The main bias of our series is the lack of references randomization of all patients. In fact, populations were different with younger patients, lower parity data, and more frequent nonconservative hysterectomies in the RH group. This bias was due to surgical indications. Benjamin syndromes were young and had smaller uterus. But they were nullipara, and it was very important for them to undergo ovariectomy. So hysterectomy was robotically assisted for this indication in all cases (1/3 of indications of RH group) in order to avoid laparotomy. Therefore we have to continue evaluation in the future with information collected prospectively and probably with randomized methodology We have not studied the related costs, although this represents a major disadvantage of the robotic surgery.

The costs related to robotic surgery are higher than those related to the laparoscopic and vaginal approaches [16] but lower than laparotomy-related operative cost. The advantages presented by the robotic surgery over the vaginal approach in hysterectomy are counterbalanced by its higher operative cost and lengthened operative time. To date, it does not seem reasonable to systematically use robotics in all hysterectomies, but the robotic procedure presents significant interest in that it allows preventing laparotomy and laparoscopic-assisted VH. Such technique could be considered in complex diseases (enlarged uterine volumes, obese patients, etc.) [17] until the reduction of its cost which should help its diffusion.
Our initial experience using the variable aspiration tissue resector (NICO Myriad, NICO, Corp.

, Indianapolis, IN, USA) involves 16 patients (Table 1) with a variety of intraventricular pathologic lesions in the lateral (n = 8) or third ventricles (n = 8). Tumors or cysts treated include a pineal cyst, lateral ventricle arachnoid cysts (n = 3), a large colloid cyst, a benign mixed astroglial cyst, low-grade gliomas (n = 4) (1 myxopapillary ependymoma, 1 WHO grade II astrocytoma, 1 pilocytic astrocytoma, and 1 subependymal giant cell astrocytoma (SEGA)), a dysembryoplastic neuroepithelial-like tumor (DNET), an epidermoid tumor, an immature teratoma, a craniopharyngioma, a giant pituitary macroadenoma with intraventricular extension, and a pineal parenchymal tumor (intermediate differentiation). Patient ages ranged from 20 to 88 (mean 44.2).

Nine patients (56%) presented with ventriculomegaly and obstructive hydrocephalus due to their intraventricular lesion. Five patients presented with memory difficulties, and two presented with seizures Entinostat as part of their initial presentation. Fourteen out of 16 patients presented with progressive headaches. Table 1 Patient characteristics. All patients underwent neuroendoscopic resection through a single frontal burr hole.