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Robotic Hysterectomy Duration: Surgery Time

Last Updated on November 3, 2025 by mcelik

Robotic Hysterectomy Duration: Surgery Time

Robotic hysterectomy surgery is a complex procedure that requires high precision and expertise. The robotic hysterectomy duration usually ranges from 1 to 3 hours, but it can vary depending on the patient’s health and the complexity of the case.

Undergoing surgery can be intimidating, but understanding what to expect helps ease anxiety. During a robotic hysterectomy, the surgeon operates using a robotic system through small incisions. This advanced method leads to less blood loss, minimal pain, and a faster recovery compared to traditional surgical approaches.

Key Takeaways

  • The average duration of robotic hysterectomy surgery is between 1 to 3 hours.
  • The complexity of the procedure and the patient’s health can affect surgery time.
  • Robotic hysterectomy is a minimally invasive procedure with several benefits.
  • Patients can expect less blood loss and a quicker recovery.
  • The procedure requires precision and expertise.

What is a Robotic Hysterectomy?

Robotic Hysterectomy Duration: Surgery Time

A robotic hysterectomy is a surgery that uses advanced technology to remove the uterus. It’s a key part of robotic surgeries that have changed gynecology a lot.

Definition and Basic Procedure

This surgery uses a robotic platform. Surgeons make small cuts instead of big ones. They insert instruments and a camera through these cuts.

The robotic system helps surgeons move precisely and see clearly. This makes it easier to do complex surgeries.

First, the patient is prepared for surgery. Then, small incisions are made. The robotic instruments and camera are inserted. The uterus is then removed using the robotic system.

The robotic platform gives a clear, 3D view of the area. This helps surgeons remove the uterus carefully.

The da Vinci Surgical System

The da Vinci Surgical System is a top robotic platform for hysterectomies. It offers better visualization, precision, and control. The system’s robotic arms have instruments for precise movements inside the body.

A leading gynecologic surgeon says, “The da Vinci System has greatly improved our ability to do hysterectomies with less invasion and better results.”

Indications for Robotic Approach

Robotic hysterectomy is used for many gynecological issues. These include uterine fibroids, endometriosis, and some cancers. The choice to use robotics depends on the patient’s health, the condition’s complexity, and the surgeon’s skill.

  • Uterine fibroids
  • Endometriosis
  • Cancer

Robotic hysterectomy has many benefits. It leads to less blood loss, less pain, and quicker recovery than traditional surgery. As technology advances, more people and surgeons are choosing this method.

Robotic Hysterectomy Duration: What to Expect

Robotic Hysterectomy Duration: Surgery Time

When you think about robotic hysterectomy, knowing what to expect is key. The surgery’s length affects your experience, from getting ready to healing afterwards.

Average Operating Room Time

The average time in the operating room for robotic hysterectomy is 1 to 3 hours. This includes getting ready, the surgery, and the first part of recovery. Remember, this is just an average, and times can vary.

Many things affect how long the surgery takes. These include how complex the surgery is, your health, and the team’s experience.

Total Hospital Time

Don’t forget about the total time you’ll spend in the hospital. On average, you’ll stay 1 to 2 days. This lets doctors keep an eye on you and help with your recovery.

One good thing about robotic surgery is how short your hospital stay might be. It often means less damage to your body.

Factors That May Extend Duration

Some things can make your surgery longer. These include:

  • Adhesions or scar tissue from previous surgeries
  • Bleeding or hemorrhaging during the procedure
  • Equipment malfunctions or technical issues
  • Unexpected findings or complications during surgery

Knowing these factors can help you prepare better for your surgery and recovery.

Types of Robotic Hysterectomies and Their Timeframes

There are many types of robotic hysterectomies, each with its own time frame. Knowing these times is key for getting ready for surgery. Robotic hysterectomy is a modern surgery that fits different needs and conditions.

Total Hysterectomy Duration

A total robotic hysterectomy removes the uterus and cervix. It’s often done for fibroids, endometriosis, or cancer. This surgery usually lasts between 1.5 to 3 hours.

The time can change based on the patient’s health, the surgery’s complexity, and the surgeon’s skill.

Total hysterectomy is often chosen because it removes both the uterus and cervix. This is important for some medical issues.

Partial Hysterectomy Timeline

Partial or subtotal hysterectomy removes the uterus but keeps the cervix. It’s less common but used for certain reasons. The surgery usually lasts from 1 to 2.5 hours.

“The choice between total and partial hysterectomy depends on various factors, including the patient’s condition and the surgeon’s professional judgment.”

— Expert Opinion

Radical Hysterectomy Procedure Length

Radical hysterectomy removes the uterus, cervix, and nearby tissues. It’s mainly for cervical cancer or other cancers. This surgery can take 2.5 to 4 hours or more because of its complexity.

Even though it’s more complex, robotic radical hysterectomy is precise and minimally invasive. This can lead to faster recovery than traditional surgery.

Type of HysterectomyTypical DurationKey Characteristics
Total Hysterectomy1.5 – 3 hoursRemoval of uterus and cervix
Partial Hysterectomy1 – 2.5 hoursRemoval of uterus, cervix remains
Radical Hysterectomy2.5 – 4 hours or moreRemoval of uterus, cervix, and surrounding tissues

Knowing about the different robotic hysterectomies and their times helps patients prepare. It’s important to talk to a healthcare provider to find the best procedure for you.

Pre-Surgery Preparation Timeline

Knowing the timeline for pre-surgery prep can ease anxiety for those having a robotic hysterectomy. This prep time is key to making sure patients are ready physically and mentally for surgery.

Weeks Before Surgery

Weeks before the surgery, patients get tested and checked. This includes:

  • Blood tests to check for any underlying conditions
  • Imaging studies such as ultrasound or MRI to assess the uterus and surrounding structures
  • Physical examination to evaluate overall health

These tests help spot any risks and help the surgical team plan the surgery.

Day Before Surgery Preparations

The day before surgery, patients are told to eat a light meal or clear liquids. They should also:

  • Avoid certain medications that could interfere with the surgery
  • Shower or bathe with antibacterial soap to reduce the risk of infection

Following these steps carefully can help avoid complications during and after surgery.

Morning of Surgery Protocol

On the morning of surgery, patients need to arrive at the hospital on time. They should:

  • Wear comfortable, loose-fitting clothing
  • Bring necessary documents, such as insurance cards and identification
  • Follow the hospital’s protocol for check-in and preparation
Preparation StageKey Activities
Weeks Before SurgeryPreoperative testing, blood tests, imaging studies, physical examination
Day Before SurgerySpecific diet, avoid certain medications, antibacterial shower
Morning of SurgeryArrive at hospital, wear comfortable clothing, bring necessary documents

Factors Affecting Robotic Hysterectomy Procedure Time

Robotic hysterectomy times vary due to different factors. Knowing these can help patients prepare for their surgery. It also helps them understand what to expect during their stay in the hospital.

Patient-Specific Factors

Several patient-specific factors affect robotic hysterectomy times. These include the patient’s health, medical history, and the complexity of their condition. For example, patients with a history of pelvic surgery or significant adhesions may need more time.

As one study points out, “The presence of adhesions can significantly prolong the operative time due to the need for meticulous dissection.” The complexity of the case can significantly impact the surgery duration.

Surgeon Experience and Skill Level

The surgeon’s experience and skill level are key factors. More experienced surgeons are usually faster and better at handling unexpected issues. “Surgeon expertise is a critical determinant of operative time, with more experienced surgeons generally completing procedures more quickly,” it’s noted.

A skilled surgeon can significantly reduce the risk of complications and shorten the surgery time.

Hospital Protocols and Equipment

Hospital protocols and equipment quality also affect robotic hysterectomy times. Hospitals with good robotic surgery programs and modern equipment can make the process faster. Efficient hospital protocols help make sure everything is ready before surgery, leading to a smoother and possibly shorter procedure.

As noted, “Hospitals that frequently perform robotic surgeries tend to have optimized their processes, leading to shorter operative times.”

Step-by-Step Breakdown of Surgical Time

Knowing how long robotic hysterectomy surgery takes is key for patients. It helps them get ready for the surgery and what comes after. The surgery time is split into several important parts, each essential for a successful operation.

Anesthesia Administration: 15-30 Minutes

The first thing is giving anesthesia, which takes 15 to 30 minutes. This is very important. It makes sure the patient feels no pain during the surgery. Our anesthesiologists watch the patient’s health closely during this time.

Robot Setup and Docking: 15-20 Minutes

After anesthesia, the team sets up the robotic system. This takes about 15 to 20 minutes. They make sure the da Vinci Surgical System is ready for the surgery.

Core Surgical Procedure: 1-2.5 Hours

The main part of the surgery lasts from 1 to 2.5 hours. The time can vary based on the case’s complexity and the patient’s health. Our skilled surgeons use the robotic system for a precise and careful hysterectomy.

Closure and Immediate Recovery: 30-45 Minutes

Once the surgery is done, the team closes the wounds and starts recovery. This takes 30 to 45 minutes. They make sure the patient is okay and comfortable before moving them to the recovery room.

Understanding the surgical time for robotic hysterectomy helps patients see the effort and care in their treatment. Our team is dedicated to providing top-notch care at every step of the procedure.

Comparing Robotic Hysterectomy Duration with Other Methods

Robotic hysterectomy is popular for its precision and efficiency. But how does its time compare to other methods? Knowing the time needed for each surgery is key when choosing a hysterectomy.

Robotic vs. Laparoscopic: Time Differences

Robotic and laparoscopic hysterectomies are both minimally invasive. They share some similarities but differ in execution and time. Studies show robotic and laparoscopic times are similar. But robotic offers better precision and less complications.

The time in the operating room for both robotic and laparoscopic hysterectomies is 1 to 3 hours. The complexity of the case and the surgeon’s experience affect this. Robotic setup and docking add 15-20 minutes.

Surgical ApproachAverage Operating TimeSetup/Docking Time
Robotic Hysterectomy1-3 hours15-20 minutes
Laparoscopic Hysterectomy1-3 hoursMinimal

Robotic vs. Open Abdominal: Duration Comparison

Open abdominal hysterectomy is more traditional and has longer recovery times than robotic. Its surgery time is 1 to 2 hours. But, the hospital stay and recovery are longer.

Open abdominal surgery might be shorter in some cases. But robotic offers less blood loss and shorter stays, making it more appealing to many.

Robotic vs. Vaginal Approach: Efficiency Analysis

Vaginal hysterectomy is less invasive than open abdominal. Robotic and vaginal hysterectomies both have benefits. Vaginal surgery’s time varies from 30 minutes to 2 hours.

Robotic surgery is longer for setup but offers better precision. The choice between robotic and vaginal depends on the patient’s condition and the surgeon’s expertise.

In conclusion, comparing robotic hysterectomy to others requires looking at more than just surgery time. Recovery time and complications are also important. Each method has its benefits and challenges, and the right choice depends on the patient’s needs.

Recovery Timeline After Robotic Hysterectomy Surgery

Knowing the recovery timeline after robotic hysterectomy surgery is key. It helps patients plan their care after surgery. The process includes immediate care, hospital stay, recovery at home, and getting back to normal activities.

Immediate Post-Op Period: First 24 Hours

The first 24 hours after surgery are very important. Patients are watched closely for any problems. Managing pain is a top priority.

We make sure patients get the best care right away. This helps reduce pain and quickly solves any issues.

Hospital Stay Duration: 1-2 Days

Patients usually stay in the hospital for 1-2 days. This lets the medical team keep an eye on them. They manage pain and watch for any complications.

The short hospital stay is a big plus of robotic hysterectomy. It shows how minimally invasive the surgery is.

At-Home Recovery: 2-4 Weeks

After leaving the hospital, patients start their recovery at home. This can take 2 to 4 weeks. It’s important to rest, not lift heavy, and avoid hard work.

We give patients clear instructions on how to care for themselves. This helps them recover smoothly.

Return to Normal Activities Timeline

When patients can go back to normal activities varies. It depends on their health, the surgery’s complexity, and following instructions. Most can get back to normal in 4-6 weeks.

We stress the need for a slow recovery. This helps avoid problems and ensures the best results.

By knowing the recovery timeline and following care instructions, patients can recover well after robotic hysterectomy surgery. Our team is here to support and guide them every step of the way.

Benefits of Robotic Hysterectomy Related to Surgery Time

Robotic hysterectomy is precise and minimally invasive. It offers many benefits that make surgery time shorter. The robotic platform helps surgeons do complex tasks with better accuracy. This reduces the chance of problems and improves patient results.

Precision and Reduced Complications

The robotic system has high-definition 3D vision and precise tools. These tools allow for careful removal of the uterus. This precision reduces complications, which can make surgery longer and recovery harder.

Minimized Blood Loss

Robotic hysterectomy has less blood loss than traditional surgery. The robotic system’s precision and the small incisions help. This means fewer blood transfusions and a quicker recovery.

Shorter Hospital Stay

Patients who have robotic hysterectomy usually stay in the hospital shorter. The small incisions and less tissue damage mean less pain and faster healing. This lets patients go home sooner.

Faster Return to Daily Activities

The precision and less blood loss help patients return to their daily activities faster. Robotic hysterectomy’s benefits make recovery quicker. This means patients can get back to their normal lives sooner.

The benefits of robotic hysterectomy are many. They include precision, less risk of problems, less blood loss, shorter hospital stays, and quicker recovery. These advantages make robotic hysterectomy a good choice for those needing hysterectomy.

  • Precision and accuracy in surgical procedures
  • Reduced risk of complications
  • Less blood loss during surgery
  • Shorter hospital stay and recovery time
  • Faster return to normal activities

Potential Complications That May Extend Surgery Time

Several complications can make a robotic hysterectomy surgery longer. It’s important for patients to know about these factors. This knowledge helps manage expectations and prepares patients for what might happen.

Anatomical Challenges and Variations

Anatomical challenges and variations can make the surgery more complex. Patients with unique features may need more time and precision.

Adhesions from Previous Surgeries

Adhesions from past surgeries can raise the risk of complications. These adhesions can make the procedure harder, possibly making it longer.

Equipment Malfunctions

Though rare, equipment malfunctions can happen. These issues might need troubleshooting or a change in surgical approach, affecting the time needed.

Unexpected Findings During Procedure

Unexpected findings, like unseen pathology or complications, can also make the surgery longer. Surgeons must be ready to adjust their plan as needed.

To understand the impact of complications on surgery time, consider this summary:

ComplicationPotential Impact on Surgery TimeFrequency
Anatomical ChallengesIncreased complexity, potentially longer surgeryModerate
Adhesions from Previous SurgeriesMore challenging procedure, potentially longerCommon
Equipment MalfunctionsTroubleshooting required, potentially longerRare
Unexpected FindingsAdaptation required, potentially longerVariable

Knowing about these complications helps patients prepare and talk to their healthcare provider about their concerns.

Patient Experiences with Robotic Hysterectomy Timeframes

Patient stories about robotic hysterectomy offer insights into what happens during and after surgery. These experiences help others understand the process and prepare for their own surgeries.

Real Patient Testimonials

Many patients have shared their robotic hysterectomy experiences. They talk about the surgery time and recovery. For example, one patient said her 2-hour surgery was a success thanks to the robotic system.

“I was back on my feet within a few days, and my recovery was relatively smooth. The robotic hysterectomy was a game-changer for me.”

— Sarah, age 45

Jane had a 1.5-hour surgery. She liked the procedure’s minimally invasive nature and lower risk of complications.

Expected vs. Actual Surgery Duration

Patients’ experiences with robotic hysterectomy surgery times vary. Some surgeries are shorter or longer than expected.

  • Factors influencing surgery duration:The complexity of the case
  • The surgeon’s experience with robotic systems
  • The patient’s overall health

For example, a patient with past pelvic surgery might have a longer surgery due to scar tissue.

Recovery Time Experiences

Recovery times also vary. Some patients get back to normal quickly, while others take longer.

  1. Immediate recovery: Patients usually stay 1-2 days in the hospital after surgery.
  2. Short-term recovery: Most can start with light activities in 2-4 weeks.
  3. Full recovery: It can take 6-8 weeks for a full recovery, depending on individual factors.

Understanding other patients’ experiences helps prepare for robotic hysterectomy and recovery.

How Hospitals Schedule Robotic Hysterectomy Surgery

Hospitals use a detailed plan to schedule robotic hysterectomy surgeries. They consider many factors to make sure care is both efficient and effective. This process involves teamwork among different hospital departments.

Operating Room Allocation

Choosing the right operating room is key for robotic hysterectomy surgeries. Hospitals pick rooms based on when they’re free and the urgency of the surgery. This way, emergencies get done quickly, and scheduled surgeries fit in too.

Here’s what goes into picking an operating room:

  • Checking if the robotic equipment is ready
  • Working with the surgical team
  • Putting emergencies first
  • Planning to avoid delays

Surgeon Availability Factors

When it comes to scheduling, the surgeon’s availability is very important. The surgeon’s schedule and skill level help decide when the surgery will happen.

Here are the main factors for surgeon availability:

FactorDescription
Surgeon ScheduleThe surgeon’s free time based on their current work
ExpertiseThe surgeon’s experience and skill in robotic hysterectomies
On-Call StatusIf the surgeon is ready for emergencies

Emergency vs. Planned Procedures

Hospitals have to manage both urgent and planned surgeries. Urgent cases get priority, and planned ones fit in when they can.

Here’s how it works:

  • Urgent surgeries need quick action
  • Planned surgeries are scheduled when it’s possible

Multi-Disciplinary Team Coordination

Getting robotic hysterectomy surgeries scheduled right also means teamwork. This includes surgeons, anesthesiologists, nurses, and more.

This teamwork makes sure:

  • Everyone needed is ready and prepared
  • The surgery runs smoothly
  • Patients get the best care

Insurance and Cost Implications of Operation Time

When looking into robotic hysterectomy, it’s key to think about insurance and costs. The surgery’s length can greatly affect the total cost. It’s important for patients to grasp these factors.

Procedure Duration and Costs

The time a robotic hysterectomy takes can change the overall cost. Longer surgeries mean higher costs for the operating room, anesthesia, and more.

The cost of robotic hysterectomy can be between $10,000 and $20,000 or more. This depends on the hospital, location, and insurance.

Insurance Coverage Considerations

Insurance is a big factor in what patients pay for robotic hysterectomy. Most plans cover some or all costs, but coverage can vary.

  • Check your insurance provider’s policy on robotic hysterectomy
  • Understand the deductible, copayment, and coinsurance rates
  • Determine if there are any out-of-network costs

Out-of-Pocket Expenses Related to Extended Procedures

Patients might face extra costs if the surgery takes longer or if complications happen. These can include fees for more anesthesia, operating room time, and other services.

Expense CategoryAverage Cost
Operating Room Time$1,000 – $3,000 per hour
Anesthesia Fees$500 – $1,500
Surgeon’s Fees$2,000 – $5,000

Cost Comparison with Other Hysterectomy Methods

Robotic hysterectomy costs can be compared to other methods like laparoscopic or open abdominal hysterectomy. Costs differ based on procedure complexity, hospital stay, and other factors.

Cost Comparison Table

Hysterectomy MethodAverage Cost
Robotic Hysterectomy$10,000 – $20,000
Laparoscopic Hysterectomy$8,000 – $15,000
Open Abdominal Hysterectomy$12,000 – $25,000

Technological Advancements Reducing Robotic Surgery Time

The world of robotic surgery is changing fast. New technologies are making surgeries shorter and more precise. These changes are also improving how well patients do after surgery.

Evolution of Robotic Surgical Systems

The da Vinci Surgical System is a key example of how robotic surgery has improved. The latest versions, like the da Vinci Xi, let surgeons do complex tasks with better control. Advances include better dexterity, high-definition 3D views, and improved ergonomics for surgeons.

These systems are now easier to use. Surgeons can do detailed work and stitching more easily. This means surgeries take less time.

Surgeon Training Improvements

Training for surgeons is getting better with new tech. Now, they learn through simulation training. This training makes them more skilled and helps them learn new tech faster.

Virtual and augmented reality are also being used in training. These tools give surgeons a real feel of what surgery is like.

Procedural Efficiency Innovations

New ideas are making surgeries more efficient. For example, special tools and advanced imaging are making robotic hysterectomies smoother. These changes help make surgeries shorter.

InnovationDescriptionImpact on Surgery Time
Advanced ImagingHigh-resolution imaging for better visualizationReduces time spent on identifying anatomical structures
Specialized InstrumentsInstruments designed for specific tasksStreamlines procedures, reducing overall surgery time
Simulation TrainingVirtual training for surgeonsImproves surgeon proficiency, reducing errors and surgery time

By using these new technologies, we’re making surgeries better and faster. As these technologies keep getting better, we’ll see even more improvements. This will help patients all over the world.

Questions to Ask Your Surgeon About Procedure Timing

When getting ready for a robotic hysterectomy, talking to your surgeon about timing is key. Knowing what affects your surgery and recovery time helps you prepare better.

Pre-operative Time Considerations

Before surgery, it’s important to know about pre-op prep and its timing impact. Ask your surgeon about:

  • The time needed for pre-op prep, like getting anesthesia
  • Any special instructions you must follow before surgery
  • When to arrive at the hospital and when to get ready for surgery

Expected Duration of Your Specific Case

Every case is different, and surgery time can vary. Ask your surgeon to guess how long your surgery will take, based on:

  • The complexity of your condition
  • Any past surgeries or health issues that might change the procedure
  • The surgeon’s experience with similar cases

Recovery Timeline Questions

Knowing your recovery time is key for post-surgery planning. Ask your surgeon about:

  • How long you’ll stay in the hospital
  • How long you’ll need to rest at home
  • Any special care instructions or follow-up visits

Return to Work and Normal Activities

Talking about going back to work and normal activities is also important. Ask about:

  • How long you should take off work or avoid normal activities
  • Any activities you should avoid during recovery
  • How to start doing normal things again safely

By asking these questions, you’ll understand what to expect during and after your surgery. This helps you prepare well for the procedure and your recovery.

Conclusion

Robotic hysterectomy is a complex procedure that needs precision and expertise. The surgery’s length can vary. This depends on the patient’s health and the procedure’s complexity.

We’ve looked at the different parts of robotic hysterectomy. This includes the average time in the operating room and the total hospital stay. We also talked about what might make the surgery longer. Knowing the recovery time is key for planning post-operative care.

Patients can make better choices by understanding the benefits and risks of robotic hysterectomy. It’s important to talk to their surgeon. They should discuss the expected surgery time and recovery. This helps ensure a smooth and successful outcome.

FAQ

What is the average duration of a robotic hysterectomy surgery?

Robotic hysterectomy surgery usually lasts about 1-3 hours in the operating room.

How long does it take to recover from a robotic hysterectomy?

You’ll likely stay in the hospital for 1-2 days. Recovery at home can take 2-4 weeks.

What factors can affect the duration of a robotic hysterectomy surgery?

Several things can influence surgery time. These include your health, the surgeon’s experience, and hospital rules.

How long does the core surgical procedure take during a robotic hysterectomy?

The main part of the surgery usually takes 1-2.5 hours.

What are the benefits of robotic hysterectomy related to surgery time?

Robotic hysterectomy has many advantages. It offers precision, fewer complications, less blood loss, and quicker recovery.

Can adhesions from previous surgeries extend the duration of a robotic hysterectomy?

Yes, adhesions from past surgeries can make the procedure more complex. This can extend the surgery time.

How do hospitals schedule robotic hysterectomy surgery?

Hospitals plan robotic hysterectomy based on room availability, surgeon schedules, and whether it’s an emergency or planned.

How does the procedure duration affect the cost of a robotic hysterectomy?

Longer procedures can increase the cost of robotic hysterectomy. Insurance also plays a role in what you’ll pay out-of-pocket.

What questions should I ask my surgeon about procedure timing?

Ask your surgeon about prep time, expected surgery length, recovery, and when you can go back to work and normal activities.

How has technological advancement impacted robotic surgery time?

New technology, like better robotic systems and training, has made surgery faster and more efficient.

What is the da Vinci Surgical System, and how is it used in robotic hysterectomy?

The da Vinci System is a key robotic tool for hysterectomy. It helps surgeons perform precise and accurate procedures.

How does robotic hysterectomy compare to other surgical methods in terms of duration?

Robotic hysterectomy is similar in time to laparoscopic hysterectomy. But it’s seen as more precise and less invasive.

References

  1. Herrinton, L. J., Pecina, J. L., Zhao, S., & Stewart, A. (2019). Outcomes of robotic hysterectomy for treatment of benign gynecologic disease in complex and noncomplex patients. Journal of Minimally Invasive Gynecology, 26(7), 1222-1230. https://pmc.ncbi.nlm.nih.gov/articles/PMC6972554/
  2. Paraiso, M. F. R., Ridgeway, B., & Hurd, W. W. (2020). Operative times of robotic hysterectomy versus other modalities: Analysis from an expert robotic surgeon. Journal of Minimally Invasive Gynecology, 27(7), S95. https://www.sciencedirect.com/science/article/abs/pii/S1553465020305045

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