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

Background: The primary goal of this study of 1 patient was to determine the feasibility of using the da Vinci((R)) Surgical System to perform a single-incision total laparoscopic hysterectomy. Case: Careful patient selection and counseling was used to identify a patient with a benign indication for a laparoscopic hysterectomy. The surgery was performed at a major urban hospital with advanced laparoscopic and robotic technology and trained staff. The patient was appropriately counseled to undergo a robotic single-incision total laparoscopic hysterectomy. The outcome was compared to historical controls for total laparoscopic hysterectomy. Results: The patient's blood loss, postoperative pain, recovery, and convalescence were similar to that of total laparoscopic hysterectomy. The number of incisions and scaring was reduced. However, operating room time was significantly longer. Prolongation was thought to result from difficulty with maintaining pneumoperitoneum and vaginal cuff closure. Conclusions: A robotic single-incision total laparoscopic hysterectomy can be done safely and effectively. 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.