Design: A prospective randomized controlled study.

Setting: A single tertiary university-affiliated medical center.

Patients or Participants: The study included all women undergoing elective robotic hysterectomy for benign gynecological indications between April 2023 to February 2024.

Interventions: Cystoscopy was conducted at the conclusion of the hysterectomy procedure using sterile water. Participants were randomly assigned to one of four groups: 1) Flat position without insufflation, 2) Trendelenburg position with insufflation to 15 mm Hg, 3) Flat position with insufflation to 15 mm Hg, and 4) Trendelenburg position without insufflation. The times were recorded for the first ureteral jet (T1), the time interval between the first and second ureteral jets (T2), and the time from T2 to the completion of the procedure after the visualization of an air bubble at the bladder dome (T3). Surgeon satisfaction was assessed using a scale ranging from 1 (not satisfied) to 5 (highly satisfied). The primary outcome was the total time for cystoscopy completion (T1+T2+T3). Data were presented as median and interquartile range.

Measurements and Main Results: A total of 136 women were randomized, with 125 patients included in the analysis (31 in arm 1, 30 in arm 2, 31 in arm 3, and 33 in arm 4). Demographic and operative characteristics were comparable between the groups. No significant differences were observed in T1, T2, and T3 between the groups. The total time for cystoscopy completion was longest in the third group (flat and insufflated), although this difference was not statistically significant (103 [61-188] vs. 116 [49-219] vs. 130 [69-211] vs. 82 [62-274] seconds; p=0.57). There were no significant differences in surgeons' satisfaction rates.

Conclusion: Patient positioning and abdominal insufflation status during cystoscopy following hysterectomy does not impact the procedure's duration or surgeon satisfaction rates.