Robotic single-site surgery versus laparo-endoscopic single-site surgery in ovarian cystectomy: A retrospective analysis in single institution

Abstract

Objective: Robotic single-site (RSS) surgery is being utilized in gynecologic surgery. However, its cost-effectiveness and limitations of the system make the application of the technique to benign surgery controversial. We compared the surgical outcome and learning curve of RSS to those of laparoendoscopic single-site (LESS) surgery. Methods: Patients who underwent ovarian cystectomy from January 2013 to December 2018 at Korea University Anam Hostital were divided into two groups according to the surgery: RSS or LESS. After exclusion of ineligible patients, 29 patients who underwent RSS surgery and 80 patients who underwent LESS surgery were included in this study. Surgical outcome data regarding bleeding, surgical time, length of stay, and the learning curves of surgical time were obtained using the cumulative sum method. Results: Patient demographics showed no differences between the groups except for tumor histology. There were no differences in bleeding, postoperative length of stay, surgical wound complication, or surgical preparation time between the groups. RSS surgery had a longer surgical time than LESS surgery (130.41 vs. 96.96 minutes; P<0.001). In a learning curve analysis, seven cases were required to be proficient in docking the RSS system. Comparing the learning curves of surgical time, RSS surgery required fewer cases to attain proficiency than LESS surgery (19 vs. 22 cases). Conclusion: RSS ovarian cystectomy is a feasible and safe option with the benefit of a quick learning curve. The longer surgical time could be overcome with further improvement of surgical techniques and development of the robotic instruments.