Design: Prospective longitudinal study

Setting: Tertiary academic institution.

Patients or Participants: All patients undergoing robotic benign gynecologic surgeries between September 2022 and March 2023 were included. Malignancy, BMI>40, and uteri >12 cm were excluded.

Interventions: Participants completed the surgical satisfaction survey at 6 weeks and POSAS (cosmetic satisfaction) survey at 6 weeks and 3 months after surgery.

Measurements and Main Results: 81 patients were enrolled. (13 SP,68 XI). Mean age/ BMI (SD) were 56.4 years(10.23)/ 24.3kg/m²(3.50) and 38.8years(12.98)/24.8 kg/m² (5.41) respectively. The median umbilical port size(IQR) for SP was 30mm(25,30) and 8.0mm(8.0,8.0) for XI. At 6 weeks, 8/13 (61.5%) SP patients and 43/68 (63.2%) XI patients completed the satisfaction surgery. Surgical satisfaction was 100% in SP and 89.8% in XI group. 20.9% of patients in the XI group wished they had less scars.

At 6 weeks POSAS was completed by 7/13(53.8%) in SP group and 46/68(67.6%) in XI group, at 3 months this was 5/13(38.4%) and 26/68(38.2%) respectively. Lesser POSAS values indicate closer resemblance to the normal skin. At 6 weeks, the median(IQR) for the scar color, stiffness and thickness for the SP were 3.0(0.0,75.0), 12.9(21.82), 14.1(21.13) and for the XI they were 88.5(51.0,100), 58.0(25.0,82.0), 62.0(27.0,83.0) respectively.

At 3 months the median (IQR) for the scar color, stiffness and thickness for the SP were 21.0(4.0, 75), 44.0(3.0, 50.0), 50.0(9.0, 75.0). For XI, these values were at 80.0(50.0,100.0), 50.0(9.0,72.0), 50.0(10.0,80.0).

Conclusion: Satisfaction following SP and XI robotic surgeries was high. Scar assessment worsened in the small sample of SP, but was overall low. XI scar assessment did not change over time but with higher scores overall. Larger sample size studies are needed to perform a comparative analysis between the two groups.