Comparative outcomes of laparoscopic versus robotic-assisted laparoscopic techniques in the surgical staging of endometrial cancer: A systematic review and meta-analysis

Background: Endometrial cancer (EC) is a prevalent gynecologic malignancy associated with escalating mortality rates. Surgical interventions continue to be the primary treatment modality for EC, with a growing utilization of minimally invasive surgeries (MIS) such as robotic-assisted laparoscopic surgery (RALS) and conventional laparoscopic surgery (CLS). Given the technical advantages of RALS, this study aimed to compare the surgical outcomes of RALS and CLS in the management of EC. Methods: A systematic search was conducted on three electronic databases, namely PubMed, Scopus, and ISI Web of Science, up to June 2024 with no date restriction. Randomized controlled trials and cohort studies that compared surgical outcomes, intraoperative parameters, and short-term postoperative outcomes between RALS and CLS in women with EC were included in the analysis. Data on age, body mass index (BMI)kg/m2, dissected lymph nodes, operative time, estimated blood loss, intraoperative complications (conversion rate to laparotomy and injuries), and short-term postoperative outcomes (length of hospital stay and complications) in both groups were collected and analyzed using R software (version 4.2.3). Weighted mean and standardized mean differences (SMDs) with 95 % confidence intervals (CIs) were used for continuous outcomes, while binary outcomes were analyzed using pooled odds ratios (ORs) with 95 % CIs using random-effects models. The risk of bias in the included studies was assessed. Results: Sixteen studies with 2,725 patients were included. RALS was associated with longer operative time (170.0 vs. 152.6 min; SMD = 0.5) but lower blood loss (109.1 vs. 180.1 mL; SMD = −0.66), fewer conversions to laparotomy (OR = 0.29), reduced intraoperative injuries (OR = 0.32), and shorter hospital stay (2.91 vs. 3.36 days; SMD = −0.4) compared to CLS. However, postoperative complications were more frequent with RALS (OR = 1.8). Most studies had methodological limitations, with over 70 % rated as “poor,” and substantial heterogeneity was observed. Conclusion: RALS provides specific advantages over CLS, including reduced blood loss, fewer conversions, and shorter hospitalization, but it is associated with longer operative time and higher postoperative complication rates. Results may primarily reflect outcomes from high-volume or experienced surgeons, limiting generalizability. Further high-quality prospective studies, including detailed patient-level and surgeon experience data, are needed to clarify the relative benefits, cost-effectiveness, and long-term outcomes of RALS versus CLS.