Abstract
BACKGROUND: The main characteristics of the robotic surgical system include high-definition three-dimensional imaging, flexible and stable instruments, and an ergonomic console design. Incorporating robotic systems with laparoendoscopic single-site surgery (LESS) represents a promising concept to restore the operational triangulation, enhance surgical dexterity and precision, and reduce surgeons' fatigue, thereby improving surgical safety and efficacy. The objective of this study was to prove the feasibility, safety and efficacy of robotic LESS (R-LESS) using the da Vinci Xi surgical system in gynecology. METHODS: This was a retrospective study conducted at a tertiary hospital. We reviewed and descriptively analyzed patients' demographics and perioperative outcomes of all benign and malignant R-LESS procedures performed at West China Second University Hospital between April 28, 2021 and September 30, 2023. RESULTS: A total of 721 patients underwent R-LESS during the study period. In the 400 benign cases, the median operative time was 145.0 (115.0, 180.8) minutes with 45.0 (20.0, 60.0) mL blood loss. Two cases (0.5%) required an additional port, and 1 (0.3%) converted to laparotomy. The intraoperative complication rate was 1.0%. These patients were discharged at a median length of 4.0 (3.0, 5.0) days postoperatively, and the mean pain score at 24 h after surgery was 2.0 ± 0.8. The postoperative complication rate within 3 months was 2.3%. In the 321 malignant cases, the median operative time was 218.0 (170.0, 282.0) minutes with blood loss of 50.0 (50.0, 100.0) mL. The intraoperative complication and conversion rates were 2.8% and 1.9%, respectively.The median hospital stay was 5.0 (4.0, 6.0) days and the pain assessment at 24 h postoperatively was 2.0 ± 0.7. The postoperative complication rate within 3 months was 13.1%. CONCLUSIONS: R-LESS using the da Vinci Xi system is feasible and safe in performing various gynecologic procedures, especially complex cases, where the surgical challenges of LESS are significantly mitigated with robotic assistance. CLINICAL TRIAL NUMBER: Not applicable.