Laparoendoscopic single-site surgery compared with conventional laparoscopy for benign adnexal diseases: a systematic review and meta-analysis of randomized controlled trials

Background Laparoscopic surgery has become the gold standard for the surgical management of benign gynecologic pathologies. Our objective was to assess the current evidence regarding the safety and efficacy of laparoendoscopic single-site surgery (LESS) in the treatment of benign adnexal diseases. Materials and methods We comprehensively searched PubMed, the Cochrane Central Register of Controlled Trials (CENTRAL), Embase, and ClinicalTrials.gov from inception to 18 October 2025. We included randomized controlled trials (RCTs) comparing LESS with conventional laparoscopy (CL) for the treatment of benign adnexal diseases. Primary outcomes were the perioperative complication rate, postoperative pain, and cosmetic satisfaction. Secondary outcomes included operative time, estimated blood loss during surgery, hemoglobin drop, conversion to laparotomy, and length of hospital stay after surgery. All analyses were performed using random effects or fixed effects models. Clinical heterogeneity was explored using subgroup and sensitivity analyses. Results We included eight articles reporting results from RCTs comparing LESS and CL in the final analysis. There were no significant differences between LESS and CL in terms of the perioperative complication rate (risk ratio (RR), 2.88; 95% confidence interval (CI), 0.70 to 11.78; p = 0.14) and postoperative pain scores at 6 h (weighted mean difference (WMD), −0.31; 95% CI, −0.75 to 0.13; p = 0.16), 24 h (WMD, −0.23; 95% CI, −0.46 to 0.00; p = 0.05), and 48 h (WMD, −0.24; 95% CI, −0.77 to 0.30; p = 0.39). There were also no differences in terms of operative time (WMD, 3.68; 95% CI, −0.81 to 8.17; p = 0.11), hospital stay after surgery (WMD, −0.13; 95% CI, −0.29 to 0.03; p = 0.11), estimated blood loss during surgery (WMD, −7.63; 95% CI, −31.83 to 16.57; p = 0.54), and hemoglobin drop (WMD, 0.18; 95% CI, −0.02 to 0.39; p = 0.08). Conclusion This systematic review and meta-analysis provides evidence that LESS appears effective and safe for the treatment of benign adnexal diseases, as it is generally equivalent to CL in terms of perioperative outcomes. Systematic review registration https://www.crd.york.ac.uk/PROSPERO/view/CRD42024608657 , Identifier: CRD42024608657.