Hysterectomy is a commonly performed gynecological surgery usually indicated for benign or malignant conditions. With technological advancement, there has been a shift toward minimally invasive hysterectomy (MIH).

Surgery usually leads to a stress response through hormone release, cytokines, and coagulation cascade activation. This response, if unregulated, can have some deleterious effects; hence, reducing surgical stress is vital in improving patient outcomes and reducing mortality and morbidity [1,2].

Kehlet and Wilmore initiated the idea of multimodal intervention in the postoperative period, which later led to enhanced recovery after surgery (ERAS) principles [3]. ERAS is an evidence-based, multidisciplinary surgical management approach that contest the traditional perioperative care.

ERAS primarily aims to maintain normal physiology and reduce stress in the perioperative period [4]. Its components include patient counseling about surgery and postoperative recovery, nausea and vomiting control, fluid management, opioid-sparing analgesia, maintenance of normothermia, early mobilization, early enteral feeding, antithrombotic and antibiotics prophylaxis, and no drains [4, 5, 6, 7, 8].

The evidence supporting ERAS in MIH for benign indications is limited [9,10]. In a previous meta-analysis, a subgroup analysis of benign indications and laparoscopic hysterectomy showed a significant reduction in the length of hospital stay (LOHS) [11]. However, their results might be underpowered by the small sample size. Numerous studies, including randomized data, were recently published, which may strengthen pooled outcomes’ power [9,10,12, 13, 14].

Therefore, we aim to perform a systematic review and meta-analysis to investigate the impact of the ERAS program in MIH for benign indications.