OBJECTIVES: Minimally invasive hysterectomy using the Da Vinci robot-assisted surgical system remains uncertain if the technology offers benefits compared with traditional laparotomy. The aim of this study was to compare effectiveness and safety of robot-assisted laparoscopic hysterectomy (RALH) compared with traditional laparotomy in endometrial cancer. METHODS: We searched potentially relevant studies using Ovid-Medline, Ovid-EMBASE, Cochrane library, and 5 local medical databases through May 2014. The outcomes were overall complications, peri-operative complications, post-operative complications and specific morbidities for safety outcomes, survival, recurrence, length of stay (LOS), estimated blood loss (EBL), operative time (OT) for effectiveness outcomes. Two independent reviewers extracted data and assessed the risk of bias for non-randomized studies. RESULTS: =90%; WMD -1.64, 95% CI -4.21-0.94, I=91%; WMD 0.96, 95% CI -1.30-3.23, I=93%, respectively). LOS and OT was shorter for RALH (WMD -2.85, 95% CI -3.28, -2.41, I=91%; WMD 44.15, 95% CI 20.91, 67.39, I=98%, respectively). EBL was significantly reduced in RALH group (WMD -159.62, 95% CI -189.73, -129.50, I=83%). Overall, intra-operative and post-operative complications (RR 0.37, 95% CI 0.28-0.49, I=9%; RR 0.40, 95% CI 0.23-0.72, I=0%; RR 0.49, 95% CI 0.36-0.68, I=0%, respectively); the incidence of wound infection, wound dehiscence, wound complications, ileus or bowel obstruction, infection, readmission, ICU stay, transfusion were significantly fewer but vaginal cuff dehiscence or separation were significantly higher in RALH than in laparotomy. Other individual peri-operative complications were similar. CONCLUSIONS: RALH may be a generally safer and better option than laparotomy in endometrial cancer. Robotic surgery is associated with shorter LOS, OT; lower EBL and fewer complications than laparotomy. Further prospective studies with long term follow-up are required.