Perioperative Outcomes Following Single Port Versus Traditional Multiport Robotic Hysterectomy With Concomitant Sacrocolpopexy

INTRODUCTION: The Da Vinci single port (SP) robotic platform advanced minimally invasive surgery by overcoming ergonomic challenges of single site approach while maintaining the advantages of single incision surgery. Literature comparing SP robotic surgery to the traditional multiport (TMP) robotic approach is limited. OBJECTIVE: To determine differences in postoperative pain following SP versus TMP robotic hysterectomy with concomitant sacrocolpopexy. METHODS: We performed a retrospective cohort study at a single tertiary care center between December 2021 and February 2023 of women undergoing SP and TMP robotic hysterectomy with concomitant sacrocolpopexy for prolapse. As part of postoperative follow-up, all patients receive a telephone call on postoperative day (POD) 1. Further postoperative office visits are scheduled at 2 and 14 weeks after surgery either in-person or via telemedicine. Participant demographics, clinical characteristics, and perioperative outcomes were abstracted from the electronic medical record. The primary objective was to identify differences in postoperative pain within the post-anesthesia care unit (PACU) and on POD1. A 1- to 10-point pain visual analogue scale was utilized to determine subjects’ pain. Surgical outcomes, adverse events, and recurrent prolapse were analyzed as secondary objectives. Recurrent prolapse was defined as new bothersome vaginal bulge symptoms, evidence of prolapse beyond the hymen at postoperative exam, or retreatment for prolapse. Group comparisons were performed using chi-square test for categorical variables. Continuous variables were compared using independent Student’s t-test or Mann-Whitney U test depending on data distributions. Logistic regression was performed to determine the association between SP robotic hysterectomy with concomitant sacrocolpopexy and postoperative pain after controlling for potential confounding variables. Backward selection was performed to determine variables for inclusion. Variables with p<0.10 on bivariate analysis were included. RESULTS: 134 women underwent robotic hysterectomy with sacrocolpopexy: 66 (49.3%) on SP and 68 (50.7%) on TMP robotic platforms. Participants in the SP cohort were younger (58.2 years +10.9 versus 61.4 +9.6, p=0.03) and leaner (BMI 25.4 kg/m2 + 4.0 versus 27.6 + 4.6, p=0.002). Pain scores were low across the cohort, but median (range) PACU pain scores were lower in the SP cohort (2 (0–8) versus 4 (0–8), p<0.001) compared to TMP. There were no differences in pain scores at the postoperative visits. On backward logistic regression, SP robotic hysterectomy with concomitant sacrocolpopexy was associated with lower PACU pain scores (aOR 0.78, 95% CI 0.65–0.95), younger age (aOR 0.96, 95% CI 0.92–0.99), and lower BMI (aOR 0.87, 95% CI 0.78–0.95). CONCLUSIONS: SP robotic surgery offers improved immediate postoperative pain control compared to TMP robotic approach following hysterectomy with concomitant sacrocolpopexy. There were no differences in adverse events or recurrent prolapse in the immediate post-op period. SP robotic approach is a safe, feasible alternative to TMP with advantages in improved pain after surgery (Tables 1 and 2).