Single-port robotic surgery versus laparo-endoscopic single-site surgery for the surgical staging of early-stage endometrial cancer: a sequential-period propensity-score analysis

We compared perioperative outcomes of da Vinci SP robotic surgery and laparo-endoscopic single-site surgery (LESS) for staging early-stage endometrial cancer in a sequential-period cohort. Between 2010 and 2025, 178 women with presumed and final FIGO stage I or II endometrial carcinoma underwent single-port staging with lymph node assessment; LESS was used through 2021 ( n = 95), and SP surgery was introduced in 2021 ( n = 83). Patients were analyzed by planned approach, including procedures requiring an additional port. The primary outcome was the hemoglobin decline from the preoperative value to the value measured on the day of surgery. The hemoglobin decline was 1.92 ± 1.14 g/dL after LESS and 0.92 ± 0.88 g/dL after SP surgery ( p < .001), and estimated blood loss was 205.4 ± 192.4 and 68.5 ± 79.3 mL ( p < .001). After inverse probability of treatment weighting, the between-group difference in hemoglobin decline (SP minus LESS) was − 1.06 g/dL (95% CI − 1.42 to − 0.70). This estimate was not materially changed by further adjustment for perioperative fluid volume and sampling time. In a sensitivity analysis restricted to patients with pelvic lymphadenectomy, the difference was attenuated to − 0.72 g/dL (95% CI − 1.21 to − 0.22), and operative time was 25.5 min longer with the SP robot. Overall operative time, hospital stay, conversions, and complications did not differ significantly. SP staging was associated with a smaller hemoglobin decline. Because the 2 approaches were used in largely different calendar periods, these findings do not establish an independent effect of the platform.