Comparative efficacy of robotic assisted versus laparoscopic gynecologic surgery in Southeast Asia: a systematic review

Abstract

With scientific evolution, the minimally invasive surgical techniques such as laparoscopic surgery (LS) and robotic-assisted surgery (RAS), have completely transformed gynecologic procedures by reducing patient morbidity, hospital stay and post procedure recovery. While there are several global literatures to validate these modalities, a focused analysis in Southeast Asia countries remains limited. To systematically compare published medical literatures on perioperative outcomes of RAS and LS in gynecologic surgeries across Southeast Asian countries. Adhering to PRISMA guidelines, we conducted a comprehensive search across PubMed, Embase, Cochrane Library and regional databases up to May 2025. Inclusion criteria encompassed studies from Southeast Asia comparing RAS and LS in gynecologic procedures, reporting on operative time, blood loss, complication rates, conversion rates and hospital stay. During the review, we identified 1,200 articles, 15 met inclusion criteria, encompassing 4,500 patients (RAS: 2,100; LS: 2,400). It was observed that RAS demonstrated reduced blood loss (mean difference: -50 mL; 95% CI: -70 to -30 mL) and shorter hospital stay (mean difference: -1.2 days; 95% CI: -1.5 to -0.9 days). However, operative times were observed to be longer in RAS (mean difference: +30 minutes; 95% CI: +20 to +40 minutes). However, no significant differences were observed in overall complication or conversion rates. In Southeast Asia, RAS offers advantages in blood loss and hospitalization duration over LS in gynecologic surgeries, albeit with increased operative times. These findings can facilitate surgical decision-making process, balancing benefits against resource availability.