Robotic versus laparoscopic and open surgery for endometrial cancer: a systematic review of randomized trials and...

To summarize randomized evidence assessing robotic surgery in relation to conventional laparoscopic and open abdominal approaches for endometrial cancer treatment, with particular attention to perioperative outcomes and conversion to open surgery. Randomized controlled trials evaluating robot-assisted surgical treatment of endometrial cancer were identified across major biomedical databases up to December 2025. Eligible studies compared the robotic approach against laparoscopic or open abdominal surgery. Quantitative pooling was undertaken only when outcome reporting was sufficiently consistent across studies. Eight randomized trials including 647 patients met the inclusion criteria. Overall, 322 patients underwent robotic surgery, 244 conventional laparoscopy, and 81 laparotomy. Most perioperative endpoints were reported heterogeneously, limiting formal pooling. Operative time varied across trials when robotics was compared with laparoscopy and was generally longer than laparotomy. Intraoperative blood loss and postoperative hospitalization did not show consistent differences between the two minimally invasive approaches. Compared with laparotomy, the robotic approach was linked to reduced postoperative stay. Conversion to laparotomy occurred less frequently after robotic surgery than after laparoscopy (0.7% vs. 8.4%; OR 0.17; p = .03). Complication reporting was inconsistent, although trials comparing robotics with laparotomy generally favored the robotic approach. Direct procedural costs were higher for robotics, whereas indirect costs favored robotics in the single study evaluating them. The robotic approach resulted in a lower need for open conversion compared with conventional laparoscopy. Other perioperative outcomes appeared broadly comparable between the two minimally invasive approaches, while comparisons with laparotomy suggested shorter hospital stay and fewer postoperative complications, although these findings should be interpreted cautiously because of the limited and heterogeneous randomized evidence.