Clinical outcomes and hospital-based cost avoidance of single-port robotic surgery in gynecology: a large comparative cohort study.

Single-port robotic surgery is increasingly used in gynecologic practice, yet large-scale comparative data describing both postoperative outcomes and the downstream use of hospital resources remain limited. In this study, we aimed to investigate postoperative outcomes and hospital-based economic analysis in single-port robotic surgery and laparoscopic surgery through a large-scale retrospective analysis. We retrospectively evaluated 8,243 consecutive patients who underwent minimally invasive surgery for benign or malignant gynecologic disease at Keimyung University Dongsan Hospital from April 2019 through December 2024. Conventional laparoscopy was performed in 6,109 patients and robotic-assisted surgery using the da Vinci Xi single-site or da Vinci SP platform in 2,134. Length of stay, transfusion, surgical site infection, postoperative complications, mortality, operative and anesthesia times, and 30-day readmission were compared. Hospital-based cost avoidance was estimated from differences in readmission, complications, and length of hospitalization. Compared with laparoscopy, robotic surgery was associated with shorter total hospitalization (2.54 vs. 3.18 days, P < 0.001) and postoperative stay (2.38 vs. 2.90 days, P < 0.001). Transfusion was less frequent after robotic surgery (0.6% vs. 2.5%, P < 0.001), whereas surgical site infection, postoperative complications, mortality, patient-controlled analgesia use, and 30-day readmission did not differ significantly. Operative room and anesthesia times were each approximately 8 min longer in the robotic group. Across 2,134 robotic procedures, differences in postoperative resource use corresponded to an estimated hospital-based medical cost avoidance of US$171,469 (US$80.4 per patient), with reduced length of stay accounting for more than 84% of the total. In this large real-world cohort, single-port robotic surgery was associated with shorter hospitalization and a lower transfusion rate than conventional laparoscopy, without a detectable increase in major perioperative adverse outcomes. The observed reduction in postoperative resource use was also associated with measurable hospital-based cost avoidance. These findings support further prospective evaluation of the clinical and economic value of single-port robotic surgery.