Comparative operative performance of three robotic platforms in benign gynecologic surgery: a single-surgeon retrospective cohort study.

This single-surgeon retrospective cohort study compared operative efficiency and perioperative outcomes among the da Vinci Xi, Hugo RAS, and da Vinci SP platforms in 218 women undergoing robotic hysterectomy or myomectomy for benign disease. The primary outcome was console time; secondary outcomes included operative time, estimated blood loss, length of stay, and complications. Hysterectomy models were adjusted for age, obesity, and total specimen weight. Myomectomy models additionally accounted for the number of myomas and maximum myoma diameter. Adjusted hysterectomy console times were 96.3 min (SP), 95.6 min (Hugo), and 136.5 min (Xi); Xi was significantly longer than SP (P = .001). Adjusted myomectomy console times were 107.6, 97.9, and 140.6 min, respectively, with no significant difference between SP and Hugo (P = .86) or between SP and Xi (P = .22). Adjusted estimated blood loss did not differ significantly from SP in hysterectomy. In myomectomy, estimated blood loss was higher with Hugo than with SP (415.8 vs. 191.1 mL; P = .04), whereas Xi did not differ from SP (P = .45). Length of stay and short-term complication rates did not differ significantly, although the study was not designed to establish equivalence. Platform-associated differences were procedure-specific and sensitive to adjustment for case complexity.