Comparing Two Types of Robotic Single-Site Myomectomy Using Propensity Score Matching: Coaxial with da Vinci Xi vs. da Vinci SP System

TL;DR

This study compares two robotic systems for single-site myomectomy, finding that one system results in less blood loss and shorter surgery time, though hospital stay is shorter with the other.

Contribution

The study introduces a direct comparison of coaxial robotic myomectomy using the da Vinci Xi and SP systems using propensity score matching.

Findings

Coaxial RSSM had significantly lower blood loss and shorter operative time compared to the SP system.

The SP system was associated with a shorter hospital stay compared to coaxial RSSM.

No significant differences were found in postoperative complications between the two groups.

Abstract

Background: This study was designed to evaluate and contrast the surgical outcomes between coaxial robotic single-site myomectomy (RSSM) performed using the da Vinci Xi system and da Vinci SP system. Methods: A retrospective review was conducted on 81 women who underwent coaxial RSSM and 108 women who underwent myomectomy with the da Vinci SP system between October 2020 and January 2024. Propensity score matching was performed based on myoma count, the dominant myoma’s maximum diameter, and the myoma type according to the International Federation of Gynecology and Obstetrics (FIGO) classification. Patient characteristics and surgical outcomes were evaluated and compared between the two groups. Results: Compared to the SP group, the coaxial RSSM group showed significantly lower estimated blood loss (102.33 ± 61.01 vs. 203.98 ± 163.15 mL, p < 0.001), shorter operative time (91.22 ± 18.25 vs. 148.69 ± 45.62 min, p < 0.001), and smaller hemoglobin decrement (1.69 ± 0.93 vs. 2.85 ± 1.30, p < 0.001). However, hospital stay was shorter in the SP group than in the coaxial group (2.06 ± 0.24 vs. 4.07 ± 0.76 days, p < 0.001). There were no statistically significant differences in postoperative complications, including ileus, fever, or wound dehiscence. Additional comparisons using cases performed by four different surgeons yielded results consistent with the one-to-one surgeon comparison. Conclusions: Coaxial RSSM was associated with a shorter operative time and lower blood loss compared to SP myomectomy. A prospective study is warranted to validate and further compare the surgical outcomes of the two techniques.

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