Farhad Shafiei, Fatemeh Kani, Ehsan Tarki, Sonia Fallahi, Niyoosha Ahmadi Beidokhti, Hananeh Zarebian, Fatemeh Roshani, Maedeh Taiebi Falah, Hossein Ali Abdolrazaghi, Amir Shokri
Robotic hysterectomy represents a safe minimally invasive option offering tangible perioperative benefits over open surgery and clinical parity with laparoscopy. Nevertheless, its clinical utility must be balanced against elevated acquisition and procedural expenditures, institutional learning curves, and established oncologic constraints in cervical malignancy.
BACKGROUND: Robotic-assisted hysterectomy has gained widespread clinical adoption; however, comparative evidence regarding its clinical outcomes, oncologic efficacy, and cost-effectiveness remains subject to ongoing debate.
METHODS: A narrative review with a structured literature search was conducted across PubMed, Scopus, Web of Science, Embase, ScienceDirect, SpringerLink, Wiley Online Library, and Google Scholar (January 2010 to May 2026). Evidence was synthesized across systematic reviews/meta-analyses, randomized trials, and observational cohorts, evaluating eight key clinical and economic domains: intraoperative metrics, oncologic outcomes, conversion rates, complications, length of stay, hospital costs, learning curves, and baseline patient characteristics.
RESULTS: Across 180 eligible studies, minimally invasive approaches (both robotic and laparoscopic) demonstrated significantly reduced estimated blood loss and shorter hospital stays compared with open hysterectomy, with robotic platforms yielding perioperative outcomes largely comparable to conventional laparoscopy. In benign indications, conversion rates between robotic and laparoscopic approaches showed no statistically significant difference, though robotic platforms conferred procedural advantages in selected high-risk cohorts (e.g., morbid obesity). Regarding oncologic outcomes, long-term survival in endometrial cancer is comparable across minimally invasive and open modalities. Conversely, for early-stage cervical cancer, evidence underscores superior disease-free and overall survival with open radical hysterectomy compared with minimally invasive approaches. Total hospital costs were consistently higher for robotic surgery, and operative times were frequently prolonged during initial institutional learning phases.
CONCLUSION: Robotic hysterectomy represents a safe minimally invasive option offering tangible perioperative benefits over open surgery and clinical parity with laparoscopy. Nevertheless, its clinical utility must be balanced against elevated acquisition and procedural expenditures, institutional learning curves, and established oncologic constraints in cervical malignancy.