Robotic versus laparoendoscopic single-site hysterectomy: a systematic review and meta-analysis

Single-site hysterectomy (SSH) laparoscopic or robotic presented distinct advantages with regards to postoperative cosmetic outcome, wound-related complications and morbidity. We aimed to evaluate the feasibility of robotic and laparoscopic SSH in patients with benign or early-stage malignant gynecological conditions and to compare the two approaches. A systematic search of four electronic databases for articles published up to September 2019 was performed. Studies reporting outcomes for women who underwent robotic or laparoscopic SSH were considered eligible. A total of 6 studies with 412 patients were included. Among them, 150 women had robotic SSH, whereas 262 had laparoscopic SSH. Neither total operative time nor total hysterectomy time were found different among the 2 groups (355 patients MD 17.47 min, 95% CI - 5.82 to 40.76, p = 0.14 and 285 patients MD 6.41 min, 95% CI - 10.24 to 23.06, p = 0.45, respectively). Robotic approach presented significantly lower blood loss and hospital stay compared to laparoscopic (287 patients MD - 10.84 ml 95% CI - 20.35 to - 1.32, p = 0.03, 328 patients MD - 0.32 days, 95% CI - 0.44 to - 0.19, p < 0.00001, respectively). No difference was found with regards to major or overall postoperative complications. The present meta-analysis supports the use of robotic SSH, since it was related to faster recovery and comparable operative times and complication rates compared to laparoscopic. Nonetheless, due to the limited number of the included studies and their retrospective nature, the aforementioned outcomes must be interpreted with caution and further larger volume studies are needed in the field.