{"product_id":"robot-assisted-vs-conventional-laparoscopic-surgery-for-endometrial-cancer-what-an-updated-review-of-10-673-patients-shows","title":"Robot-Assisted vs. Conventional Laparoscopic Surgery for Endometrial Cancer: What an Updated Review of 10,673 Patients Shows","description":"\u003cp\u003eThis updated systematic review and meta-analysis pooled 30 studies, including 2 randomized controlled trials and 28 observational studies, covering 10,673 patients with endometrial cancer. Robot-assisted laparoscopic surgery (RALS) was linked to significantly less estimated blood loss (mean difference −78.36 mL) than conventional laparoscopic surgery (CLS). RALS was also linked to a much lower rate of conversion to open abdominal surgery (risk ratio 0.35) than CLS. Most other outcomes were comparable between the two approaches, including operative time, blood transfusion, lymph nodes harvested, hospital stay, recurrence, and 3-year and 5-year overall survival. The authors caution that most evidence comes from observational studies with substantial heterogeneity, so high-quality randomized trials are still needed.\u003c\/p\u003e\n\n\u003ch1\u003eRobot-Assisted vs. Conventional Laparoscopic Surgery for Endometrial Cancer: What an Updated Review of 10,673 Patients Shows\u003c\/h1\u003e\n\n\u003ch2\u003eTable of Contents\u003c\/h2\u003e\n\u003cul\u003e\n\u003cli\u003e\u003ca href=\"#ddn-key-points\"\u003eKey Points\u003c\/a\u003e\u003c\/li\u003e\n\n  \u003cli\u003e\u003ca href=\"#background\"\u003eBackground: Why Compare These Two Surgeries?\u003c\/a\u003e\u003c\/li\u003e\n  \u003cli\u003e\u003ca href=\"#methods\"\u003eHow the Researchers Conducted the Review\u003c\/a\u003e\u003c\/li\u003e\n  \u003cli\u003e\u003ca href=\"#studies\"\u003eThe Studies and Patients Included\u003c\/a\u003e\u003c\/li\u003e\n  \u003cli\u003e\u003ca href=\"#quality\"\u003eStudy Quality and Publication Bias\u003c\/a\u003e\u003c\/li\u003e\n  \u003cli\u003e\u003ca href=\"#injuries\"\u003eKey Finding: Intraoperative Visceral Injuries\u003c\/a\u003e\u003c\/li\u003e\n  \u003cli\u003e\u003ca href=\"#transfusion\"\u003eKey Finding: Blood Transfusion\u003c\/a\u003e\u003c\/li\u003e\n  \u003cli\u003e\u003ca href=\"#conversion\"\u003eKey Finding: Conversion to Open Surgery\u003c\/a\u003e\u003c\/li\u003e\n  \u003cli\u003e\u003ca href=\"#recurrence\"\u003eKey Finding: Cancer Recurrence\u003c\/a\u003e\u003c\/li\u003e\n  \u003cli\u003e\u003ca href=\"#bloodloss\"\u003eKey Finding: Estimated Blood Loss\u003c\/a\u003e\u003c\/li\u003e\n  \u003cli\u003e\u003ca href=\"#nodes\"\u003eKey Finding: Lymph Nodes Harvested\u003c\/a\u003e\u003c\/li\u003e\n  \u003cli\u003e\u003ca href=\"#stay\"\u003eKey Finding: Length of Hospital Stay\u003c\/a\u003e\u003c\/li\u003e\n  \u003cli\u003e\u003ca href=\"#time\"\u003eKey Finding: Operative Time\u003c\/a\u003e\u003c\/li\u003e\n  \u003cli\u003e\u003ca href=\"#survival\"\u003eKey Finding: 3-Year and 5-Year Survival\u003c\/a\u003e\u003c\/li\u003e\n  \u003cli\u003e\u003ca href=\"#implications\"\u003eWhat These Findings Mean for Patients\u003c\/a\u003e\u003c\/li\u003e\n  \u003cli\u003e\u003ca href=\"#limitations\"\u003eLimitations: What the Review Could Not Prove\u003c\/a\u003e\u003c\/li\u003e\n  \u003cli\u003e\u003ca href=\"#recommendations\"\u003ePractical Recommendations\u003c\/a\u003e\u003c\/li\u003e\n  \u003cli\u003e\u003ca href=\"#ddn-faq\"\u003eFrequently Asked Questions\u003c\/a\u003e\u003c\/li\u003e\n\u003cli\u003e\u003ca href=\"#source\"\u003eSource Information\u003c\/a\u003e\u003c\/li\u003e\n\u003c\/ul\u003e\n\n\u003c!-- ddn:keypoints:start --\u003e\n\u003ch2 id=\"ddn-key-points\"\u003eKey Points\u003c\/h2\u003e\n\u003cul\u003e\n\u003cli\u003eIn pooled data from 20 studies of 2,989 patients, robot-assisted surgery was linked to about 78 mL less estimated blood loss than conventional laparoscopy, though variation between studies was high.\u003c\/li\u003e\n\u003cli\u003eAcross 17 studies of 2,791 patients, the risk of converting to open abdominal surgery was about one-third as high with robot-assisted surgery as with conventional laparoscopy.\u003c\/li\u003e\n\u003cli\u003eOperative time, blood transfusion, lymph nodes removed, hospital stay, recurrence, and 3-year and 5-year survival did not differ significantly between the two approaches in the pooled analyses.\u003c\/li\u003e\n\u003cli\u003eOnly 2 of the 30 included studies were randomized trials; the other 28 were observational, and variation between studies was substantial for several outcomes.\u003c\/li\u003e\n\u003cli\u003eThe paper's introduction notes that drawbacks of robotic surgery reported in other literature include longer operative times, higher costs, technical limitations, and the need for specialized staff and training; in this review's own pooled analysis, operative time did not differ significantly, and cost-effectiveness was not assessed.\u003c\/li\u003e\n\u003c\/ul\u003e\n\u003c!-- ddn:keypoints:end --\u003e\n\n\n\u003ch2 id=\"background\"\u003eBackground: Why Compare These Two Surgeries?\u003c\/h2\u003e\n\u003cp\u003eEndometrial cancer is the most common gynecologic malignancy (cancer of the female reproductive organs) in high-income countries, and its incidence is increasing. The rise is driven by obesity, aging, and hormonal factors, which makes endometrial cancer a growing public health concern. The disease most often presents with postmenopausal bleeding.\u003c\/p\u003e\n\n\u003cp\u003eSurgical staging is essential for assessing how far the disease has spread and for guiding treatment. Traditionally, surgeons performed this staging through open laparotomy (a large abdominal incision). Today, minimally invasive approaches such as laparoscopy and robotic surgery are preferred. These approaches offer lower morbidity (fewer complications) without compromising oncologic outcomes (cancer control results).\u003c\/p\u003e\n\n\u003cp\u003eConventional laparoscopic surgery (CLS) is a minimally invasive technique. The surgeon inserts a laparoscope (a thin camera) into the abdomen to guide a hysterectomy (removal of the uterus) and bilateral salpingo-oophorectomy (removal of both ovaries and fallopian tubes). Because laparoscopy is less invasive, it is associated with less pain, faster recovery, and a shorter hospital stay.\u003c\/p\u003e\n\n\u003cp\u003eDespite these advantages over open surgery, laparoscopy can still cause major complications. These include injury to major blood vessels or nerves, lymphedema (swelling caused by lymph fluid buildup), and associated cellulitis (skin infection). The risk of these complications means that an experienced surgeon should perform the procedure, with skill in laparoscopic hysterectomy and lymph node sampling.\u003c\/p\u003e\n\n\u003cp\u003eRobot-assisted laparoscopic surgery (RALS), also called robotic surgery, has emerged as an advanced alternative. Gynecologic oncologists have adopted RALS rapidly since 2005, when the US Food and Drug Administration (FDA) approved it. Compared with conventional laparoscopy, RALS may offer greater dexterity, tremor filtration (filtering out hand shaking), reduced reliance on an assistant, and a shorter learning curve.\u003c\/p\u003e\n\n\u003cp\u003eSeveral studies comparing robotic-assisted hysterectomy with lymphadenectomy (lymph node removal) to traditional laparoscopy suggest advantages for the robotic approach. These advantages include reduced blood loss and a shorter operative time. However, one study by Cardenas-Goicoechea and colleagues reported that the mean number of lymph nodes retrieved was similar between the groups. That study also found no significant differences in time to discharge, readmission, or reoperation rates.\u003c\/p\u003e\n\n\u003cp\u003eRobotic surgery has also been shown to be a feasible, safe, and reproducible alternative to laparoscopic surgery, even in obese or elderly patients with endometrial cancer. Evidence in patients with severe obesity remains particularly relevant, because this group presents unique surgical challenges. A retrospective study compared robotic-assisted, laparoscopic, and vaginal hysterectomy in morbidly obese women with endometrial cancer. That study found that minimally invasive approaches, particularly robotic-assisted surgery, were feasible and safe in this high-risk group, with acceptable perioperative outcomes.\u003c\/p\u003e\n\n\u003cp\u003eNevertheless, robotic surgery has drawbacks. These include longer operative times, higher costs, technical limitations of the robotic system, and the need for specialized staff and training. Findings from studies comparing conventional and robot-assisted laparoscopy for endometrial cancer have been inconsistent. This inconsistency underscores the need for clearer evidence through comprehensive analysis.\u003c\/p\u003e\n\n\u003cp\u003eThe authors limited this review to clinical effectiveness, including operative, perioperative, and oncologic adequacy outcomes. Economic evaluations, such as cost-effectiveness, were outside the scope of this analysis. This updated meta-analysis adds recent studies comparing the two approaches. It evaluates perioperative and oncologic outcomes, including recurrence and overall survival, and it incorporates newly published randomized controlled trials. The authors also performed subgroup analyses and meta-regression to explore sources of heterogeneity (variation between studies).\u003c\/p\u003e\n\n\u003ch2 id=\"methods\"\u003eHow the Researchers Conducted the Review\u003c\/h2\u003e\n\u003cp\u003eThe authors reported this meta-analysis according to the Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) guidelines. They registered the review prospectively with PROSPERO, an international registry of systematic reviews, under the registration number CRD420251120306.\u003c\/p\u003e\n\n\u003cp\u003eThe researchers searched PubMed, the Cochrane Library, and Google Scholar from database inception to April 15, 2025. They used predefined terms for robotic surgery, laparoscopy, and endometrial cancer to find studies comparing robot-assisted and conventional laparoscopic surgery for endometrial cancer. Boolean operators combined synonyms (OR) and different concepts (AND). The search included MeSH terms (standardized medical subject headings used in PubMed) and free-text keywords for every concept. The researchers applied filters for human and English-language publications.\u003c\/p\u003e\n\n\u003cp\u003eGoogle Scholar was searched for supplementary or gray literature, including trial registries and conference abstracts. The authors acknowledge limitations regarding the reproducibility of Google Scholar searches. The search strategy followed Cochrane Handbook recommendations to ensure comprehensive and reproducible results. The full search strategies for each database are provided in Supplementary Table S1 of the original article.\u003c\/p\u003e\n\n\u003cp\u003eTwo reviewers screened titles and abstracts and assessed full texts. Disagreements were resolved by consensus with a third reviewer. The study selection process followed PRISMA guidelines and is illustrated in a PRISMA flow diagram (Figure S1 in the original article).\u003c\/p\u003e\n\n\u003cp\u003eStudies were included if they were randomized controlled trials or observational studies. Each study had to compare robot-assisted laparoscopic surgery with conventional laparoscopic surgery in patients with endometrial cancer and report at least one predefined outcome measure. For multiple publications from the same cohort, only the most comprehensive or most recent report was included.\u003c\/p\u003e\n\n\u003cp\u003eThe exclusion criteria were:\u003c\/p\u003e\n\u003cul\u003e\n  \u003cli\u003eConference abstracts, reviews, editorials, letters, and case reports\u003c\/li\u003e\n  \u003cli\u003eNon-English publications\u003c\/li\u003e\n  \u003cli\u003eStudies on recurrent endometrial cancer\u003c\/li\u003e\n  \u003cli\u003eStudies without direct comparisons between RALS and CLS\u003c\/li\u003e\n\u003c\/ul\u003e\n\n\u003cp\u003eTwo reviewers independently extracted data using a standardized collection form. The extracted information included study characteristics (first author, year, country), study design, and sample size. It also included patient characteristics (age, body mass index, disease stage, tumor grade) and surgical characteristics (uterine weight and adjuvant therapy).\u003c\/p\u003e\n\n\u003cp\u003eThe primary outcome was intraoperative visceral injury, meaning injury during surgery to the ureters, bladder, bowel, or blood vessels. The secondary outcomes were operative time, estimated blood loss, blood transfusion rate, and total number of lymph nodes harvested. The secondary outcomes also included conversion to laparotomy, length of hospital stay, and recurrence rate. The remaining secondary outcomes were overall survival, 3-year survival, and 5-year survival.\u003c\/p\u003e\n\n\u003cp\u003eTwo reviewers independently assessed methodological quality. They evaluated randomized controlled trials with the Cochrane risk of bias tool (RoB 2.0) and observational studies with the Newcastle–Ottawa Scale (NOS). Disagreements were resolved by consensus with a third reviewer's input. The authors did not formally assess the certainty of evidence using GRADE, so conclusions about comparative effectiveness should be interpreted with caution.\u003c\/p\u003e\n\n\u003cp\u003eThe authors performed a random effects meta-analysis using Review Manager (RevMan) version 5.4.1. They analyzed survival outcomes (3-year and 5-year survival) using risk ratios (RRs), because the included studies reported data mainly as total events and total patients per group. Hazard ratios (HRs) were not consistently available and could not be derived because of the lack of time-to-event data. Kaplan–Meier curves were not uniformly reported in a form suitable for reliable digitization, so the authors did not reconstruct hazard ratios from survival curves. For continuous outcomes such as operative time and estimated blood loss, the authors used mean differences (MDs) with 95% confidence intervals (CIs).\u003c\/p\u003e\n\n\u003cp\u003eThe authors measured heterogeneity with the Higgins I² statistic. They classified I² values of 25–50%, 50–75%, and greater than 75% as mild, moderate, and severe heterogeneity, respectively. Statistical significance was set at p \u0026lt; 0.05 for all analyses. The authors used a random-effects model to account for anticipated clinical and methodological variability across studies.\u003c\/p\u003e\n\n\u003cp\u003eThe authors evaluated publication bias for outcomes that included 10 or more studies. They did this through visual inspection of funnel plots, in accordance with Cochrane Handbook recommendations. When funnel plots showed asymmetry, they performed Egger's regression test using Comprehensive Meta-Analysis software to further assess small-study effects. Outcomes with fewer than 10 studies were not formally assessed for publication bias because such analyses would be unreliable.\u003c\/p\u003e\n\n\u003cp\u003eThe authors conducted a series of prespecified subgroup analyses to explore potential sources of between-study heterogeneity. They stratified studies by:\u003c\/p\u003e\n\u003col\u003e\n  \u003cli\u003eStudy design (randomized controlled trials versus observational studies)\u003c\/li\u003e\n  \u003cli\u003eDisease stage (early stage versus mixed or advanced-stage disease)\u003c\/li\u003e\n  \u003cli\u003eBody mass index (obese, defined as ≥ 30 kg\/m², versus nonobese, defined as \u0026lt; 30 kg\/m²)\u003c\/li\u003e\n  \u003cli\u003eData reporting format (mean ± standard deviation versus values requiring statistical conversion from median and dispersion measures)\u003c\/li\u003e\n  \u003cli\u003eGeographic region (United States, Europe, and Asia)\u003c\/li\u003e\n  \u003cli\u003eStudy size (large studies with ≥ 200 patients versus small studies with \u0026lt; 200 patients)\u003c\/li\u003e\n\u003c\/ol\u003e\n\n\u003cp\u003eThe authors performed subgroup analyses for all continuous outcomes, including estimated blood loss, length of hospital stay, operative time, and total lymph node harvest. They assessed differences between subgroups with the chi-square test for subgroup differences in RevMan, with a P value \u0026lt; 0.05 indicating statistical significance. For studies reporting continuous data as medians, the authors converted values to means and standard deviations using established statistical methods (for example, the method of Wan and colleagues). They also conducted additional subgroup analyses to evaluate the potential impact of these transformations on pooled estimates.\u003c\/p\u003e\n\n\u003cp\u003eThe authors performed meta-regression analyses to explore potential sources of heterogeneity. They evaluated two prespecified moderators, age and body mass index, across four continuous outcomes that showed substantial heterogeneity. The meta-regression models used the maximum likelihood estimator with random effects.\u003c\/p\u003e\n\n\u003ch2 id=\"studies\"\u003eThe Studies and Patients Included\u003c\/h2\u003e\n\u003cp\u003eThe systematic literature search yielded 5,524 articles. After screening, the researchers excluded duplicates and ineligible articles. A total of 30 studies were included in the meta-analysis.\u003c\/p\u003e\n\n\u003cp\u003eTwo of the included studies were randomized controlled trials, and 28 were cohort studies. Together, the studies included 10,673 patients: 3,553 in the RALS group and 7,120 in the CLS group. The mean age was 56.34 years in the RALS group and 56.94 years in the CLS group.\u003c\/p\u003e\n\n\u003cp\u003eMost included studies were observational in design (28 of 30), with only two randomized controlled trials. Baseline oncologic characteristics, including disease stage, tumor grade, uterine weight, and adjuvant therapy, were inconsistently reported across studies. Several of these variables were not reported in a substantial proportion of studies.\u003c\/p\u003e\n\n\u003cp\u003eThe included studies came from many countries and varied widely in size. The table below summarizes the study design, country, and group sizes for each included study.\u003c\/p\u003e\n\n\u003cul\u003e\n  \u003cli\u003e\n\u003cstrong\u003eArgenta et al., 2022\u003c\/strong\u003e — retrospective, USA — 566 RALS, 461 CLS (total 1,027)\u003c\/li\u003e\n  \u003cli\u003e\n\u003cstrong\u003eBell et al., 2008\u003c\/strong\u003e — retrospective, USA — 40 RALS, 30 CLS (total 70)\u003c\/li\u003e\n  \u003cli\u003e\n\u003cstrong\u003eBoggess et al., 2008\u003c\/strong\u003e — retrospective, USA — 103 RALS, 81 CLS (total 184)\u003c\/li\u003e\n  \u003cli\u003e\n\u003cstrong\u003eCardenas Goicoechea et al., 2014\u003c\/strong\u003e — retrospective, USA — 187 RALS, 245 CLS (total 432)\u003c\/li\u003e\n  \u003cli\u003e\n\u003cstrong\u003eChiou et al., 2015\u003c\/strong\u003e — retrospective, Taiwan — 86 RALS, 150 CLS (total 236)\u003c\/li\u003e\n  \u003cli\u003e\n\u003cstrong\u003eCoronado et al., 2012\u003c\/strong\u003e — retrospective, Spain — 71 RALS, 84 CLS (total 155)\u003c\/li\u003e\n  \u003cli\u003e\n\u003cstrong\u003eCorrado et al., 2015\u003c\/strong\u003e — retrospective, Italy — 72 RALS, 277 CLS (total 349)\u003c\/li\u003e\n  \u003cli\u003e\n\u003cstrong\u003eEscobar et al., 2012\u003c\/strong\u003e — retrospective, Korea — 30 RALS, 30 CLS (total 60)\u003c\/li\u003e\n  \u003cli\u003e\n\u003cstrong\u003eEoh et al., 2021\u003c\/strong\u003e — retrospective, Korea — 315 RALS, 3,248 CLS (total 3,563)\u003c\/li\u003e\n  \u003cli\u003e\n\u003cstrong\u003eEoh et al., 2023\u003c\/strong\u003e — retrospective, Korea — 551 RALS, 452 CLS (total 1,003)\u003c\/li\u003e\n  \u003cli\u003e\n\u003cstrong\u003eGehrig et al., 2008\u003c\/strong\u003e — retrospective, USA — 49 RALS, 32 CLS (total 81)\u003c\/li\u003e\n  \u003cli\u003e\n\u003cstrong\u003eHiratsuka et al., 2023\u003c\/strong\u003e — retrospective, Japan — 34 RALS, 31 CLS (total 65)\u003c\/li\u003e\n  \u003cli\u003e\n\u003cstrong\u003eHoekstra et al., 2009\u003c\/strong\u003e — prospective, USA — 32 RALS, 7 CLS (total 39)\u003c\/li\u003e\n  \u003cli\u003e\n\u003cstrong\u003eJohanssons et al., 2023\u003c\/strong\u003e — retrospective, Australia — 39 RALS, 41 CLS (total 80)\u003c\/li\u003e\n  \u003cli\u003e\n\u003cstrong\u003eJung et al., 2010\u003c\/strong\u003e — prospective, Korea — 28 RALS, 25 CLS (total 53)\u003c\/li\u003e\n  \u003cli\u003e\n\u003cstrong\u003eKivekas et al., 2025\u003c\/strong\u003e — randomized controlled trial, Finland — 49 RALS, 48 CLS (total 97)\u003c\/li\u003e\n  \u003cli\u003e\n\u003cstrong\u003eLim et al., 2011\u003c\/strong\u003e — retrospective, USA — 122 RALS, 122 CLS (total 244)\u003c\/li\u003e\n  \u003cli\u003e\n\u003cstrong\u003eMaenpaa et al., 2016\u003c\/strong\u003e — randomized controlled trial, Finland — 50 RALS, 49 CLS (total 99)\u003c\/li\u003e\n  \u003cli\u003e\n\u003cstrong\u003eMagrina et al., 2011\u003c\/strong\u003e — retrospective, USA — 67 RALS, 37 CLS (total 104)\u003c\/li\u003e\n  \u003cli\u003e\n\u003cstrong\u003eManchana et al., 2015\u003c\/strong\u003e — retrospective, Thailand — 28 RALS, 47 CLS (total 75)\u003c\/li\u003e\n  \u003cli\u003e\n\u003cstrong\u003eMartino et al., 2011\u003c\/strong\u003e — retrospective, USA — 101 RALS, 114 CLS (total 215)\u003c\/li\u003e\n  \u003cli\u003e\n\u003cstrong\u003eNezhat et al., 2019\u003c\/strong\u003e — retrospective, USA — 57 RALS, 48 CLS (total 105)\u003c\/li\u003e\n  \u003cli\u003e\n\u003cstrong\u003ePerroni et al., 2021\u003c\/strong\u003e — retrospective, Italy — 455 RALS, 766 CLS (total 1,221)\u003c\/li\u003e\n  \u003cli\u003e\n\u003cstrong\u003eSeamon et al., 2009\u003c\/strong\u003e — retrospective, USA — 105 RALS, 76 CLS (total 181)\u003c\/li\u003e\n  \u003cli\u003e\n\u003cstrong\u003eSeror et al., 2014\u003c\/strong\u003e — retrospective, France — 40 RALS, 106 CLS (total 146)\u003c\/li\u003e\n  \u003cli\u003e\n\u003cstrong\u003eShah et al., 2011\u003c\/strong\u003e — retrospective, USA — 43 RALS, 118 CLS (total 161)\u003c\/li\u003e\n  \u003cli\u003e\n\u003cstrong\u003eSilva et al., 2018\u003c\/strong\u003e — retrospective, Brazil — 44 RALS, 45 CLS (total 89)\u003c\/li\u003e\n  \u003cli\u003e\n\u003cstrong\u003eTurunen et al., 2013\u003c\/strong\u003e — retrospective, Finland — 67 RALS, 150 CLS (total 217)\u003c\/li\u003e\n  \u003cli\u003e\n\u003cstrong\u003eVenkat et al., 2012\u003c\/strong\u003e — retrospective, USA — 27 RALS, 27 CLS (total 54)\u003c\/li\u003e\n  \u003cli\u003e\n\u003cstrong\u003eYoon et al., 2024\u003c\/strong\u003e — retrospective, Korea — 95 RALS, 173 CLS (total 268)\u003c\/li\u003e\n\u003c\/ul\u003e\n\n\u003ch2 id=\"quality\"\u003eStudy Quality and Publication Bias\u003c\/h2\u003e\n\u003cp\u003eThe authors assessed the quality of the 28 cohort studies and 2 randomized controlled trials using the Newcastle–Ottawa quality assessment scale and the RoB-2 tool, respectively. All included randomized controlled trials had a low risk of bias.\u003c\/p\u003e\n\n\u003cp\u003eThe authors assessed outcomes consisting of 10 or more studies for publication bias using funnel plots. Funnel plots that revealed asymmetry were further assessed for confirmation using Begg's and Egger's tests. The p values for Begg's and Egger's tests are provided in Table S4 of the original article.\u003c\/p\u003e\n\n\u003ch2 id=\"injuries\"\u003eKey Finding: Intraoperative Visceral Injuries\u003c\/h2\u003e\n\u003cp\u003eRobot-assisted surgery did not significantly reduce the risk of intraoperative visceral injury compared with conventional laparoscopy. Fourteen studies were included in this analysis, encompassing 5,774 patients: 1,274 in the RALS group and 4,500 in the CLS group.\u003c\/p\u003e\n\n\u003cp\u003eThe pooled analysis found a similar risk of intraoperative visceral injury between the RALS and CLS groups. The risk ratio was 0.72 (95% CI: 0.43–1.19; p = 0.20). Heterogeneity among the studies was minimal (I² = 0%), which indicates consistent findings across the included studies.\u003c\/p\u003e\n\n\u003cp\u003eOverall, these results suggest that RALS does not significantly reduce the risk of intraoperative visceral injury compared with CLS. In plain terms, the chance of injury to the ureters, bladder, bowel, or blood vessels during surgery was statistically comparable between the two approaches.\u003c\/p\u003e\n\n\u003ch2 id=\"transfusion\"\u003eKey Finding: Blood Transfusion\u003c\/h2\u003e\n\u003cp\u003eBlood transfusion rates were similar between the two surgical groups. Ten studies reported blood transfusion rates, including 1,805 patients: 768 in the RALS group and 1,037 in the CLS group.\u003c\/p\u003e\n\n\u003cp\u003eThe pooled analysis found no appreciable difference in blood transfusion rates between the two groups. The risk ratio was 0.73 (95% CI: 0.40–1.33; p = 0.30), with moderate heterogeneity (I² = 27%).\u003c\/p\u003e\n\n\u003cp\u003eThis means that patients who had robot-assisted surgery were not significantly more or less likely to need a blood transfusion than patients who had conventional laparoscopy.\u003c\/p\u003e\n\n\u003ch2 id=\"conversion\"\u003eKey Finding: Conversion to Open Surgery\u003c\/h2\u003e\n\u003cp\u003ePatients in the robot-assisted group had significantly fewer conversions to laparotomy (open abdominal surgery) than patients in the conventional laparoscopy group. This was one of the clearest differences between the two approaches.\u003c\/p\u003e\n\n\u003cp\u003eThe conversion rate was examined in 17 studies encompassing 2,791 patients: 1,247 in the RALS group and 1,544 in the CLS group. The risk ratio was 0.35 (95% CI: 0.23–0.53; p \u0026lt; 0.00001), with no heterogeneity (I² = 0%).\u003c\/p\u003e\n\n\u003cp\u003eA risk ratio of 0.35 means that the risk of conversion to open surgery in the RALS group was about one-third of the risk in the CLS group. The very low p value (p \u0026lt; 0.00001) indicates that this finding is statistically highly significant, meaning there is less than a 0.001% probability that the difference is due to chance. The absence of heterogeneity (I² = 0%) means the studies agreed closely on this result.\u003c\/p\u003e\n\n\u003ch2 id=\"recurrence\"\u003eKey Finding: Cancer Recurrence\u003c\/h2\u003e\n\u003cp\u003eThere was no conclusive evidence that robot-assisted surgery reduced the risk of cancer recurrence compared with conventional laparoscopy. Six studies reported recurrence rates among 2,921 patients: 1,265 in the RALS group and 1,656 in the CLS group.\u003c\/p\u003e\n\n\u003cp\u003eThe pooled risk ratio was 0.85 (95% CI: 0.59–1.23; p = 0.39), with moderate heterogeneity (I² = 34%). Because the confidence interval crosses 1.0 and the p value is above 0.05, the difference was not statistically significant.\u003c\/p\u003e\n\n\u003cp\u003eIn practical terms, the data do not show that one surgical approach is better than the other at preventing the cancer from coming back.\u003c\/p\u003e\n\n\u003ch2 id=\"bloodloss\"\u003eKey Finding: Estimated Blood Loss\u003c\/h2\u003e\n\u003cp\u003eRobot-assisted surgery was associated with significantly less estimated blood loss than conventional laparoscopy. This was the other major difference between the two approaches.\u003c\/p\u003e\n\n\u003cp\u003eEstimated blood loss was analyzed in 20 studies involving 2,989 patients: 1,302 in the RALS group and 1,687 in the CLS group. The pooled mean difference was −78.36 mL (95% CI: −99.07 to −57.65; p = 0.0001).\u003c\/p\u003e\n\n\u003cp\u003eThis means that, on average, patients having robot-assisted surgery lost about 78 mL less blood than patients having conventional laparoscopy. The p value of 0.0001 indicates that this finding is statistically significant.\u003c\/p\u003e\n\n\u003cp\u003eHowever, heterogeneity was high (I² = 81%). Sensitivity and subgroup analyses did not fully explain this high heterogeneity. Therefore, the authors state that these results should be interpreted as indicative of a trend rather than definitive.\u003c\/p\u003e\n\n\u003ch2 id=\"nodes\"\u003eKey Finding: Lymph Nodes Harvested\u003c\/h2\u003e\n\u003cp\u003eThe total number of lymph nodes harvested (removed and examined) was similar between the two groups. This measure matters because the number of lymph nodes removed is one indicator of surgical quality in cancer staging.\u003c\/p\u003e\n\n\u003cp\u003eTwelve studies involving 1,980 patients (908 in the RALS group and 1,072 in the CLS group) reported total lymph node harvest. The pooled mean difference was 0.98 (95% CI: −2.36 to 4.31; p = 0.57).\u003c\/p\u003e\n\n\u003cp\u003eThis result was not statistically significant. However, heterogeneity was very high (I² = 90%), and sensitivity and subgroup analyses did not fully explain this variability. Therefore, the authors state that these results should be interpreted as indicative of a directional trend rather than a definitive effect.\u003c\/p\u003e\n\n\u003ch2 id=\"stay\"\u003eKey Finding: Length of Hospital Stay\u003c\/h2\u003e\n\u003cp\u003eThe length of hospital stay was similar between the two groups. Twenty-one studies involving 6,444 patients (1,555 in the RALS group and 4,889 in the CLS group) reported this outcome.\u003c\/p\u003e\n\n\u003cp\u003eThe pooled mean difference was −0.35 days (95% CI: −0.72 to 0.02; p = 0.07). This means that patients in the robot-assisted group stayed in the hospital about one-third of a day less, on average. However, the result did not reach statistical significance.\u003c\/p\u003e\n\n\u003cp\u003eHeterogeneity was very high (I² = 94%), and sensitivity and subgroup analyses did not fully explain this variability. Therefore, the authors state that these results should be interpreted as indicative of a directional trend rather than a definitive effect.\u003c\/p\u003e\n\n\u003ch2 id=\"time\"\u003eKey Finding: Operative Time\u003c\/h2\u003e\n\u003cp\u003eOperative time did not differ significantly between robot-assisted and conventional laparoscopic surgery. Twenty-two studies involving 4,295 patients (1,799 in the RALS group and 2,496 in the CLS group) reported operative time.\u003c\/p\u003e\n\n\u003cp\u003eThe pooled mean difference was 11.49 minutes (95% CI: −7.12 to 30.10; p = 0.23). This means that robot-assisted surgery took about 11 minutes longer on average, but this difference was not statistically significant.\u003c\/p\u003e\n\n\u003cp\u003eHeterogeneity was very high (I² = 97%), and sensitivity and subgroup analyses did not fully explain this variability. Therefore, the authors state that these results should be interpreted as indicative of a directional trend rather than a definitive effect.\u003c\/p\u003e\n\n\u003ch2 id=\"survival\"\u003eKey Finding: 3-Year and 5-Year Survival\u003c\/h2\u003e\n\u003cp\u003eOverall survival at 3 years and at 5 years was not significantly different between the two surgical approaches. Four studies reported 3-year survival (n = 1,796 patients), and four studies reported 5-year survival (n = 6,028 patients).\u003c\/p\u003e\n\n\u003cp\u003eFor 3-year survival, the risk ratio was 1.01 (95% CI: 0.96–1.06; p = 0.82), with heterogeneity of I² = 67%. For 5-year survival, the risk ratio was 1.01 (95% CI: 0.98–1.05; p = 0.38), also with heterogeneity of I² = 67%.\u003c\/p\u003e\n\n\u003cp\u003eThese findings are based on a limited number of studies. The authors also derived them using pooled risk ratios at fixed time points rather than time-to-event analyses, which may limit their robustness. The authors therefore advise that these survival estimates should be interpreted cautiously.\u003c\/p\u003e\n\n\u003ch2 id=\"implications\"\u003eWhat These Findings Mean for Patients\u003c\/h2\u003e\n\u003cp\u003eFor patients deciding between robot-assisted and conventional laparoscopic surgery for endometrial cancer, this review suggests that the two approaches are broadly comparable for most outcomes. The clearest advantages of robot-assisted surgery were less blood loss and a lower chance of needing to switch to open abdominal surgery during the operation.\u003c\/p\u003e\n\n\u003cp\u003eThe review found no significant differences between the two approaches for several important outcomes:\u003c\/p\u003e\n\u003cul\u003e\n  \u003cli\u003eIntraoperative visceral injuries (risk ratio 0.72; p = 0.20)\u003c\/li\u003e\n  \u003cli\u003eBlood transfusion (risk ratio 0.73; p = 0.30)\u003c\/li\u003e\n  \u003cli\u003eTotal lymph nodes harvested (mean difference 0.98; p = 0.57)\u003c\/li\u003e\n  \u003cli\u003eLength of hospital stay (mean difference −0.35 days; p = 0.07)\u003c\/li\u003e\n  \u003cli\u003eOperative time (mean difference 11.49 minutes; p = 0.23)\u003c\/li\u003e\n  \u003cli\u003eRecurrence (risk ratio 0.85; p = 0.39)\u003c\/li\u003e\n  \u003cli\u003e3-year survival (risk ratio 1.01; p = 0.82)\u003c\/li\u003e\n  \u003cli\u003e5-year survival (risk ratio 1.01; p = 0.38)\u003c\/li\u003e\n\u003c\/ul\u003e\n\n\u003cp\u003eThe authors note that robotic surgery has drawbacks, including longer operative times, higher costs, technical limitations of the robotic system, and the need for specialized staff and training. These factors may matter to patients and hospitals when choosing between approaches.\u003c\/p\u003e\n\n\u003cp\u003eThe paper's introduction cites a separate retrospective study in morbidly obese women with endometrial cancer, which found minimally invasive approaches, particularly robotic-assisted surgery, feasible and safe with acceptable perioperative outcomes; this was not a finding of the review's own analyses. This is relevant because obesity is a major driver of the rising incidence of endometrial cancer.\u003c\/p\u003e\n\n\u003ch2 id=\"limitations\"\u003eLimitations: What the Review Could Not Prove\u003c\/h2\u003e\n\u003cp\u003eThe authors emphasize several limitations that affect how strongly the conclusions can be stated. The most important limitation is that most of the evidence comes from observational studies rather than randomized controlled trials. Only 2 of the 30 included studies were randomized controlled trials; the other 28 were observational.\u003c\/p\u003e\n\n\u003cp\u003eSubstantial heterogeneity was observed across several outcomes. For estimated blood loss, heterogeneity was 81%. For lymph node harvest, heterogeneity was 90%. For length of hospital stay, heterogeneity was 94%. For operative time, heterogeneity was 97%. Sensitivity and subgroup analyses did not fully explain this variability for several of these outcomes.\u003c\/p\u003e\n\n\u003cp\u003eSurvival data were limited. The 3-year and 5-year survival estimates were based on only four studies each. The authors also derived these estimates using pooled risk ratios at fixed time points rather than time-to-event analyses, which may limit their robustness.\u003c\/p\u003e\n\n\u003cp\u003eThe authors did not formally assess the certainty of evidence using GRADE. Therefore, conclusions regarding comparative effectiveness should be interpreted with caution.\u003c\/p\u003e\n\n\u003cp\u003eBaseline oncologic characteristics, including disease stage, tumor grade, uterine weight, and adjuvant therapy, were inconsistently reported across studies. Several of these variables were not reported in a substantial proportion of studies, which limits adjustment for differences between patient groups.\u003c\/p\u003e\n\n\u003cp\u003eEconomic evaluations, such as cost-effectiveness, were outside the scope of this analysis. The review therefore does not answer questions about the relative value or affordability of the two approaches.\u003c\/p\u003e\n\n\u003cp\u003eGiven the predominance of observational evidence, persistent heterogeneity, and limited survival data, the authors state that these findings should be interpreted with caution. High-quality randomized trials are needed to better define the comparative effectiveness of these approaches.\u003c\/p\u003e\n\n\u003ch2 id=\"recommendations\"\u003ePractical Recommendations\u003c\/h2\u003e\n\u003cp\u003eBased on this review, patients and clinicians can consider the following points when discussing surgical options for endometrial cancer:\u003c\/p\u003e\n\n\u003col\u003e\n  \u003cli\u003eThe review found no significant differences in lymph nodes harvested, recurrence, or 3-year and 5-year survival between robot-assisted and conventional laparoscopic surgery, but the authors say these findings are based on few studies and the evidence for long-term cancer-control equivalence is limited. The review found no significant differences in lymph nodes harvested, recurrence, or 3-year and 5-year survival between robot-assisted and conventional laparoscopic surgery.\u003c\/li\u003e\n  \u003cli\u003e\n\u003cstrong\u003eWeigh the blood loss and conversion advantages of robotic surgery.\u003c\/strong\u003e Robot-assisted surgery was associated with about 78 mL less blood loss and roughly one-third the risk of conversion to open surgery. The reduction in blood loss was similar in obese and nonobese patients, with no significant difference between these subgroups.\u003c\/li\u003e\n  \u003cli\u003e\n\u003cstrong\u003eAsk about hospital and surgeon experience.\u003c\/strong\u003e Robotic surgery requires specialized staff and training. The paper says robotic surgery may offer a shorter learning curve, but the review did not test this, and hospital resources and surgeon familiarity vary.\u003c\/li\u003e\n  \u003cli\u003e\n\u003cstrong\u003eDiscuss costs and access.\u003c\/strong\u003e Robotic surgery has higher costs, and this review did not evaluate cost-effectiveness. Patients should ask how costs and insurance coverage may differ between the two approaches.\u003c\/li\u003e\n  \u003cli\u003e\n\u003cstrong\u003eRecognize the limits of the evidence.\u003c\/strong\u003e Most evidence comes from observational studies with substantial heterogeneity. Patients should ask their care team how these findings apply to their individual case, including disease stage, tumor grade, body mass index, and other health conditions.\u003c\/li\u003e\n  \u003cli\u003e\n\u003cstrong\u003eAsk about clinical trials.\u003c\/strong\u003e The authors call for high-quality randomized trials to better define the comparative effectiveness of these approaches. Patients interested in contributing to stronger evidence can ask whether relevant trials are available.\u003c\/li\u003e\n\u003c\/ol\u003e\n\n\u003c!-- ddn:faq:start --\u003e\n\u003ch2 id=\"ddn-faq\"\u003eFrequently Asked Questions\u003c\/h2\u003e\n\u003ch3\u003eWhat is the difference between robot-assisted and conventional laparoscopic surgery for endometrial cancer?\u003c\/h3\u003e\n\u003cp\u003eBoth are minimally invasive operations to remove the uterus and both ovaries and fallopian tubes, and to sample lymph nodes for staging. In conventional laparoscopy the surgeon guides a camera and instruments directly. In robot-assisted surgery a robotic system translates the surgeon's hand movements, filtering out tremor. Both aim to stage the cancer with fewer complications than a large abdominal incision.\u003c\/p\u003e\n\u003ch3\u003eWhich operation had less blood loss in the pooled analysis?\u003c\/h3\u003e\n\u003cp\u003eAcross 20 studies involving 2,989 patients, robot-assisted surgery was linked to about 78 mL less estimated blood loss on average than conventional laparoscopy. The authors note high variation between studies and describe this as a trend rather than a definitive effect. Blood transfusion rates did not differ significantly between the two groups.\u003c\/p\u003e\n\u003ch3\u003eHow likely is it that surgery switches to an open abdominal operation?\u003c\/h3\u003e\n\u003cp\u003eAcross 17 studies of 2,791 patients, the chance of converting to open surgery during robot-assisted surgery was about one-third of the chance with conventional laparoscopy. This was one of the clearest differences between the approaches, and the studies agreed closely on it. Your own risk depends on your individual circumstances, which your care team can discuss.\u003c\/p\u003e\n\u003ch3\u003eDoes robot-assisted surgery remove as many lymph nodes as conventional laparoscopy?\u003c\/h3\u003e\n\u003cp\u003eThe number of lymph nodes removed and examined was similar between the two approaches across 12 studies of 1,980 patients. This matters because lymph node count is one indicator of surgical quality in cancer staging. Variation between studies was very high, so the authors describe this as a directional trend rather than a definitive effect.\u003c\/p\u003e\n\u003ch3\u003eWill survival or the chance of the cancer returning differ between the two operations?\u003c\/h3\u003e\n\u003cp\u003eThe review found no significant difference in cancer recurrence, or in 3-year and 5-year overall survival, between robot-assisted and conventional laparoscopy. These survival estimates came from only four studies each and were calculated at fixed time points, so the authors advise interpreting them cautiously. Cancer control appeared broadly comparable with either approach.\u003c\/p\u003e\n\u003ch3\u003eHow long is the hospital stay and operation with each approach?\u003c\/h3\u003e\n\u003cp\u003eHospital stay was similar, about one-third of a day shorter on average with robot-assisted surgery, but this was not statistically significant. Operative time was about 11 minutes longer on average with robot-assisted surgery, also not statistically significant. Variation between studies was very high for both outcomes, so the authors describe these as directional trends.\u003c\/p\u003e\n\u003ch3\u003eWhat are the drawbacks of robot-assisted surgery and how strong is the evidence?\u003c\/h3\u003e\n\u003cp\u003eRobot-assisted surgery has drawbacks, including longer operative times, higher costs, technical limitations of the robotic system, and the need for specialized staff and training. Most evidence comes from 28 observational studies and only 2 randomized trials, with substantial variation between studies. The authors call for high-quality randomized trials and advise interpreting the findings with caution.\u003c\/p\u003e\n\u003ch3\u003eShould I get a second opinion before choosing robot-assisted or conventional laparoscopic surgery for endometrial cancer?\u003c\/h3\u003e\n\u003cp\u003eA second opinion can be useful when weighing these two minimally invasive approaches. The evidence shows they are broadly comparable for most outcomes, including lymph nodes harvested, recurrence, and 3-year and 5-year survival. Robot-assisted surgery was associated with about 78 mL less blood loss and roughly one-third the risk of conversion to open surgery, though most evidence comes from observational studies with substantial heterogeneity. A second opinion can help clarify how these trade-offs, along with surgeon and hospital experience and costs, apply to your stage, tumor grade, and body mass index. Diagnostic Detectives Network provides independent expert second opinions.\u003c\/p\u003e\n\u003c!-- ddn:faq:end --\u003e\n\n\u003ch2 id=\"source\"\u003eSource Information\u003c\/h2\u003e\n\u003cp\u003e\u003cstrong\u003eOriginal article title:\u003c\/strong\u003e Robot-assisted versus conventional laparoscopic surgery for endometrial cancer: an updated systematic review and meta-analysis.\u003c\/p\u003e\n\n\u003cp\u003e\u003cstrong\u003eAuthors:\u003c\/strong\u003e Majeed K, Ahmed M, Ali H, Kashif A, Murtaza M, Hanif ZM, Sidra F, Batool A, Onesime J, Akilimali A.\u003c\/p\u003e\n\n\u003cp\u003e\u003cstrong\u003ePublication details:\u003c\/strong\u003e BMC Surgery (2026) 26:475. DOI: https:\/\/doi.org\/10.1186\/s12893-026-03802-6. Open Access under a Creative Commons Attribution-NonCommercial-NoDerivatives 4.0 International License.\u003c\/p\u003e\n\n\u003cp\u003e\u003cstrong\u003eReview registration:\u003c\/strong\u003e PROSPERO CRD420251120306.\u003c\/p\u003e\n\n\u003cp\u003e\u003cstrong\u003eNote:\u003c\/strong\u003e This patient-friendly article is based on peer-reviewed research. It restructures the findings of one systematic review and meta-analysis for a general audience. It does not replace advice from a qualified healthcare professional. Patients should discuss their individual treatment options with their care team.\u003c\/p\u003e","brand":"DiagnosticDetectives.Com","offers":[{"title":"Default Title","offer_id":48163213475996,"sku":null,"price":0.0,"currency_code":"RUB","in_stock":true}],"thumbnail_url":"\/\/cdn.shopify.com\/s\/files\/1\/0599\/5449\/5644\/files\/ddn-medical-article-robot-assisted-vs-conventional-laparoscopic-surgery-for-endometrial-cancer-what-an-updated-review-of-10-673-patients-sho-hero.png?v=1793513840","url":"https:\/\/diagnosticdetectives.ru\/products\/robot-assisted-vs-conventional-laparoscopic-surgery-for-endometrial-cancer-what-an-updated-review-of-10-673-patients-shows","provider":"DiagnosticDetectives.Com","version":"1.0","type":"link"}