Robotic-assisted hysterectomy using DEXTER®: the first prospective multicentre study.

Background: Minimally invasive hysterectomy is increasingly performed robotically as new systems expand options and address limitations of traditional platforms, including financial, infrastructure, and workflow demands. The DEXTER® Robotic Surgery System was designed to address some of these challenges. Objectives: To confirm perioperative and early postoperative safety, and evaluate the clinical performance of DEXTER in hysterectomy. Methods: This prospective multicentre study included 34 patients who underwent robotic-assisted hysterectomy for benign or low-risk malignant diseases between November 2022 and November 2023. DEXTER was integrated into the surgical workflows of the four participating centres, which used their existing laparoscopic towers. Main Outcome Measures: Primary outcomes were procedural conversions and Clavien-Dindo grade III-V events up to 30 days post-surgery. Results: Median patient age was 45.5 years; median body mass index was 26.0 kg/m2. There were no conversions to laparotomy, intraoperative complications or transfusions, with a median estimated blood loss of 100 mL. Median skin-to-skin operative time was 125.5 min, including a median docking time of 5 minutes. Median length of hospitalisation was 2 days. Two Clavien-Dindo grade IIIb adverse events were recorded, neither of which was device-related. In 3 cases, the surgeons decided to finish the procedure laparoscopically. Conclusions: Hysterectomy assisted with DEXTER can be safely performed even in the early learning phase. DEXTER facilitated an adaptable OR workflow allowing greater flexibility in procedural approaches. Further investigation with a larger cohort and a longer follow-up is required to evaluate long-term outcomes. What is New?: First prospective multicentre study to confirm robotic-assisted hysterectomy using DEXTER is a feasible and safe approach for treating benign and low-risk malignant conditions.