Robotic vs. Non-Robotic Single-Site Hysterectomy: Marchand Institute's New Meta-Analysis Provides Clarity on Surgical Outcomes - Marchand Institute For Minimally Invasive Surgery

The Marchand Institute for Minimally Invasive Surgery is pleased to announce the online publication of our latest research, appearing today in the Journal of Gynecology Obstetrics and Human Reproduction (JOGOH). Our new paper, titled “Comparison of the Efficacy and Safety of Single-Site Laparoscopic Hysterectomy with and without Robotic Assistance: A Meta-Analysis,” offers a rigorous evaluation of the two primary modalities for single-incision hysterectomy.

As surgical technology evolves, clinicians and patients alike are increasingly faced with the choice between robotic-assisted techniques and traditional laparoscopic methods. This study was designed to provide a high-level, evidence-based comparison to help guide that decision-making process.

Read the Full Study Here:

PubMed (NCBI): PMID: 41713553
Official Journal Link (Elsevier): DOI: 10.1016/j.jogoh.2026.103145

Evaluating the Single-Site Frontier

The move toward single-site surgery represents the next logical step in the “minimally invasive” revolution. By consolidating the surgical entry point into a single, small umbilical incision, surgeons aim to improve cosmetic outcomes and potentially reduce postoperative discomfort. However, the technical challenges of single-site surgery—such as the “crowding” of instruments and loss of triangulation—have led to the development of two distinct approaches: Laparoendoscopic Single-Site Hysterectomy (LESS-H) and Robotic Single-Site Hysterectomy (RSSH).

While robotic platforms offer enhanced dexterity and 3D visualization to overcome these challenges, they also come with higher costs and different setup requirements. Our research team sought to determine if the robotic assistance actually translates into superior clinical outcomes for the patient.

Study Design and Methodology

Our team conducted a comprehensive systematic review and meta-analysis following the PRISMA guidelines. We synthesized data from all available observational studies comparing RSSH and LESS-H, searching major medical databases (including Medline, PubMed, and the Cochrane Library) from their inception through July 2024.

The primary outcomes analyzed included:

Total operative time
Estimated blood loss (EBL)
Length of hospital stay
Pain scores (VAS) at 1 and 12 hours
Complication, conversion, and transfusion rates

Key Findings: A Balanced Comparison

The results of the meta-analysis highlight that while both techniques are safe and effective, they offer different trade-offs in the operating room.

Operative Time: On average, Robotic Single-Site Hysterectomy (RSSH) was associated with longer operative times compared to the non-robotic approach. For benign cases specifically, RSSH took approximately 23.5 minutes longer (MD = 23.51 mins, p = 0.009). However, in cases of early-stage endometrial carcinoma, the robotic approach trended toward being faster, although this difference did not reach statistical significance.
Blood Loss: RSSH was associated with a modestly lower estimated blood loss (MD = -6.84 ml, p = 0.01). While statistically significant, our authors note that a difference of less than 7 milliliters is likely not clinically impactful in a standard hysterectomy.
Safety and Recovery: There were no significant differences between the two groups in terms of complication rates, blood transfusion requirements, or the length of the patient’s hospital stay.
Postoperative Pain: Patients reported similar pain scores at both the 1-hour and 12-hour marks, regardless of whether a robot was used.

Clinical Takeaways for Surgeons and Patients

The findings of this meta-analysis suggest that for most benign gynecologic conditions, robotic assistance in single-site surgery may increase operative time without offering a substantial clinical advantage in terms of pain reduction or hospital stay.

“Our data shows that both RSSH and LESS-H are highly safe modalities for performing a hysterectomy through a single incision,” says the research team at the Marchand Institute. “The choice between the two may ultimately come down to the surgeon’s comfort level, the specific pathology—such as malignancy—and the resources available at the institution.”

This study provides an important baseline for counseling patients. It suggests that while the “robot” is a powerful tool, the traditional laparoscopic single-site approach remains a highly efficient and comparable alternative in the hands of a skilled surgeon.

Acknowledgements

We would like to thank our dedicated research staff and the contributing authors from the University of Arizona College of Medicine, Creighton University, and Midwestern University. This collaborative effort is essential for advancing the field of minimally invasive gynecologic surgery (MIGS).

About the Marchand Institute

The Marchand Institute for Minimally Invasive Surgery is a non-profit research and educational institution dedicated to the advancement of gynecologic surgery. We focus on developing and evaluating surgical techniques that reduce recovery time, minimize pain, and improve the overall quality of care for women worldwide.

For more information on our surgical fellowships or to view our library of research, please visit MarchandInstitute.org.