Robotic-Assisted vs Conventional Laparoscopy for Endometrial Cancer Staging: A Comparative Two-Center Study

Abstract

Purpose: To compare surgical outcomes between conventional laparoscopic and robotic-assisted laparoscopic approaches in the treatment of endometrial cancer. Patients and Methods: This retrospective, two-center case-control study analyzed data from patients undergoing total laparoscopic hysterectomy and lymphadenectomy for endometrial cancer between January 2020 and January 2025. Primary outcomes included estimated blood loss, hemoglobin and hematocrit decrease, operative time, and complication rates. Results: A total of 136 patients were included (66 conventional laparoscopy, 70 robotic-assisted laparoscopy). No significant differences were observed in baseline demographics, comorbidities, or cancer staging. Robotic-assisted surgery was associated with lower blood loss (100 vs 200 mL, p<0.001), reduced hemoglobin and hematocrit decrease (p<0.05), less frequent peritoneal drainage (28.6% vs 80%, p<0.001) and greater number of pelvic nodes on pathology with the median [IQR] of 4 [3–7] vs 2 [1-6], (p<0.001). However, robotic procedures had longer operative times (146 vs 120 min, p<0.001). Conversion rates (2.9% vs 7.6%, p=0.264) and intraoperative/postoperative complications were comparable between groups. Conclusion: Robotic-assisted laparoscopic surgery for endometrial cancer is a safe and effective alternative to conventional laparoscopy, offering advantages in blood loss reduction while requiring longer operative times. Further prospective studies are needed to validate these findings and assess cost-effectiveness.