Comparison of hysterectomy using four different robotic surgical systems; a retrospective cohort study.

Robot-assisted surgery has become a cornerstone of minimally invasive gynecologic procedures. While the da Vinci system has long dominated the field, new robotic platforms, such as hinotori™ and Hugo™, have recently been introduced, expanding surgical options. However, no previous study has directly compared surgical outcomes across these four systems. This study aimed to evaluate and compare the perioperative outcomes of four robotic systems-da Vinci X, da Vinci Xi, hinotori™, and Hugo™-in total hysterectomies. We conducted a retrospective analysis of patients who underwent robotic-assisted total hysterectomy at Tottori University Hospital between April 2019 and January 2025. Patients were categorized into four groups based on the robotic system used. Key surgical parameters, including operative time, blood loss, complication rates, and hospital stay, were analyzed. Subgroup analyses were also performed, including comparisons limited to robot-assisted total laparoscopic hysterectomy without lymphadenectomy and the first 10 cases following the introduction of each system. A total of 293 patients were included. No significant differences were observed among the four systems in terms of operative time, blood loss, or complication rates in the overall cohort analysis or the robot-assisted total laparoscopic hysterectomy subgroups. In the early-case subgroup, Hugo showed a significantly shorter pre-console time, while hinotori demonstrated a significantly shorter console time, both compared to Xi. Total hysterectomy can be safely and effectively performed using all four robotic platforms.