Robotic single-port (da Vinci SP) versus multiport (da Vinci Xi) for the treatment of atypical endometrial hyperplasia and endometrial cancer: A multi-institutional comparison of surgical outcomes

Introduction: The da Vinci SP robotic platform offers a novel single-port approach for minimally invasive surgery. Despite its potential, data on its safety and performance in gynecologic oncology remain limited. We aimed to compare surgical outcomes of da Vinci SP versus da Vinci Xi systems in the staging of endometrial cancer (EC). Methods: This is a multi-institutional study. Data of consecutive patients with apparent early-stage EC or atypical endometrial hyperplasia who underwent robotic surgery between January 2023–March 2025 were collected. The primary outcome was to compare the surgical outcomes between da Vinci SP and da Vinci Xi. Results: A total of 189 patients were included: 97 (51.3 %) underwent SP surgery and 92 (48.7 %) Xi. The median (range) of operative time, estimated blood loss, and postoperative hospital stay were comparable for SP and Xi groups (140 [70–296] vs. 143 [60–297] min, p = 0.66, 40 [0–250] vs. 64 [0–1300] mL, p = 0.12, 3 [1–11] vs. 3[1–10] days, p = 1). Docking time was significantly shorter in the SP group (10 [4–31] vs. 12 [7–30] min for SP and Xi, respectively, p = 0.004). Intraoperative or post-operative complications rates were comparable (p = 0.30 and p = 0.14,respectively). The patient-reported pain score was significantly lower at 12h and 24h in the Xi group (p = 0.001), while was comparable at 48h after surgery (p = 1). Conclusion: The da Vinci SP system appears to be non-inferior to the multiport da Vinci Xi for surgical staging of early-stage EC. Comparable perioperative outcomes support its clinical use, although patient selection criteria and long-term results require further investigation.