Comparison of the efficacy and safety of robotic single-site hysterectomy versus robotic multi-port hysterectomy: a systematic review and meta-analysis.

OBJECTIVES

Robotic single-site hysterectomy (RSSH) has emerged as an innovative minimally invasive approach for total hysterectomy, designed to minimize surgical trauma compared with the established robotic multi-port hysterectomy (RMPH). However, high-quality comparative evidence on their relative efficacy and safety is currently lacking. To address this uncertainty, a systematic review and meta-analysis was conducted to compare perioperative outcomes between RSSH and RMPH.

METHODS

A comprehensive literature search was performed across eight electronic databases-including PubMed, Embase, the Cochrane Library, Web of Science, CNKI, WanFang Data, VIP, and CBM-from inception to July 2025, using a combination of Medical Subject Headings (MeSH) terms and free-text keywords. The primary outcomes were intraoperative and postoperative complication rates; secondary outcomes included operative time, estimated blood loss, blood transfusion rates, postoperative hemoglobin decline, conversion to laparotomy, and length of hospital stay. Study quality was assessed using the Newcastle-Ottawa Scale (NOS), and statistical analyses were carried out with Review Manager (RevMan, version 5.4).

RESULTS

From an initial yield of 881 records, seven retrospective cohort studies involving 962 patients were included. Pooled analysis showed that RSSH was associated with a significantly lower rate of intraoperative complications (RR = 0.17, 95% CI: 0.04 to 0.66; p = 0.01), reduced estimated blood loss (MD = - 65.94 mL, 95% CI: -124.47 to - 7.40; p = 0.03), and a shorter postoperative hospital stay (SMD = - 0.28, 95% CI: -0.54 to - 0.01; p = 0.04) compared with RMPH, albeit with a significantly longer operative time (MD = 7.25 min, 95% CI: 2.18 to 12.32; p = 0.005). No statistically significant differences were observed between the two approaches in postoperative complication rates, conversion rates to laparotomy, blood transfusion requirements, or postoperative hemoglobin decline.

CONCLUSIONS

This meta-analysis of seven retrospective cohort studies demonstrated that robotic single-site hysterectomy (RSSH) was associated with significantly lower intraoperative complication rates, less estimated blood loss, and shorter postoperative hospital stay compared with robotic multi-port hysterectomy (RMPH), although RSSH required a remarkably longer operative time.