Comparison of the Efficacy and Safety of Single-Site Laparoscopic Hysterectomy with and without Robotic Assistance: A Meta-Analysis - 26/02/26
, Hollie Ulibarri a, Amanda Arroyo a, Daniela Gonzalez Herrera a, Brooke Hamilton a, Kate Ruffley a, Mckenna Robinson a, Elianna Emerson b, Anna Sabin b, Sara Kayser b, Ali Azadi c, dAbstract |
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.
Le texte complet de cet article est disponible en PDF.Keywords : Robotic single-site hysterectomy, Laparoendoscopic single-site hysterectomy, Meta-analysis, Operative time, Estimated blood loss, Length of hospital stay, Postoperative complications, Benign gynecologic conditions, Endometrial carcinoma, Surgical outcomes, Comparative efficacy
Plan
| www.marchandinstitute.org |
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| Article Type: Systematic Review and Meta-Analysis |
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| Condensation page 1. Tweetable statement: The latest meta-analysis from @MarchandSurgery shows that robotic single-site hysterectomy (RSSH) and laparoendoscopic single-site hysterectomy (LESS-H) appear comparable in safety and recovery for hysterectomy, with modestly lower estimated blood loss but longer operative time in benign cases with RSSH; however, considerable heterogeneity and observational limitations prevent definitive superiority claims. 2. Short Title: Comparison of the Efficacy and Safety of Robotic Single-Site versus Laparoendoscopic Single-Site Hysterectomy A. Why was this study conducted? As minimally invasive gynecologic surgery advances, single-site laparoscopic approaches, both with and without robotic assistance, are becoming more common. Our authors wanted to compare the safety and efficacy of these techniques in an objective, pooled manner. B. What are the key findings? RSSH was associated with modestly lower estimated blood loss but longer operative time compared to LESS-H in benign cases, with otherwise comparable outcomes for hospital stay, pain, complications, conversion, and transfusion rates. C. What does this study add to what is already known? This study adds the largest pooled comparison to date (1113 patients) of RSSH versus LESS-H, extending prior smaller analyses while highlighting persistent heterogeneity and the need for cautious interpretation given the observational design. |
Vol 55 - N° 5
Article 103145- mai 2026 Retour au numéro
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