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Robotic Single Incision Total Laparoscopic Hysterectomy: A Novel New Surgical Technique

Study Objective: The primary goal of this study was to determine the feasibility of using the da Vinci Surgical System to perform a single incision Total Laparoscopic Hysterectomy.

Design: Careful patient selection and counseling was employed to identify a patient with a benign indication for a laparoscopic hysterectomy, and no prior abdominal surgery. Outcome was compared to historical controls for total laparoscopic hysterectomy.

Setting: Major urban hospital with advanced laparoscopic and robotic technology and trained staff.

Patients: One patient appropriately counseled to undergo a robotic single incision total laparoscopic hysterectomy.

Intervention: Robotic single incision total laparoscopic hysterectomy.

Measurements and Main Results: A preliminary evaluation reveals that a robotic single total laparoscopic hysterectomy can be done safely and effectively. Blood loss, postoperative pain, recovery and convalescence were similar to that of total laparoscopic hysterectomy. Number of incisions and scaring was reduced. However operating room time was significantly longer. Prolongation was thought to be due to difficulty maintaining pneumoperitoneum and vaginal cuff closure.

Conclusion: These findings suggest that robotic single incision total laparoscopic hysterectomy may be a safe alternative to traditional laparoscopic hysterectomy. However increased operating room time may be a limiting factor. Improvement in pneumoperitoneum and vaginal cuff closure may enhance operative efficiency. Additional study is needed.