Safety of Continuous Force Feedback in Robotic Hysterectomy and Myomectomy

초록

Background and Objectives: United States labeling of the newest robotic surgical platform contraindicates the use of force feedback instruments during hysterectomy and myomectomy because of a theoretical, clinically unexamined bleeding risk. We describe real-world outcomes and quantified intraoperative force during continuous force feedback use throughout these procedures, including closure, in a setting where this restriction does not apply. Methods: This single-surgeon observational cohort comprised 93 consecutive patients undergoing robotic hysterectomy or myomectomy between December 2024 and April 2026, classified into 3 groups: force feedback active throughout (43), the same instruments with the feature disabled (13), and conventional instruments (37). The primary outcome was a composite of vaginal cuff dehiscence, uterine wound disruption, or readmission or reintervention for bleeding within 30 days. Results: Baseline characteristics were comparable across groups. Mean intraoperative force in the active group was 2.1 newtons for hysterectomy and 2.2 newtons for myomectomy. The composite event occurred in 1 of 43 active-group patients (a readmission for bleeding) and in no patient in the other groups; no cuff dehiscence or uterine wound disruption occurred in any group. After adjustment for procedure, higher mean force was associated with shorter operative time. Conclusion: Continuous force feedback through the closure phases of robotic hysterectomy and myomectomy was not associated with cuff dehiscence or uterine wound disruption, and mean operative force clustered near 2 newtons. These hypothesis-generating findings warrant larger studies before safety equivalence can be inferred.

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