Single-port versus multiport robotic hysterectomy for large myomatous uteri: a comparison of operative time and perioperative outcomes.

Data comparing single-port (SP) and multiport (MP) robotic hysterectomy for enlarged myomatous uteri (≥ 250 g) remain limited. We aimed to compare operative time between SP and MP robotic hysterectomy, and to assess differences in perioperative outcomes in this setting. In this retrospective, single center cohort study, we reviewed 48 patients who underwent robotic hysterectomy for benign leiomyomas with a uterine weight ≥ 250 g at Mayo Clinic Arizona between January 2020 and May 2026. Patients were divided into single-port (SP, n = 21) and multiport (MP, n = 27) groups. The primary outcome was operative time; secondary outcomes included estimated blood loss, postoperative pain, complications, and length of stay. Multivariable regression and weight-stratified comparisons were performed. Baseline characteristics, including age, body mass index, parity, comorbidity indices, and uterine weight, were comparable between the groups (all p > 0.05). Operative time was similar between the SP and MP groups (181.2 ± 43.9 vs. 173.7 ± 46.6 min; p = 0.574), as were estimated blood loss, postoperative pain, 30-day complications, same-day discharge, and length of stay. Transumbilical specimen extraction was more frequent in the SP group (71.4% vs. 25.9%; p = 0.003). In multivariable analysis, uterine weight (β = 7.5 min per 100 g; p < 0.001) and operating surgeon (p < 0.001) independently predicted operative time, whereas surgical approach did not (p = 0.532); the surgeon-associated difference exceeded the difference between approaches, and all procedures were performed by two surgeons. In exploratory subgroup analyses, no significant difference in operative time was detected across uterine weight categories; however, these subgroups were small. For large uteri, SP robotic hysterectomy showed no statistically significant difference from the MP approach in operative time or perioperative outcomes, with operative time driven by uterine weight and surgeon rather than approach. No safety signal was identified in this series, and the approach appeared feasible, without an observed increase in perioperative complications, for the experienced robotic surgeon.