Comparison of the efficacy and safety of robotic single-site hysterectomy versus robotic multi-port hysterectomy: a systematic review and meta-analysis

This meta-analysis was conducted in strict accordance with the Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) guidelines [ 11 ]. To enhance transparency and reduce the risk of bias, the study protocol was prospectively registered in the International Prospective Register of Systematic Reviews (PROSPERO; registration number CRD420251106151) prior to data extraction. As this study synthesized data from previously published studies, ethical approval was not required. The RSSH cohort served as the experimental group, while the RMPH cohort acted as the control group. A comprehensive literature search was performed across eight electronic databases: PubMed, Embase, the Cochrane Library, Web of Science, China National Knowledge Infrastructure (CNKI), WanFang Data, Chinese Biomedical Literature Database (CBM), and Chinese Scientific Journal Database (VIP), from database inception to July 2025. The search strategy combined Medical Subject Headings (MeSH) terms and free-text keywords related to robotic surgery (e.g., robotic surgical procedures, da Vinci, computer-assisted surgery) and surgical approach (single-site, single-port, single-incision, single-trocar) along with hysterectomy (Supplementary Material 1). Additionally, manual screening of reference lists from included studies and relevant systematic reviews was conducted to identify further eligible publications. Only studies published in English or Chinese were considered. Two authors independently selected the articles and extracted the data using a standardized form. Any disagreement in study selection and/or data extraction was resolved by consensus between the two authors. When necessary, a third author was consulted to reach a final decision (though none was required). Only studies that met the inclusion criteria were included. Studies were eligible for inclusion if they met the following criteria: (1) Population: patients diagnosed with benign uterine conditions, precancerous lesions, or early-stage gynecological malignancies; (2) Intervention: robotic single-site hysterectomy (RSSH); (3) Control: robotic multi-port hysterectomy (RMPH); (4) Outcomes: reporting of at least one primary (intraoperative or postoperative complication rate) or secondary outcome (e.g., operative time, estimated blood loss); (5) Study design: original peer-reviewed research articles (randomized controlled trials or observational studies). Exclusion criteria were: (1) non-original publications (e.g., conference abstracts, letters, editorials, case reports); (2) studies comparing robotic surgery with laparoscopic or open approaches; (3) studies lacking extractable or calculable outcome data. Two independent reviewers screened titles, abstracts, and full texts. Disagreements were resolved through discussion, with a third reviewer consulted when consensus could not be reached. Data extraction was conducted systematically using a standardized form. For each included study, information was collected on study characteristics, patient baseline data, and perioperative outcome measures. Study characteristics encompassed the author, publication year, country, study design, study period, sample size, and additional details pertinent to assessing the study’s adherence to the inclusion and exclusion criteria. Patient baseline data included age (years), body mass index (BMI), uterine weight (g) or volume (cm 3 ), history of previous abdominal surgery, type of surgical instruments, and surgical approach. Perioperative outcomes were assessed through metrics such as operative time (minutes), postoperative length of stay (days or hours), estimated blood loss (mL), Postoperative hemoglobin drop (g/L), transfusion, visual analog scale (VAS) pain scores, intraoperative complications, postoperative complications, and conversion to laparotomy. Intraoperative and postoperative complications were identified as the primary outcomes to evaluate the safety of the two surgical approaches. Intraoperative complications mainly referred to additional injuries caused by surgical manipulation during the procedure, including bladder injury, bowel injury, major vessel injury, nerve injury, retroperitoneal hematoma, and ureteral injury. Postoperative complications were assessed using the Clavien-Dindo classification, and postoperative complications were defined as those classified as Clavien-Dindo Grade ≥ II. These mainly included abdominal infection, cystitis, omphalitis, ureteral stenosis, vaginal dehiscence, vaginal abscess, lower extremity deep venous thrombosis, and pulmonary embolism. None of the included studies reported severe complications of Grade IV or above, or any deaths. Secondary outcomes comprised quantifiable perioperative indicators used to compare the two surgical approaches, including operative time, estimated blood loss, blood transfusion rates, postoperative hemoglobin decline, conversion to laparotomy, and length of hospital stay. We assessed the risk of bias for each included study using the ROBINS-I tool [ 12 ]. This tool evaluates seven domains of bias: bias due to confounding; bias in selection of participants into the study; bias in classification of interventions; bias due to deviations from intended interventions; bias due to missing data; bias in measurement of outcomes; and bias in selection of the reported result. Two reviewers independently conducted the risk of bias assessments, and any disagreements were resolved through discussion or by consulting a third reviewer. For each domain, the risk of bias was classified as ‘Low,’ ‘Moderate,’ ‘Serious,’ or ‘Critical,’ and an overall risk of bias judgment was then determined for each study. Furthermore, we generated traffic light plots using the robvis visualization tool, which allow readers to quickly and intuitively understand the risk of bias levels across different domains for each included study, thereby facilitating the identification of overall strengths and weaknesses of the body of evidence. We also assessed the methodological quality using the Newcastle-Ottawa Scale (NOS). The NOS evaluates studies across three domains—selection, comparability, and outcome—with a maximum score of 9. Studies scoring ≥ 7 were classified as high quality, 5–6 as moderate, and < 5 as low quality. Discrepancies were resolved by discussion, with arbitration by a third reviewer when necessary. Statistical analyses were performed using Review Manager (RevMan, version 5.4). For dichotomous outcomes, pooled effect estimates were expressed as relative risks (RR) with 95% confidence intervals (CIs), calculated using the Mantel-Haenszel method. For continuous outcomes, mean differences (MD) or standardized mean differences (SMD) with 95% CIs were computed using the inverse variance method, depending on outcome homogeneity. Heterogeneity was assessed using the x 2 test ( P   50% denoting substantial heterogeneity). A fixed-effect model was applied in the absence of significant heterogeneity; otherwise, a random-effects model was used. Sensitivity analyses were conducted to evaluate the robustness of results when substantial heterogeneity was present. Statistical significance was defined as p  < 0.05. The certainty of evidence for the primary outcome was assessed using the GRADE approach. The assessment considered five domains: study limitations, inconsistency of results, indirectness of evidence, imprecision, and publication bias [ 13 , 14 ]. Observational studies started at low certainty and could be downgraded or upgraded based on the presence of serious limitations or large effect sizes. The certainty of evidence was categorized according to the following definitions: High certainty—we are very confident that the true effect lies close to that of the estimate of the effect; Moderate certainty—we are moderately confident in the effect estimate: the true effect is likely to be close to the estimate of the effect, but there is a possibility that it is substantially different; Low certainty—our confidence in the effect estimate is limited: the true effect may be substantially different from the estimate of the effect; Very low certainty—we have very little confidence in the effect estimate: the true effect is likely to be substantially different from the estimate of the effect [ 15 ].

A comprehensive search of eight electronic databases yielded 881 records. After applying predefined eligibility criteria, seven retrospective cohort studies involving 962 patients (RSSH group: n = 486; RMPH group: n = 476) were included in this meta-analysis [ 16 – 22 ]. The study selection process is detailed in the PRISMA 2020 flow diagram (Fig. 1 ). At the full-text screening stage, studies that did not meet the eligibility criteria were excluded, and a list of these excluded studies is provided in Supplementary Material 2. This table includes the first author, year of publication, DOI, and reason for exclusion for each excluded study. Exclusion reasons were classified according to our pre-defined eligibility criteria, such as inappropriate study design (non-comparative studies, wrong comparator), inappropriate intervention (not RSSH), unavailable outcome data, non-original research, etc. The studies were published between 2016 and 2025 and conducted in China, the United States, Italy, South Korea, and Japan. Table 1 summarizes the key characteristics of the included studies, and Table 2 presents baseline patient demographics. Across the studies, baseline characteristics were generally well-balanced between groups, although uterine weight tended to be higher in the RMPH cohort in several reports. Fig. 1 PRISMA flow diagram of the literature search PRISMA flow diagram of the literature search Table 1 Characteristics and quality assessment of the included studies [ 16 – 22 ] NOS Newcastle-Ottawa Scale, N/A Not available Characteristics and quality assessment of the included studies [ 16 – 22 ] NOS Newcastle-Ottawa Scale, N/A Not available Table 2 Baseline patient demographics (RSSH versus RMPH) [ 16 – 22 ] RSSH Robotic single-site hysterectomy, RMPH Robotic multiport hysterectomy, BMI Body mass index, N/A Not available a Weight of uterus b Volume of uterus c Median Baseline patient demographics (RSSH versus RMPH) [ 16 – 22 ] RSSH Robotic single-site hysterectomy, RMPH Robotic multiport hysterectomy, BMI Body mass index, N/A Not available a Weight of uterus b Volume of uterus c Median The risk of bias assessment results for each included study, assessed using the ROBINS-I tool, are presented in Fig.  2 . The figure shows that the risk of bias was primarily concentrated in the domain of bias due to confounding, whereas the remaining six domains were mostly at low risk of bias in the vast majority of studies. Fig. 2 Risk of bias assessment of the included studies using the ROBINS-I tool Risk of bias assessment of the included studies using the ROBINS-I tool The results of the NOS are presented in Table  1 . As shown, all studies scored between 7 and 9, indicating high methodological quality. Due to the small number of included studies ( n  = 7), formal assessment of publication bias was not performed, as such analyses are underpowered and unreliable with fewer than 10 studies. Five studies reported data on intraoperative complications. Among these, two studies observed no intraoperative complications in either RSSH or RMPH groups [ 16 , 18 ]. The pooled estimate suggested a lower rate of intraoperative complications with RSSH compared to RMPH (RR = 0.17, 95% CI: 0.04 − 0.66; p = 0.01; I² = 0) (Fig. 3 ). The GRADE assessment resulted in a low certainty rating for intraoperative complications (Table 3 ). Fig. 3 Forest plot of intraoperative complications Forest plot of intraoperative complications Table 3 GRADE analysis for primary outcomes a Downgraded by one level for imprecision: total events only 16; 95% CI wide; optimal information size (OIS) not reached b Upgraded by one level for large effect size: pooled RR %3C 0.2, representing a very large reduction in risk c Downgraded by one level for imprecision: low event count; OIS not reached GRADE analysis for primary outcomes a Downgraded by one level for imprecision: total events only 16; 95% CI wide; optimal information size (OIS) not reached b Upgraded by one level for large effect size: pooled RR %3C 0.2, representing a very large reduction in risk c Downgraded by one level for imprecision: low event count; OIS not reached Four studies reported data on postoperative complications. The pooled analysis showed no statistically significant difference in postoperative complication rates between RSSH and RMPH (RR = 0.78, 95% CI: 0.39 − 1.56; p  = 0.48), with low heterogeneity (I² = 28%) (Fig.  4 ). The GRADE assessment resulted in a very low certainty rating for postoperative complications (Table  3 ). Fig. 4 Forest plot of postoperative complications Forest plot of postoperative complications Operative time was reported in five studies. The pooled analysis showed that RSSH was associated with significantly longer operative time compared to RMPH (MD = 7.25 min, 95% CI: 2.18 − 12.32; p  = 0.005; I² = 7% ) (Fig.  5 ). Fig. 5 Forest plot of operative time Forest plot of operative time Four studies compared estimated blood loss between RSSH and RMPH. The pooled analysis revealed a statistically significant reduction in intraoperative blood loss in the RSSH group compared to the RMPH group (MD = − 65.94 ml, 95% CI: −124.47 to − 7.40; p  = 0.03; I² = 84% ) (Fig.  6 ). However, substantial heterogeneity was detected. A sensitivity analysis was subsequently performed, which confirmed the consistency of the results when the effect model was modified (MD = − 70.67 ml, 95% CI: −93.59 to − 47.75; p  < 0.00001) (Supplementary Material 3). Fig. 6 Forest plot of intraoperative blood loss Forest plot of intraoperative blood loss Four studies provided data concerning transfusion outcomes. Two of these studies indicated that no blood transfusions were required regardless of the surgical approach [ 14 , 16 ]. The pooled analysis demonstrated no statistically significant difference in transfusion rate between the RSSH and RMPH groups (RR = 0.86, 95% CI: 0.21 − 3.51; p = 0.83; I² = 0%) (Fig. 7 ). Fig. 7 Forest plot of blood transfusion rates Forest plot of blood transfusion rates Four studies provided data concerning the reduction in hemoglobin levels. The aggregated data revealed no statistically significant difference in hemoglobin reduction between the RSSH and RMPH groups (MD = − 1.84 g/L, 95% CI: −8.89 to 5.21; p = 0.61; I² = 89%) (Fig. 8 ). The meta-analysis demonstrated considerable heterogeneity. A sensitivity analysis, conducted by systematically excluding individual studies, identified that the heterogeneity was predominantly due to a single study [ 17 ]. Upon excluding this study, a subsequent pooled analysis indicated no statistically significant difference in hemoglobin reduction between the RSSH and RMPH groups (MD = − 1.37 g/L, 95% CI: −2.23 to 4.97; p = 0.46; I² = 34%) (Supplementary Material 4). Fig. 8 Forest plot of hemoglobin reduction Forest plot of hemoglobin reduction Four studies provided data on conversion rates. Of these, three studies found that neither the single-site approach nor the multi-port approach necessitated conversion to laparotomy procedures [ 13 , 16 , 18 ]. However, one study reported conversion rates of 2.73% (3/110) for the RSSH group and 1.68% (2/119) for the RMPH group [ 14 ]. The difference in conversion rates between the two surgical approaches was not statistically significant (RR = 1.62, 95% CI: 0.28 − 9.53; p = 0.59) (Fig. 9 ). Fig. 9 Forest plot of conversion rates Forest plot of conversion rates Four studies reported data on postoperative hospital stay. Pooled analysis showed that patients undergoing RSSH had a significantly shorter postoperative hospital stay compared to those undergoing RMPH (SMD = − 0.28, 95% CI: − 0.54 to − 0.01; p  = 0.04; I² = 59%), indicating moderate heterogeneity across studies (Fig.  10 ). To ensure the reliability of these findings, a sensitivity analysis was conducted, which confirmed the robustness of the results upon modification of the effect model (SMD = − 0.25, 95% CI: −0.41 to − 0.09; p  = 0.003; I² = 59%) (Supplementary Material 5). Fig. 10 Forest plot of postoperative hospital stay Forest plot of postoperative hospital stay

Hysterectomy, a prevalent surgical intervention, is increasingly performed via minimally invasive approaches [ 23 , 24 ]. Minimally invasive surgery offers multiple benefits, including reduced tissue trauma, lower risk of intraoperative and postoperative complications, less blood loss, fewer port-site injuries, diminished postoperative pain, and shorter recovery times [ 25 ]. Robotic surgical platforms further enhance these procedures through three-dimensional high-definition vision, improved instrument dexterity, and tremor filtration, which have facilitated their rapid adoption in gynecologic surgery [ 26 ]. Current evidence indicates that robot-assisted hysterectomy confers significant patient benefits compared to conventional laparoscopy, without increasing surgical risk [ 27 , 28 ]. In this context, the da Vinci Single-Port (SP) robotic platform was introduced for hysterectomy and adnexal surgery in 2013. Unlike traditional single-incision laparoscopic surgery, the robotic single-port approach improves surgical ergonomics, enables more precise dissection in confined anatomical spaces, and reduces instrument clashing [ 29 ]. To date, numerous studies have investigated robotic single-site surgery. To evaluate the comparative efficacy and safety of RSSH versus RMPH for total hysterectomy, we conducted a systematic review and meta-analysis of perioperative outcomes. Our analysis found that RSSH was associated with reduced intraoperative blood loss and a shorter postoperative hospital stay. Notably, the RSSH group demonstrated a significantly lower rate of intraoperative complications, whereas postoperative complication rates were comparable between groups. No significant differences were observed in conversion to laparotomy, blood transfusion requirements, or postoperative hemoglobin drop. However, operative time was significantly longer in the RSSH group. Park et al. reported that while RMPH required longer docking and port placement times due to multiple access sites, RSSH incurred prolonged wound closure time owing to the larger umbilical incision; however, uterine resection console time did not differ significantly between groups [ 20 ]. In contrast, Gardella et al. observed a significantly longer console time for RSSH but noted a consistent decline in operative duration from 2012 to 2018, suggesting that surgeons gradually overcome the technical constraints of the single-site platform through accumulated experience [ 17 ]. This learning effect was further supported by Lopez et al., who identified vaginal cuff closure—particularly in the absence of fully articulated instruments—as a key technical challenge in RSSH [ 30 ]. Advances in robotic dexterity and surgeon proficiency have since mitigated this limitation, leading to reduced intracorporeal suturing times. Similarly, Buckley et al. demonstrated that procedural efficiency in single-port robotic surgery improves markedly with increasing surgeon and team experience [ 31 ]. The interpretation of operative time must account for the learning curve inherent to robotic surgery. RSSH differs substantially from multi-port robotic approaches and follows a distinct learning trajectory. In a systematic review, Gala et al. reported that proficiency in gynecologic robotic surgery was typically achieved after approximately 20 procedures—considerably fewer than the 49 cases required for conventional laparoscopic surgery [ 32 ]. Cela et al. described the RSSH learning curve as comprising two phases: an initial phase of approximately six cases, followed by a subsequent optimization phase focused on reducing operative time [ 33 ]. Their findings also indicated that the learning curve for RSSH was significantly steeper than that for traditional single-incision laparoscopic hysterectomy. Similarly, Iavazzo et al. suggested that the initial phase of the RSSH learning curve could be achieved within the first five cases, while further optimization might require up to 14 procedures [ 34 ]. In this study, operative time was significantly longer in the RSSH group than in the RMPH group. Most of the original studies did not report the surgeon’s learning curve or level of proficiency. In some included studies, the institutions were performing RSSH for the first time, whereas RMPH had been introduced earlier and was generally performed with greater technical maturity. This suggests that the longer operative time in the RSSH group may be related to less proficient surgical technique. Intraoperative complications primarily involved injury to adjacent structures, such as the ureter, bladder, and bowel. Pooled analysis revealed that RSSH was associated with a significantly lower risk of intraoperative complications compared to RMPH (RR = 0.17, 95% CI: 0.04 − 0.66; p  = 0.01; I² = 0). Postoperative complications included fever, urinary retention, bowel obstruction, pelvic hematoma, surgical site infection, and pulmonary embolism. The risk of postoperative complications did not differ significantly between groups (RR = 0.78, 95% CI: 0.39 − 1.56; p  = 0.48). Furthermore, the results indicate that RSSH reduces intraoperative blood loss (MD = − 65.94 mL, 95% CI: −124.47 to − 7.40; p  = 0.03). However, it is worth noting that no significant differences were observed between the two groups in terms of transfusion requirements or the magnitude of postoperative hemoglobin decline. This is related to the relatively small absolute volume of intraoperative blood loss, which is insufficient to cause a significant decrease in hemoglobin or necessitate blood transfusion. These findings suggest that RSSH may be a safe alternative for hysterectomy, offering a favorable intraoperative safety profile without increasing overall surgical risk. Although our pooled analysis showed a significantly lower rate of intraoperative complications with RSSH compared to RMPH, the ROBINS-I assessment revealed a serious risk of bias across all included studies, particularly in the domains of confounding (D1) and participant selection (D2). Given that all studies were non-randomized, patients selected for RSSH were generally younger, smaller uteri, and fewer prior abdominal surgeries compared to those receiving RMPH. This confounding by indication is likely to overestimate the apparent benefit of RSSH. Furthermore, the lack of blinding in outcome assessment may have introduced detection bias. Therefore, the observed RR of 0.17 should be interpreted with caution, as it may represent a best-case scenario rather than a true effect estimate. Future high-quality randomized controlled trials are needed to confirm these findings. Furthermore, pooled analysis showed that the RSSH group was associated with significantly lower intraoperative blood loss compared to the RMPH group. Several potential confounding factors may explain this difference. First, differences in surgical learning curves may have played a role; surgeons performing RSSH may have achieved technical proficiency relatively quickly, facilitating more efficient hemostasis. Second, baseline differences in uterine size likely contributed: across most included studies, patients in the RSSH group had smaller uteri (by weight or volume) than those in the RMPH group, which may partially account for the higher blood loss in the latter. Third, a greater proportion of patients in the RMPH group had a history of prior pelvic or abdominal surgery, which can lead to adhesions and increased surgical difficulty, thereby elevating blood loss. Indeed, prior cesarean delivery—a major source of pelvic adhesions—has been linked not only to greater blood loss but also to a higher risk of urinary tract injury during laparoscopic hysterectomy ( p < 0.001) [ 35 ]. Notably, despite the difference in intraoperative blood loss, no significant between-group differences were observed in postoperative hemoglobin drop or blood transfusion requirements. This is likely because blood loss in both groups remained low overall. Consequently, although statistically significant, the magnitude of the difference in blood loss was small and unlikely to be of clinical relevance. The entry method for single-port laparoscopy is also crucial for surgical safety. A recent randomized controlled study by Güner et al. comparing abdominal entry techniques in gynecologic laparoscopy demonstrated that an anatomy-guided approach—specifically the median umbilical ligament lift-up (MULU) technique—significantly reduced entry-related complications such as extraperitoneal insufflation and visceral injury compared to the Veress needle technique [ 36 ]. This suggests that refining the initial abdominal access method, much like advancing robotic platform design, contributes meaningfully to lowering intraoperative risks in minimally invasive gynecologic surgery. Cosmetic outcomes are an important consideration for many women undergoing surgery for benign gynecologic conditions. In a randomized controlled trial, Song et al. found that patients undergoing single-port laparoscopic hysterectomy reported significantly greater satisfaction with cosmesis than those undergoing multi-port surgery [ 37 ]. Akdemir et al. further reported that single-port robotic and single-port laparoscopic hysterectomies resulted in similar levels of patient satisfaction and cosmetic outcomes [ 38 ]. Similar cosmetic benefits of the single-port approach have also been reported in other minimally invasive procedures, including urologic surgery [ 39 ]. Moreover, the improved cosmetic result of single-port surgery may positively influence body image and contribute to better health-related quality of life [ 40 ]. As noted by Fagotti et al., a patient’s perception of postoperative scars is not merely a cosmetic concern but is intertwined with disease-related memories and bodily experiences [ 41 ]. Therefore, given its minimally invasive profile and the concealment of the incision within the umbilicus, robotic single-site surgery may represent a favorable option for patients who prioritize cosmetic outcomes. Several limitations should be considered when interpreting the findings of this systematic review and meta-analysis. First, all included studies were non-randomized comparative cohorts, which are inherently susceptible to residual confounding despite adjustment in some reports. The ROBINS-I risk of bias assessment showed that bias due to confounding was the predominant concern and was prevalent across the included studies. This was mainly driven by confounding by indication: patients selected for RSSH were generally younger, had lower BMI, smaller uteri, and less complex disease, while those receiving RMPH had opposite characteristics. Because the surgical approach was not randomized, these patient characteristics influenced both the choice of procedure and perioperative outcomes, resulting in effect estimates potentially confounded by patient-specific factors. Moreover, some studies had non-concurrent control groups (e.g., Bogliolo 2016), introducing learning curve and temporal trend biases, and several studies did not employ propensity score matching or multivariable regression to adjust for confounding. Second, because the original studies enrolled predominantly benign cases and did not report outcomes stratified by lesion type (benign vs. malignant), the corresponding subgroup analysis could not be performed. Consequently, the heterogeneity could not be further explored via subgroup analysis by lesion type. Third, several studies had small sample sizes, limiting statistical power; furthermore, surgeons in some series were likely in the early phase of their learning curve, which may have influenced perioperative outcomes. Finally, none of the included studies reported long-term follow-up data, precluding evaluation of important late outcomes such as trocar-site hernia, sustained cosmetic satisfaction, and pelvic adhesion formation.

In conclusion, compared with RMPH, RSSH demonstrates several advantages, including a lower incidence of intraoperative complications and faster postoperative recovery, and may offer improved cosmetic outcomes based on available evidence from individual studies. RSSH is a safe and effective technique for total hysterectomy. However, due to the limited number of included studies and their retrospective nature, the above findings must be interpreted with caution. Further large-scale studies, especially multicenter randomized controlled trials, are warranted to further confirm the advantages and disadvantages of these two surgical approaches.

Minimally invasive surgery (MIS) has become the standard of care for a wide range of gynecological conditions, especially benign uterine disorders and early-stage malignancies [ 1 , 2 ]. Among MIS procedures, laparoscopic hysterectomy is one of the most commonly performed operations in gynecology, indicated for abnormal uterine bleeding, symptomatic uterine fibroids, uterine prolapse, and adenomyosis [ 3 ]. To mitigate complications associated with multiple trocar insertions—such as bleeding, wound infection, postoperative pain, incisional hernia, visceral injury, and cosmetically undesirable abdominal scars—surgeons have sought to minimize the number of access sites. This led to the development and clinical adoption of single-site laparoscopy, which utilizes a single umbilical incision for instrument insertion and offers improved cosmetic outcomes along with a reduced risk of wound-related morbidity [ 4 ]. However, conventional single-site laparoscopy is inherently limited by compromised instrument triangulation, diminished depth perception, and significant instrument crowding and collision, resulting in ergonomic challenges that demand extensive training and experience [ 5 ]. Consequently, it has not been widely adopted as a standard approach in gynecological surgery. In 2005, the U.S. Food and Drug Administration (FDA) approved the da Vinci robotic surgical system for gynecological applications, facilitating the widespread integration of robotic-assisted surgery into clinical practice owing to its distinct advantages—including enhanced dexterity, high-definition three-dimensional visualization, tremor filtration, ergonomic console-based operation, and a relatively short learning curve [ 6 , 7 ]. Robotic-assisted hysterectomy (RAH) has since become a widely used minimally invasive approach for benign uterine pathology. Although most RAH procedures are performed via a multi-port configuration, the advent of RSSH presents a promising alternative designed to further enhance cosmesis and minimize surgical trauma [ 8 ]. The robotic single-site platform incorporates wristed instruments that provide an expanded range of motion, improved ergonomics, tremor elimination, and immersive 3D visualization. Preliminary evidence suggests that RSSH is both safe and effective, effectively overcoming many technical limitations of conventional single-site laparoscopy while avoiding the less favorable cosmetic results associated with multi-port robotic approaches [ 9 , 10 ]. Given the paucity of high-quality comparative data, this systematic review and meta-analysis was conducted to evaluate and compare the perioperative efficacy and safety of RSSH versus RMPH in the management of benign gynecological conditions.

Supplementary Material 1. Supplementary Material 1. Supplementary Material 2. Supplementary Material 2. Supplementary Material 3. Supplementary Material 3. Supplementary Material 4. Supplementary Material 4. Supplementary Material 5. Supplementary Material 5.