Surgical outcomes for robotic-assisted single-site hysterectomy compared to multi-port hysterectomy

Background: Data regarding the use of single-site robotic surgery in gynecology remains limited, but the approach is anecdotally felt to be beneficial to patients. This study aims to assess the surgical outcomes of robotic-assisted single-site hysterectomy (SSH) and multi-port hysterectomy (MPH). Methods: Data were obtained via retrospective chart review of eligible patients from a single academic health care system who underwent surgery between October 2013–June 2022. During this time, 127 SSH and 445 MPH were performed. Results: 78% of SSH patients had a normal or overweight body mass index (BMI) compared to 49% of MPH patients (p < 0.001). 28% of SSH patients had a preoperative cancer diagnosis compared to 58% of MPH patients (p < 0.001). There were no differences in average number of prior abdominal surgeries (p = 0.838). Median operative time was 118 minutes for SSH compared to 162 minutes for MPH (p < 0.001). 23% of SSH patients were discharged on the day of surgery compared to 8% of MPH patients (p < 0.001). The plurality (47%) of SSH patients had blood loss of <50 mL compared to 50–100 mL for the plurality (36%) of MPH patients (p < 0.001). 7% of patients undergoing MPH experienced major complications compared to 2% of patients undergoing SSH (p = 0.025). Propensity score matched results using a 1:1 model were consistent with the overall analysis and prior findings, demonstrating statistically significant differences in median operative times, blood loss and lengths of postoperative stay between SSH and MPH patients. Conclusions: SSH has overall good outcomes, with this study demonstrating decreased operative times, decreased blood loss, lower rates of major complications and shorter lengths of postoperative stay when compared to MPH. SSH may be an alternate surgical modality with utility in risk-reducing, precancerous, or early-stage cancer in gynecologic patients.