Comparative analysis of nerve-sparing modified radical hysterectomy for deep endometriosis using the da Vinci SP versus Xi systems.

This study compared surgical approaches and perioperative outcomes of nerve-sparing modified radical hysterectomy (NSmRH) for deep endometriosis (DE) using the da Vinci SP and Xi systems. This retrospective cohort study included consecutive patients who underwent robot-assisted NSmRH for DE at a single tertiary referral center between March 2020 and October 2025. Disease severity was evaluated using the revised American Society for Reproductive Medicine (rASRM) and #Enzian classifications, and perioperative outcomes—including operative time (OT), console time (CT), docking time (DT), estimated blood loss (EBL), and complications—were compared. The analysis included 100 patients: 32 in the SP group and 68 in the Xi group. Advanced disease was prevalent in both cohorts, with rASRM stage IV observed in 72% of the SP group and 70% of the Xi group. The distribution of #Enzian classifications was comparable between groups. Median OT and CT did not differ significantly between groups (OT: 159 [123–196] vs. 144 [122–164] min, p = 0.16; and CT: 144 [101–180] vs. 130 [108–153] min, p = 0.22), whereas DT was shorter in the SP group (1.8–2.0 vs. 2.0–3.0 min, p = 0.0036). EBL was significantly lower in the SP group (5 vs. 15 mL; p = 0.0015). No intraoperative injuries, severe postoperative complications, or voiding dysfunction were observed in either group. NSmRH for DE was performed safely using both SP and Xi systems. These findings indicate that the SP system represents a feasible alternative robotic platform for selected high-complexity nerve-sparing procedures in DE.