To discuss the application value of robotic-assisted surgery in difficult hysterectomy and summarize the surgical technique.

We retrospectively analyzed the hysterectomy cases performed by the same surgeon in the Seventh Medical Center of Chinese PLA General Hospital from Apr. 2021 to Jun. 2023. Clinical data such as demographic characteristics, parameters of uteri, and intraoperative and postoperative details was described.

The average age of 24 patients was 47.50 years and the average BMI value was 24.62 kg/m². 11 patients had a history of abdominal surgery and 5 had a history of myomectomy. 66.67% of the patients were found uterine size exceeding 16 weeks of pregnancy before surgery, and the average weight of the uteri measured after surgery was 752.58 g, with the maximum weight reaching 2650 g. The median operation time of all patients was 136.50 min, and the median bleeding volume was 150 ml. Only 1 patient was converted to laparotomy. The postoperative venting time was 1-2 days, and the mean length of postoperative hospital stay was 5.63 days. The complications in 4 patients included vaginal stump bleeding, pneumothorax, lower limb intermuscular thrombosis and residual ovarian syndrome. No patient had urinary and intestinal injuries.

Surgical robot has a clear and enlarged 3D field of view, a flexible and powerful robotic arm with the function of filtering tremors, which brings innovations in field of view amplification, operational flexibility and stability. It could help to decrease blood loss, reduce complications and accelerate postoperative recovery, so it has certain advantages in difficult hysterectomy.