Robot-assisted versus conventional laparoscopic surgery for endometrial cancer: an updated systematic review and meta-analysis

BACKGROUND: Endometrial cancer is commonly treated with minimally invasive staging procedures. Whether robotic assistance improves outcomes compared with conventional laparoscopy remains debatable. Robot-assisted surgery (RAS) and conventional laparoscopic surgery (CLS) have been used to manage endometrial cancer. OBJECTIVES: To compare the perioperative and oncologic outcomes of robot-assisted and conventional laparoscopy for endometrial cancer. METHODS: We conducted a meta-analysis of studies comparing robot-assisted and conventional laparoscopic surgeries for endometrial cancer. We searched PubMed, the Cochrane Library, and Google Scholar from inception to April 15, 2025, for comparative studies. Random effects meta-analysis was used to estimate risk ratios or mean differences, and heterogeneity was assessed via the I² statistic. Relevant randomized controlled trials (RCTs) and observational studies were identified. The perioperative outcomes of interest included intraoperative visceral injuries, operation time, estimated blood loss (EBL), blood transfusion, total number of lymph nodes harvested (TLNH), conversion to laparotomy, length of hospital stay, recurrence and overall 3-year and 5-year survival rates. Data were synthesized via random effects models, and heterogeneity was evaluated via I² statistics. RESULTS: Thirty studies (2 RCTs and 28 observational studies) including 10,673 patients were analyzed. RAS was associated with reduced estimated blood loss (MD - 78.36) and a lower rate of conversion to laparotomy (RR 0.35). There were no statistically significant differences between groups in operative time, blood transfusion, total lymph node harvested, length of hospital stay, or recurrence. Three-year and five-year overall survival were not significantly different; however, these estimates were based on a limited number of studies and should be interpreted cautiously. Substantial heterogeneity was observed across several outcomes. CONCLUSION: RALS is associated with reduced blood loss and fewer conversions to laparotomy compared with CLS, while most perioperative and oncologic outcomes remain comparable. Given the predominance of observational evidence, persistent heterogeneity, and limited survival data, these findings should be interpreted with caution, and high-quality randomized trials are needed to better define the comparative effectiveness of these approaches.