Robotic-Assisted Versus Conventional Laparoscopic Hysterectomy for Benign Gynaecological Conditions: A Systematic Review and Meta-Analysis of Clinical Outcomes, Perioperative Efficiency, and Complications
Keywords:
robotic surgery, laparoscopic hysterectomy, benign gynecological disease, minimally invasive surgery, systematic review, meta-analysis.Abstract
Background: Robotic-assisted laparoscopic hysterectomy (RALH) has been increasingly adopted for benign gynaecological indications, yet its comparative value relative to conventional laparoscopic hysterectomy (CLH) remains debated, given its higher acquisition and operative cost.
Objectives: This systematic review and meta-analysis aimed to compare RALH and CLH with respect to operating time, estimated blood loss, conversion rate, length of hospital stay, complication rates, return to normal activity, and cost among adult women undergoing hysterectomy for benign gynecological disease.
Methods: PubMed, Embase, the Cochrane Library, Web of Science, and Scopus were searched from January 2010 to June 2026 for randomized controlled trials and comparative cohort studies. Data were extracted independently by two reviewers, risk of bias was assessed using RoB 2 and ROBINS-I, and random-effects meta-analysis was performed where heterogeneity was substantial. Heterogeneity was quantified using the I² statistic, and publication bias was evaluated through funnel plot inspection and Egger's test.
Results: Nine comparative studies (two randomized trials and seven cohort studies) met the inclusion criteria, collectively encompassing several hundred thousand women when the largest contributing national cohort is included. Pooled analysis demonstrated no statistically significant difference between RALH and CLH in operating time, conversion rate, or complication rates. A non-significant trend favored RALH for estimated blood loss and length of hospital stay, while cost was consistently and significantly higher with RALH, exceeding CLH by approximately US$1,600 to US$2,500 per case in the United States cohorts.
Conclusions: Current evidence does not demonstrate clinically meaningful superiority of RALH over CLH for benign hysterectomy, while cost remains substantially higher for the robotic approach. Adoption decisions should weigh institutional cost structures, surgeon proficiency, and case complexity rather than assumed clinical superiority.
