The Benign COMPARE Study: Comparing Perioperative Outcomes of Benign Minimally Invasive Laparoscopic, da Vinci Robotic, and Open Procedures: A Systematic Review and Meta-Analysis of Evidence.

OBJECTIVES: To assess perioperative and quality-of-life outcomes of da Vinci robotic-assisted surgery (dV-RAS), laparoscopic, and open surgery for 13 benign procedures. BACKGROUND: Prior studies demonstrate dV-RAS benefits in oncologic procedures, but potential benefits in benign procedures remain undetermined. METHODS: Preferred Reporting Items for Systematic Reviews and Meta-Analyses-guided systematic searches (PROSPERO CRD420251001402) of PubMed, Scopus, and Embase (last searched October 22, 2025) identified randomized controlled trials (RCTs), database studies, and comparative cohort studies (2010-2024). Primary endpoints included operative time (OT), transfusions, length of stay (LOS), conversions, intraoperative and postoperative complications, surgical site infections (SSIs), readmissions, reoperations, and mortality. Secondary endpoints included pain, pain medication use, return to activities of daily living (ADL), and return to work (RTW). Pooled odds ratios (ORs), risk differences, or mean differences (MD) were estimated using fixed or random-effects models, with bias assessed using Risk of Bias in Non-Randomized Studies of Interventions and Cochrane risk-of-bias tool for randomized trials. RESULTS: Three hundred sixty-six studies (13 RCTs, 21 prospective, 101 database, and 231 retrospective) comprising 1,469,565 dV-RAS, 10,699,092 laparoscopy, and 1,730,656 open patients were analyzed. Compared with open surgery, dV-RAS was associated with fewer transfusions [OR, 0.31 (0.24-0.42); P < 0.01], intraoperative [OR, 0.64 (0.55-0.74); P < 0.01] and postoperative complications [OR, 0.54 (0.43-0.68); P < 0.01], lower SSI [OR, 0.40 (0.28-0.56); P < 0.01], readmissions [OR, 0.66 (0.51-0.85); P < 0.01], reoperations [OR, 0.70 (0.51-0.96); P = 0.03], and mortality [OR, 0.37 (0.29-0.46); P < 0.01], with shorter LOS [MD, -1.97 (-2.36 to -1.58); P < 0.01], reduced pain medication [OR, 0.63 (0.43-0.91); P = 0.01], and faster RTW [MD, -5.19 (-9.27 to -1.12); P = 0.01]. Pain scores and ADL were comparable; OT was 46 minutes longer (176.3 vs 130.0 min; P < 0.01). Compared with laparoscopy, dV-RAS was associated with lower conversion [OR, 0.46 (0.37-0.57); P < 0.01], fewer transfusions [OR, 0.87 (0.77-0.98); P = 0.02], shorter LOS [MD, -0.17 (-0.27 to -0.08); P < 0.01], lower pain scores [MD, -0.69 (-1.2 to -0.18); P < 0.01], reduced pain medication use [OR, 0.88 (0.83-0.92); P < 0.01], and faster RTW [MD, -2.04 (-3.43 to -0.64); P < 0.01]. OT was 24 minutes longer (148.5 vs 124.9 min; P < 0.01), with other outcomes comparable. Heterogeneity was procedure-driven. CONCLUSIONS: dV-RAS was associated with fewer conversions, less pain, and faster recovery compared with open and laparoscopic surgery, supporting its effectiveness for benign indications.