Robotic gynecologic surgery in Saudi Arabia: a descriptive retrospective cohort study of contemporary second-decade perioperative outcomes.

BACKGROUND/AIM: Following early feasibility reports in 2010, this retrospective cohort study evaluates contemporary robotic gynecologic outcomes after ten years of institutional integration. We aim to assess perioperative safety and explore clinical trends associated with adverse events during this phase at a Saudi tertiary center.

PATIENTS AND

METHODS

A retrospective cohort study of robotic-assisted surgeries performed between January 2018 and December 2020 at King Saud University Medical City, Riyadh. Adult women (N=112) undergoing elective robotic surgery for benign (e.g., symptomatic fibroids, AUB) or malignant conditions were included. We excluded emergency cases, patients scheduled for primary open/laparoscopic approaches, and those with incomplete perioperative records. Data on demographics, surgical metrics (OR time, blood loss), and complications were analyzed using binary logistic regression (p < 0.05) to identify risk factors.

RESULTS

Among 112 patients (mean age 56.9 years, mean BMI 36.67 kg/m2), 72.3% had prior abdominal surgeries and 54.5% had multiple comorbidities. The conversion rate to laparotomy was 0%. Indications included abnormal uterine bleeding (28.6%), endometrial cancer (27.7%), and hyperplasia (17%). Median blood loss was 100 mL, and the mean operation duration was 142 minutes. Most patients (75.9%) were discharged within one day. Five complications occurred (4.5%): two gastrointestinal, two bladder injuries, and one hernia/obstruction. Univariate analysis identified potential exploratory associations between perioperative events and prior cesarean sections (p=0.048), blood loss (p=0.016), and operating room (OR) duration (p=0.005). Due to the low event rate (4.5%), a multivariate model could not reliably confirm independent risk factors.

CONCLUSION

This second-decade experience demonstrates a high level of safety and technical feasibility in robotic gynecology. The zero conversion rate and low overall morbidity, even in high-BMI and multi-scarred patients, affirm robotic surgery as a dependable primary modality. The identified risk factors should be interpreted strictly as exploratory trends for perioperative planning rather than definitive predictors.