Feasible Techniques Named "Pure" Robotic Simple Hysterectomy With 4 Robotic Arms "4+0" Mode for Hysterectomy in da Vinci Xi.

Introduction: The three-arm approach is mainly selected, despite the multiple robotic arms in da Vinci Xi. This type of surgical setup may provide less autonomy to the console surgeon and result in greater dependence on the bedside surgical assistant. Therefore, the 4th arm is used instead of the assist port, which is why we developed "pure" robot simple hysterectomy (PRSH) as a novel surgical technique, in which all ports are operated by robotic arms.

Materials And Surgical Technique: After pneumoperitoneum was established, trocars were inserted under visual control: three 8 mm robotic ports on the same horizontal line spaced 8 cm apart at the level of the endoscope port. The 2nd arm was used to insert the endoscope, and the fenestrated bipolar forceps in the 1st arm and Maryland bipolar forceps in the 3rd arm were operated using the double bipolar method. In this technique, the uterine manipulator is not used because the Cadiere forceps in the 4th arm manipulate the uterus. For suturing, the 3rd arm was equipped with a SutureCut needle driver from Maryland bipolar forceps, which enabled suturing and thread cutting. Suction and intra-abdominal transport of the needle was introduced into the abdominal cavity by pulling out the instrument in the 3rd arm. Hence, since all robotic arms are used for all ports, we named this technique "pure" robot simple hysterectomy.

Discussion: The routine use of a fourth robotic arm "4+0" mode during PRSH provides the operating surgeon with greater independence during critical phases of the procedure without requiring a uterine manipulator and assistant.

Trial Registration: 5043-03.