Comparison of ArtiSential and Conventional Laparoscopic Instruments in Hysterectomy for Gynecologic Cancers: A Hybrid Observational Study on Surgical Outcomes, Pain Control, and Oncologic Safety

Objective: To evaluate the clinical and oncologic outcomes of gynecologic cancer surgeries performed using multi-joint laparoscopic instruments (ArtiSential) compared to conventional instruments, focusing on hysterectomy. Design: A hybrid observational study combining prospective data for the ArtiSential group (n = 44) and retrospective data for the conventional group (n = 136). Setting: International multicenter study conducted in Korea, Taiwan, and Japan. Participants: 180 patients who underwent hysterectomy for gynecological cancers. Interventions: Laparoscopic hysterectomy using either ArtiSential or conventional laparoscopic instruments. Results: No significant differences were observed in operative time (100.1 min vs. 99.7 min, p = .95) or estimated blood loss (111.6 mL vs. 125.0 mL, p = .39) between the ArtiSential and conventional groups. The ArtiSential group showed numerical reduction in moderate-to-severe postoperative pain without statistical significance in total group (6.8% vs. 18.4%, p = .09), but a statistically significant reduction in uterine cancer patients (3.6% vs. 21.4%, p = .04). Complication rates were generally lower in the ArtiSential group across all cancer types, although not statistically significant. In radical hysterectomy, the ArtiSential group demonstrated shorter operative times (109.2 min vs. 135.9 min, p = .14) and reduced estimated blood loss (150.0 mL vs. 162.9 mL, p = .75). Multivariate Cox analysis revealed that FIGO stage, operative time, and estimated blood loss significantly affected progression-free survival in uterine cancer, while ArtiSential use did not (p = .47) Conclusions: ArtiSential instruments appear to be feasible for gynecological cancer surgeries, offering potential benefits such as reduced postoperative pain and fewer complications but without statistical significance. While these findings highlight the utility of ArtiSential in complex pelvic surgeries, further prospective multicenter studies with larger cohorts and longer follow-up periods are required to confirm oncologic safety and long-term complication.