Twenty-one studies were included for review (2,666 participants). Study design was not reported.
Patients who underwent robot-assisted laparoscopic hysterectomy had a significantly shorter length of stay (summary effect -0.43, 95% CI -0.68 to -0.17, p=0.05; 17 studies) and fewer postoperative complications (summary OR 0.69, 95% CI 0.43 to 1.09; 14 studies) compared to patients who underwent traditional laparoscopic hysterectomy. There were significantly fewer conversions to laparotomy with robot-assisted laparoscopic hysterectomy compared to traditional laparoscopic hysterectomy (OR 0.50, 95% CI 0.31 to 0.79; 15 studies). There was no significant difference between robot-assisted and traditional laparoscopic hysterectomy in operative time or estimated blood loss. There was no evidence of significant statistical heterogeneity for any outcomes.
For the outcomes of operative time and postoperative complications, t-tests showed significant differences between benign and malignant cases. The results of subgroup analyses for these outcomes were reported. Sensitivity analyses that excluded the study with the largest sample did not significantly alter the findings. There were no differences in outcomes between the random-effects and fixed-effect models. There was no difference in uterine weight between robot-assisted and traditional laparoscopy groups. The authors stated there was no publication bias but inspection of funnel plots suggested that there may have been some missing data.