title: Robotic single-site hysterectomy: feasibility, learning curve and surgical outcome.
abstract: BACKGROUND
  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.
  
  
  METHODS
  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.
  
  
  RESULTS
  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.
  
  
  CONCLUSIONS
  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.
authors: Division of Gynecology and Obstetrics, University of Pisa, Pisa, Italy.
authors: V
authors: V
authors: Cela
authors: L
authors: L
authors: Freschi
authors: G
authors: G
authors: Simi
authors: M
authors: M
authors: Ruggiero
authors: R
authors: R
authors: Tana
authors: N
authors: N
authors: Pluchino
mesh_terms: D016063:Blood Loss, Surgical; D015992:Body Mass Index; D005240:Feasibility Studies; D005260:Female; D006801:Humans; D007044:Hysterectomy / Q000379:methods*; D010535:Laparoscopy; D059032:Learning Curve; D007902:Length of Stay; D008875:Middle Aged; D061646:Operative Time; D009929:Organ Size; D063868:Patient Outcome Assessment; D012371:Robotics; D014599:Uterus / Q000473:pathology / Q000601:surgery
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