Robotic versus laparoscopic surgery in hepatobiliary procedures: a scoping review

Abstract Background Robotic platforms have expanded the technical capabilities of minimally invasive hepatobiliary surgery. However, their clinical value compared with laparoscopy remains heterogeneous and appears to vary according to procedural complexity, anatomical constraints, and institutional experience. Methods A procedure-stratified scoping review was conducted in accordance with the Preferred Reporting Items for Systematic Reviews and Meta-Analyses extension for Scoping Reviews and the Joanna Briggs Institute Manual for Evidence Synthesis. PubMed, Scopus, and Web of Science were searched for comparative studies published between 2019 and 2025 evaluating robotic versus laparoscopic hepatobiliary surgery. Evidence was synthesized using a procedure-specific analytical framework to account for heterogeneity in technical complexity and outcome reporting. Results Seventy studies met inclusion criteria, the majority of which were retrospective. In technically demanding procedures, particularly major hepatectomy and resections of posterosuperior liver segments, robotic surgery was more frequently associated with lower intraoperative blood loss and reduced conversion to open surgery. Operative time was generally longer for robotic procedures across most indications. Overall perioperative morbidity, mortality, and early oncological outcomes were comparable between robotic and laparoscopic approaches. Postoperative recovery outcomes were inconsistently reported and heterogeneous, while procedural costs were consistently higher for robotic surgery. Conclusions Robotic hepatobiliary surgery may offer context-dependent advantages in anatomically complex procedures, particularly in settings with appropriate surgical expertise. However, given the predominance of retrospective and heterogeneous evidence, these findings should be interpreted cautiously. Overall, robotic and laparoscopic approaches demonstrate comparable safety and effectiveness across most indications. These findings support a procedure-based and context-sensitive integration of robotic technology rather than universal adoption.