Literature search results

A total of 1219 articles were obtained, and after eliminating duplicates by Endnote X9, and then eliminating irrelevant papers by reading the title and abstract, 15 articles were retained after reading the full text [8,9,10,11,12,13,14,15,16,17,18,19,20,21,22]. See Table 1 for basic information on the selected literature. A total of 45,702 patients, 11,618 patients in the RALM group and 34,084 patients in the LM group. The literature screening process and results are shown in Fig. 1.

Table 1 Basic information about the included studiesFig. 1

Flow diagram of literature retrieval and screening

Quality evaluation of the included literature

The NOS scores for the included cohort studies are shown in Table 1, and all studies were of high quality with NOS scores between 7 and 9.

Meta-analysis resultsComparison of operation times

A total of 14 studies were included [8,9,10,11,12,13,14,15, 17,18,19,20,21,22]. The results [MD = 38.61, 95%CI (19.36, 57.86), P < 0.0001] indicate a statistically significant difference between the two surgical approaches in terms of operative time, suggesting that the LM group has shorter operative time than the RALM group, the results of the meta-analysis are shown in Fig. 2.

Fig. 2

Meta-analysis forest plot for operative time

Comparison of intraoperative bleeding

A total of 11 studies [8,9,10, 12,13,14,15, 17, 18, 21, 22]. The results [MD =  − 24.67, 95% CI (− 41.91, − 7.43), P = 0.005] demonstrate a statistically significant difference in intraoperative bleeding between the two surgical approaches. This suggests that the RALM group exhibits lower levels of intraoperative bleeding compared to the LM group. The findings of the meta-analysis are presented in Fig. 3.

Fig. 3

Meta-analysis forest plot of intraoperative bleeding

Comparison of the incidence of blood transfusions

A total of 11 studies were included [8, 10,11,12, 14,15,16,17, 19, 21, 22]. The results [OR = 0.86, 95% CI (0.77, 0.97), P = 0.01] reveal a statistically significant difference in the incidence of blood transfusions between the two procedures. This implies that the RALM group had a lower rate of blood transfusion compared to the LM group. The meta-analysis findings are presented in Fig. 4.

Fig. 4

Meta-analysis of the forest for the incidence of blood transfusions

Comparison of hospital stay

A total of 10 studies were included [9, 10, 12,13,14,15, 17, 20,21,22]. The results [OR =  − 0.11, 95%CI (− 0.21, − 0.01), P = 0.03] illustrate a statistically significant difference in the length of stay between the two surgical procedures, indicating that the RALM group has a lesser length of stay than the LM group; the results of the meta-analysis are shown in Fig. 5.

Fig. 5

Meta-analysis forest plot for hospital stay

Comparison of transit open belly rate

A total of 11 studies were included [8,9,10,11,12,13,14,15,16,17, 22]. The results [OR = 0.82, 95% CI (0.73, 0.92), P = 0.0006] demonstrate a statistically significant difference in the incidence of open bellies between the two surgical approaches. This indicates a lower incidence of open belly in the RALM group compared to the LM group. The meta-analysis results are illustrated in Fig. 6.

Fig. 6

Meta-analysis forest plot of transit open belly rate

Comparison of the incidence of postoperative complications

A total of 11 studies were included [8,9,10,11,12,13,14,15, 17, 19, 21]. The results [OR = 0.58, 95%CI (0.40, 0.86), P = 0.006] illustrate a statistically significant difference between the two surgical approaches in terms of postoperative complications (endometriosis, postoperative wound infection, bowel injury), indicating that the RALM group has fewer postoperative complications than the LM group. The results of the meta-analysis are shown in Fig. 7.

Fig. 7

Meta-analysis forest plot of postoperative complication rate

Comparison of the largest myoma diameters

A total of 12 studies were included [8,9,10,11,12,13,14, 18,19,20,21,22]. The results [MD = 0.26, 95%CI (− 0.17, 0.70), P = 0.24] indicate that there was no significant difference in maximum myoma diameter between the RALM and LM groups. The meta-analysis findings are presented in Fig. 8.

Fig. 8

Meta-analysis forest plot of maximum myoma diameter

Sensitivity analysis

We sequentially excluded individual studies before combining the analyses for each of the indicators measured, and the results did not change significantly, indicating that the findings of this study are reliable.

Publication bias

A funnel plot was drawn with the incidence of postoperative complication as an example, as shown in Fig. 9. It was found that the individual studies were evenly distributed on both sides of the funnel plot and that all studies were distributed inside the funnel plot, indicating that the publication bias of this study was low.

Fig. 9

Funnel plot of postoperative complication rate