Reduced-port robotic surgery versus multiport robotic surgery in endometrial cancer: a systematic review and meta-analysis.

Reduced-port robotic surgery, including single-site and single-port approaches, has been increasingly applied in endometrial cancer. However, its clinical value compared with conventional multiport robotic surgery remains uncertain. To systematically compare perioperative outcomes and safety between reduced-port and multiport robotic techniques used for endometrial cancer surgery. Following the PRISMA 2020 recommendations, we carried out a systematic review and meta-analysis that was prospectively registered in PROSPERO (CRD420261443180). Relevant publications were retrieved by searching PubMed, Embase, Web of Science, and the Cochrane Library from their inception until April 2026. Comparative studies evaluating reduced-port robotic surgery (single-site or single-port) against conventional multiport robotic surgery were eligible for inclusion. Treatment effects for continuous variables were pooled as mean differences, while binary outcomes were combined as odds ratios, each with 95% confidence intervals. A random-effects model was consistently applied in all analyses to accommodate anticipated methodological and clinical heterogeneity among the included studies. Eight comparative studies involving 905 patients (350 in the reduced-port group and 555 in the multiport group) met the inclusion criteria. Meta-analysis demonstrated no significant difference in operative time between reduced-port and multiport robotic surgery (MD = 12.54 min, 95% CI: -7.76 to 32.84; P = 0.23). Compared with multiport robotic surgery, the reduced-port approach was associated with modest reductions in estimated blood loss (MD = - 14.83 mL, 95% CI: -29.25 to - 0.41; P = 0.04) and postoperative hospital stay (MD = - 2.12 days, 95% CI: -4.19 to - 0.06; P = 0.04). However, these findings should be interpreted cautiously given the substantial heterogeneity observed across studies. No significant differences were identified in transfusion requirement (OR = 0.55, 95% CI: 0.09-3.16; P = 0.50), conversion to open surgery, intraoperative complications, overall postoperative complications, or Clavien-Dindo grade ≥ III complications (all P > 0.05). Postoperative pain scores were comparable between groups at both 6 and 24 h. Subgroup analysis suggested a potential reduction in early postoperative pain with single-port robotic systems, although this finding did not reach statistical significance in the overall analysis. The available evidence suggests that reduced-port robotic surgery represents a viable option for selected patients with endometrial cancer, with broadly similar short-term perioperative outcomes to conventional multiport surgery. Potential modest reductions in estimated blood loss and postoperative hospital stay were observed; however, the clinical relevance of these differences remains uncertain because of the small absolute effect size and substantial heterogeneity among studies. While no overall benefit in postoperative pain was observed, potential differences between platforms, particularly single-port systems, warrant further investigation.