​​​​Comparative efficacy and safety of robotic-assisted versus open retroperitoneal lymph node dissection in testicular cancer management: a systematic review and meta-analysis​​​.

Open retroperitoneal lymph node dissection (O-RPLND) has historically been the established standard surgical procedure for managing retroperitoneal lymph node disease in testicular cancer. In recent years, however, the adoption of robotic surgical systems has led to a gradual shift in urological practice, with numerous procedures traditionally performed via open surgery being increasingly accomplished using robotic techniques. This study aims to systematically compare the perioperative safety and clinical efficacy of robotic-assisted retroperitoneal lymph node dissection (RA-RPLND) versus O-RPLND in the treatment of testicular cancer. Following the AMSTAR quality rating criteria and PRISMA principles, a thorough literature search was carried out. With no start date restrictions, databases such as Web of Science, Embase, PubMed, and the Cochrane Library were searched for pertinent papers until September 2025. The study was prospectively registered in PROSPERO with the registration number CRD420251147469. Statistical analyses were carried out with Review Manager version 5.4. WMD and OR were used as effect measures for continuous and dichotomous variables, respectively, with 95% CIs. This meta-analysis incorporated 10 comparative studies comprising 6,802 patients, including 587 who underwent RA-RPLND and 6,215 treated with O-RPLND. The analysis revealed that RA-RPLND was associated with significantly prolonged operative duration (WMD = 47.71 min; 95% CI: -0.62 to 96.04; P = 0.05), yet demonstrated advantages in reduced hospitalization period (WMD = -3.89 days; 95% CI: -4.89 to -2.88; P < 0.00001). The robotic approach also showed superior outcomes in terms of diminished intraoperative blood loss (WMD = -135.11 ml; 95% CI: -162.50 to -107.71; P < 0.00001) and lower transfusion requirements (OR = 0.11; 95% CI: 0.06 to 0.21; P < 0.00001). No statistically significant differences were observed between the surgical approaches regarding overall complications, major complications (Clavien-Dindo grade ≥ III), lymph node yield, nodal positivity rates, recurrence during surveillance, or postoperative ejaculatory function. ​​Conclusion:​​ Both RA-RPLND and O-RPLND demonstrate acceptable safety and efficacy profiles for patients with testicular cancer. While the robotic technique needs longer operational durations, it has some advantages, including less blood loss, fewer transfusions, shorter hospital stays, and faster recovery. RA-RPLND therefore offers a feasible alternative to traditional open surgery. However, more studies with longer follow-up periods are needed to establish its long-term oncological results and safety profile.