Robotic versus traditional laparoendoscopic single-site radical hysterectomy with no-manipulation technique: a retrospective cohort study

Background and objectives Controversies and challenges over minimally invasive approach in performing radical hysterectomy for early-stage cervical cancer have been raised. This study aimed to determine whether robotic approach was superior to traditional single-site radical hysterectomy with no-manipulation technique for early-stage cervical cancer. Methods Patients diagnosed with FIGO 2018 stage IB1, IB2 or IIA1 cervical cancer who underwent robotic or traditional single-site radical hysterectomy and pelvic lymphadenectomy between April 2019 and December 2023 were enrolled to assess the perioperative and survival outcomes. Results 73 patients were included in the robotic group and 51 cases in the traditional group. The robotic group had significantly shorter operative time (236.5 ± 52.8 vs 390.8 ± 73.5 min, p<0.001), less blood loss (50.0 vs 150.0 mL, p<0.001), and shorter drainage time (3.7 ± 1.2 vs 4.7 ± 1.9 days, p=0.001), with a tendency of less conversions and complications compared to the traditional group. The two groups exhibited comparable 3-year disease-free survival (89.8% vs 95.8%, p=0.399) and overall survival (95.8% vs 96.3%, p=0.752) rates. Conclusion Robotic and traditional single-site radical hysterectomies with no-manipulation techniques are both feasible and safe for early-stage cervical cancer with comparable survival outcomes, though longer follow-up is needed to confirm non-inferiority. The robotic system could significantly reduce surgical difficulties and improve perioperative outcomes.