Comparison of the Efficacy and Safety of Single-Site Laparoscopic Hysterectomy with and without Robotic Assistance: A Meta-Analysis.

OBJECTIVE

Minimally invasive surgery (MIS) is quickly becoming standard in many benign pathologies and early-stage malignancies. We sought to compare the outcomes of robotic single-site hysterectomy (RSSH) versus laparoendoscopic single-site hysterectomy (LESS-H) in terms of operative time, estimated blood loss (EBL), length of hospital stay, pain scores, hysterectomy time, complications, conversion rates, and transfusion rates.

DATA SOURCES: Our study was conducted following PRISMA guidelines. Our search included Web of Science, Medline, PubMed, Cochrane Library, ClinicalTrials.Gov and SCOPUS. We searched from each database's inception until July 1st 2024.

STUDY ELIGIBILITY CRITERIA: We included all observational studies comparing RSSH and LESS-H. Operative time, estimated blood loss (EBL), length of hospital stay, VAS pain scores, incidence of blood transfusion, and intra-operative and postoperative complications were our predetermined outcomes.

STUDY APPRAISAL AND SYNTHESIS

METHODS

Statistical analysis was done using Review Manager Software v5.9.7.

RESULTS

RSSH was associated with a longer operative time compared to LESS-H (MD = 16.02 min, 95% CI [-0.07, 32.11], P = 0.05), with significant heterogeneity (I² = 89%). Subgroup analysis showed significantly longer operative time with RSSH for benign cases (MD = 23.51 min, 95% CI [5.79, 41.22], P = 0.009; I² = 86%) but a non-significant shorter time for early-stage endometrial carcinoma cases (MD = -10.94 min, 95% CI [-28.53, 6.64], P = 0.22; I² = 0). RSSH was associated with modestly lower EBL compared to LESS-H (MD = -6.84 ml, 95% CI [-12.34, -1.34], P = 0.01; I² = 0), though the clinical importance of this small difference remains uncertain. There was no significant difference in length of hospital stay (MD = -0.05 days, 95% CI [-0.57, 0.46], P = 0.84), pain scores at 1 hour (MD = 1.55, P = 0.26) or 12 h (MD = -0.02, P = 0.91), operative time specific to hysterectomy (MD = 2.75 min, P = 0.72), or complication rates (risk ratio = 1.161, 95% CI [0.588, 2.291], P = 0.667). Conversion and transfusion rates were also comparable between the two techniques.

CONCLUSION

RSSH showed modestly lower estimated blood loss but longer operative time in benign cases compared with LESS-H, with otherwise similar safety profiles; however, substantial heterogeneity and the observational nature of the evidence limit firm conclusions on superiority.