Comparison of Robotic and Laparoscopic Approaches for Para‐Aortic Lymphadenectomy in Patients With Endometrial or Ovarian Cancer

AIM: To compare the surgical and oncological outcomes between robotic and laparoscopic para-aortic lymphadenectomy (PALND) in Japanese women with endometrial cancer or ovarian cancer. METHODS: This retrospective study included patients who underwent minimally invasive surgery, including PALND, between March 2018 and January 2025 at three Japanese institutions. Patients with endometrial cancer or ovarian cancer were divided into robotic and laparoscopic surgery groups. Surgical outcomes and oncological outcomes were compared between the two groups. RESULTS: A total of 60 patients were analyzed (robotic group: n = 33; laparoscopic group: n = 27). The operative time was significantly longer in the robotic group, whereas intraoperative blood loss did not differ significantly between the groups. No significant differences were observed in intraoperative or postoperative complication rates, nor in the length of hospital stay. The total number of retrieved pelvic and para-aortic lymph nodes was comparable between the two groups 70.0 (robotic group) vs. 72.5 (laparoscopic group), p = 0.480. Furthermore, there were no significant differences in overall survival (p = 0.483) or progression-free survival (p = 0.837) between the groups. CONCLUSIONS: Robotic PALND demonstrated perioperative safety, surgical quality, and oncological outcomes comparable to those of laparoscopic PALND. These findings suggest that robotic-assisted PALND can be performed safely and effectively, with outcomes comparable to those achieved with conventional laparoscopic approaches in Japanese patients with gynecological cancers.