Robotic assisted versus non-robotic retroperitoneal lymph node dissection for testicular cancer: an updated systematic review and meta-analysis.

Retroperitoneal lymph node dissection (RPLND) remains a fundamental pillar in the treatment of selected patients with testicular cancer, particularly nonseminomatous germ cell tumours (NSGCT). While open RPLND has traditionally been regarded as the standard of care, it is linked to substantial perioperative morbidity. Robotic-assisted RPLND (R-RPLND) has been introduced as a minimally invasive option; however, evidence remains largely observational, and its comparative benefits over non-robotic approaches require further clarification. PubMed, Embase, and Google Scholar were searched from inception to August 2025 for comparative studies evaluating R-RPLND versus non-robotic RPLND (open or laparoscopic) in patients with testicular cancer. Randomized trials and cohort studies reporting perioperative or oncologic outcomes were included. Pooled effect estimates were calculated using fixed- or random-effects models based on heterogeneity. Outcomes assessed included estimated blood loss, transfusion rate, length of hospital stay, operative time, lymph node yield, postoperative complications (including ejaculatory dysfunction), and recurrence. Fourteen comparative cohort studies encompassing 7,908 patients were included. Compared with non-robotic RPLND, R-RPLND was associated with significantly reduced estimated blood loss (mean difference − 362.99 mL, p = 0.0035), lower transfusion rates (risk ratio 0.12, p < 0.0001), and shorter hospital stay (mean difference − 5.40 days, p < 0.0001). No statistically significant differences were observed between groups in operative time, lymph node yield, overall postoperative complications, postoperative ejaculatory dysfunction, or recurrence rates. Considerable heterogeneity was observed across several perioperative outcomes, although sensitivity analyses confirmed the robustness of the pooled estimates. Robotic-assisted RPLND offers meaningful perioperative advantages over non-robotic approaches, including reduced blood loss, transfusion requirements, and length of hospitalization, while maintaining comparable oncologic and functional outcomes. These findings support R-RPLND as a safe and effective alternative to conventional techniques in appropriately selected patients. However, further prospective multicenter studies are warranted to address residual heterogeneity and to evaluate long-term outcomes.