Umbilical Total Hysterectomy: Robotic or Laparoscopic?

Objective: The aim of this study was to compare the early surgical outcomes in patients who underwent total hysterectomy with laparoendoscopic single-site surgery (LESS-TH) versus robotic single-site total hysterectomy (RSS-TH). Methods: Twenty-four patients who underwent RSS-​TH and thirty-four patients who underwent LESS-TH were retrospectively evaluated. Patient characteristics, operation time, intraoperative data (conversions, complications, estimated blood loss, etc.) and postoperative pain scores were compared. Results: The total operation time was significantly longer in the robotic surgery group, with a time of 98.5 vs. 86 min (p = 0.013), while vaginal closure time was significantly higher in the laparoscopic surgery group (p = 0.011). Intraoperative outcomes and postoperative pain scores were similar in the two groups. Conclusion: RSS-TH helps surgeons to overcome the technical disadvantages of LESS-TH, particularly vaginal cuff closure, ergonomics and instrument crowding and clashing. Early surgical outcomes are comparable in the two groups, and both techniques are safe and feasible.

Robotic Single Site Hysterectomy with Bilateral Salpingo-Oophorectomy in Female to Male Transsexualism

We read with interest the recent letter by Lazard et al. on laparoscopic single port access total hysterectomy and salpingooophorectomy (THSO) for female to male transsexualism [1]. The minimal invasive approach is certainly the best option for such individuals because it reduces the aesthetic damage. However, the standard laparoscopic hysterectomy still requires three pelvic accesses in abdominal wall, a sign indicating gynecological surgery with potential psychological consequences in vulnerable patients. The recent introduction of laparoendoscopic single-site surgery (LESS) in several surgical procedures, as hysterectomy and or adnexal surgery, permits to overcome standard laparoscopic aesthetic limitations, further reducing postoperative pain and offering a more rapid return to normal activity [2,3]. The introduction of robotic surgery by using the da Vinci Surgical System (Intuitive Surgical System, Sunnyvale, CA, USA), approved by the U.S. Food and Drugs Administration in 2005, seems to represent a step further in advancing the efficiency and the performance of complex laparoscopic maneuvers and permits a minimally invasive approach in many more patients [4]. LESS surgery still presents some obstacles, in particular, the “sword fighting” among instruments, and the recent development of single-site port robotic devices represents a substantial evolution. Indeed, the insertion of surgical instruments into the abdominal cavity through the umbilical access can cause a crossing of them with a reversion of the hands and a consequent major difficulty for the surgeon. The robot plays an important role by decreasing the impact of these technical limitations and still has the advantages of LESS in term of aesthetic outcome and pain reduction. Recently, we started a pilot study with the aim to investigate the effectiveness of robotic single port hysterectomy in sex reassignment surgery. Through a 2 cm trans-umbilical incision, we introduced in abdomen cavity the single-site port, grasped just above the lower rim using an atraumatic clamp, with a descending movement within the incision. The technique used for THSO was similar to that used in standard robotic surgery. Vaginal cuff was closed both with transvaginal and laparoscopic approach. Table 1 reports the perioperative data of the first five successful cases at our Institution. To the best of our knowledge, this is the first case series of THSO described in literature by using robotic single site device in the treatment of female to male transsexualism. Stefano Bogliolo, MD, Chiara Cassani, MD, Luciana Babilonti, MD, Valentina Musacchi, MD, Rossella Elena Nappi, PhD, and Arsenio Spinillo, PhD Department of Obstetrics and Gynaecology, IRCCS-Fondazione Policlinico San Matteo and University of Pavia, Pavia, Italy

Robotic single-site hysterectomy (RSS-H) vs. laparoendoscopic single-site hysterectomy (LESS-H) in early endometrial cancer: A double-institution case–control study

ObjectiveTo report our experience with single-site robotic platform for IS3000 “Da Vinci” Si Surgical System to perform robotic single site hysterectomy (RSS-H), and to compare peri-operative results with a historical series of laparoendoscopic single site hysterectomies (LESS-H). MethodsThis is a retrospective case–control study, performed at the Gynecologic Oncologic Unit, National Cancer Institute “Regina Elena”, Rome, and at the Gynecologic Oncologic Unit, Catholic University of the Sacred Heart, Rome, Italy between December 2011 and January 2013. Results19 women underwent RSS-H (cases) and 38 patients were submitted to LESS-H (controls) for early endometrial cancer. Pre-surgical procedures (port placement and docking) required a median time of 8min in the RSS-H group and a median time of 2min in the LESS-H group (p=0.0001). The median estimated blood loss was 75ml in the cases and 30ml in the controls (p=0.005). The median operative time, calculated from the beginning of intraperitoneal procedures to the skin closure, was 90min in the cases and 107ml in the controls (p=ns). The median time to discharge from the hospital was postoperative day two for both techniques. ConclusionsThe few differences we registered do not seem clinically relevant, thus making the two procedures comparable.

Robotic Single-site Hysterectomy in Low Risk Endometrial Cancer: A Pilot Study

To evaluate the feasibility and the safety of robotic single-site hysterectomy (RSSH) in low risk early endometrial cancer. Patients with clinical low risk early endometrial cancer were enrolled onto a prospective cohort trial. All surgical procedures were performed through a single 2-2.5cm umbilical incision, with a multichannel system consisting of a five-lumen port providing access for two single-site instruments (da Vinci Si Surgical System, Intuitive Surgical, Sunnyvale, CA), the 8.5mm 3D HD endoscope, a 5/10mm accessory port, and an insufflation adaptor. Between December 2011 and June 2012, a total of 17 patients were included in our pilot study. The median age of the patients was 64years (range, 42-84years), and median body mass index was 26.6kg/m(2) (range, 18-52kg/m(2)). One patient was excluded from the study as a result of pelvic metastasis during inspection of abdominal cavity, and another patient was converted to vaginal surgery as a result of problems of hypercapnia. The median docking time, console time, and total operative time was 8min (range, 5-14min), 48min (range, 45-51min), and 90min (range, 70-147min), respectively. The median blood loss was 75mL (range, 50-150mL). No laparoscopy/laparotomy conversion was registered. The median time to discharge was 2days (range, 1-3days). Neither intraoperative nor postoperative complications occurred. At a median of 7.5months' follow-up, all patients were disease-free. RSSH is technically feasible in patients affected by low risk early endometrial cancer. Additional studies with gynecologic oncologic cases should be performed to explore the possible benefits of RSSH.

Robotic single-site hysterectomy: feasibility, learning curve and surgical outcome

The field of laparoscopy has undergone several changes to improve the morbidity and cosmesis of laparoscopic surgery. The robotic single-site surgery is the inevitable hybridization of robotic technology with laparoendoscopic single-site surgery. Perioperative information of 12 robotic single-site hysterectomies (R-SSH) were collected to evaluate the surgical feasibility and the possible influence of the body mass index (BMI) and the uterine weight on operative times. The mean operative time was 85 ± 33 min (range, 355 to 149 min), the mean docking time was 9 ± 3 min, and the mean console time was 76 ± 33 min. The mean blood loss was 80 ± 18 mL, and the median weight of resected uteri was 220 ± 45 g. No serious postoperative complications occurred. The CUSUM learning curve was observed to consist of two different phases: phase 1 (the initial 6 cases) and phase 2 (the last 6 cases) with significant reduction in operative and console time observed between the two phases. For BMI, no correlation was found with operative times, console times, and docking times, and no correlation was found between uterine weight and operative time. This series, identifying two different phases of the learning curve and suggesting that the initial learning phase for the procedure can be achieved after six cases, confirms the feasibility and safety of a robotic approach for single-site hysterectomy. However, the limits of this study mainly rely on the limited casuistic and short follow-up, although the preliminary results appear promising. Larger series and prospective studies comparing R-SSH hysterectomy with standard robotic multiport hysterectomy are necessary to define properly the role of this innovative surgical technique.