Surgical Endoscopy

, Volume 27, Issue 7, pp 2638–2643

Robotic single-site hysterectomy: feasibility, learning curve and surgical outcome

  • V. Cela
  • L. Freschi
  • G. Simi
  • M. Ruggiero
  • R. Tana
  • N. Pluchino
New Technology



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.


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.


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.


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.


Single-site Robotic Feasibility Learning curve Hysterectomy 


  1. 1.
    Spana G, Rane A, Kaouk JH (2011) Is robotics the future of laparoendoscopic single-site surgery (LESS)? BJU Int 108:1018–1023PubMedCrossRefGoogle Scholar
  2. 2.
    Konstantinidis KM, Hirides P, Hirides S, Chrysocheris P, Georgiou M (2012) Cholecystectomy using a novel Single-Site® robotic platform: early experience from 45 consecutive cases. Surg Endosc 26:2687–2694PubMedCrossRefGoogle Scholar
  3. 3.
    Nam EJ, Kim SW, Lee M, Yim GW, Paek JH, Lee SH, Kim S, Kim JH, Kim JW, Kim YT (2011) Robotic single-port transumbilical total hysterectomy: a pilot study. J Gynecol Oncol 22:120–126PubMedCrossRefGoogle Scholar
  4. 4.
    Haber GP, White MA, Autorino R, Escobar PF, Kroh MD, Chalikonda S, Khanna R, Forest S, Yang B, Altunrende F, Stein RJ, Kaouk JH (2010) Novel robotic da Vinci instruments for laparoendoscopic single-site surgery. Urology 76:1279–1282PubMedCrossRefGoogle Scholar
  5. 5.
    Pietrabissa A, Sbrana F, Morelli L, Badessi F, Pugliese L, Vinci A, Klersy C, Spinoglio G (2012) Overcoming the challenges of single-incision cholecystectomy with robotic single-site technology. Arch Surg 147:709–714PubMedCrossRefGoogle Scholar
  6. 6.
    Escobar PF, Knight J, Rao S, Weinberg L (2012) Da Vinci® single-site platform: anthropometrical, docking and suturing considerations for hysterectomy in the cadaver model. Int J Med Robot 8:191–195PubMedCrossRefGoogle Scholar
  7. 7.
    Kaouk JH, Goel RK (2009) Single-port laparoscopic and robotic partial nephrectomy. Eur Urol 55:1163–1169PubMedCrossRefGoogle Scholar
  8. 8.
    Bokhari MB, Patel CB, Ramos-Valadez DI, Ragupathi M, Haas EM (2011) Learning curve for robotic-assisted laparoscopic colorectal surgery. Surg Endosc 25:855–860PubMedCrossRefGoogle Scholar
  9. 9.
    Buchs NC, Pugin F, Bucher P, Hagen ME, Chassot G, Koutny-Fong P, Morel P (2012) Learning curve for robot-assisted Roux-en-Y gastric bypass. Surg Endosc 26:1116–1121PubMedCrossRefGoogle Scholar
  10. 10.
    Escobar PF, Kebria M, Falcone T (2011) Evaluation of a novel single-port robotic platform in the cadaver model for the performance of various procedures in gynecologic oncology. Gynecol Oncol 120:380–384PubMedCrossRefGoogle Scholar
  11. 11.
    Escobar PF, Haber GP, Kaouk J, Kroh M, Chalikonda S, Falcone T (2011) Single-port surgery: laboratory experience with the daVinci single-site platform. JSLS 15:136–141PubMedCrossRefGoogle Scholar
  12. 12.
    Weinberg L, Rao S, Escobar PF (2011) Robotic surgery in gynecology: an updated systematic review. Obstet Gynecol Int 852061 doi: 10.1155/2011/852061
  13. 13.
    Verit A, Rizkala E, Autorino R, Stein RJ (2012) Robotic laparoendoscopic single-site surgery: from present to future. Indian J Urol 28:76–81PubMedCrossRefGoogle Scholar
  14. 14.
    White MA, Haber GP, Autorino R, Khanna R, Altunrende F, Yang B, Stein RJ, Kaouk JH (2010) Robotic laparoendoscopic single-site surgery. BJU Int 106(6 Pt B):923–927PubMedCrossRefGoogle Scholar

Copyright information

© Springer Science+Business Media New York 2013

Authors and Affiliations

  • V. Cela
    • 1
  • L. Freschi
    • 1
  • G. Simi
    • 1
  • M. Ruggiero
    • 1
  • R. Tana
    • 1
  • N. Pluchino
    • 1
  1. 1.Division of Gynecology and ObstetricsUniversity of PisaPisaItaly

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