Comparative Safety and Efficacy of Open and Robotic Surgery in Living Right-Donor Hepatectomy: A Systematic Review and Meta-Analysis

Objective to compare the safety and efficacy of robotic surgery and traditional open surgery in living donor liver hepatectomy. Methods This meta-analysis included 9 retrospective studies involving a total of 3379 patients, evaluating the primary and secondary outcomes of robotic surgery versus open surgery in donors and recipients. Binary variables were analyzed using odds ratios (ORs) and 95% confidence intervals (CIs), while continuous variables were analyzed using standardized mean differences (SMDs) and 95% CI. Results Robotic donor hepatectomy demonstrated significantly longer operative time (SMD = 1.26, 95% CI 0.75-1.76, I 2 = 90.1%) and warm ischemia time (SMD = 2.24, 95% CI 0.94-3.53, I 2 = 97.4%) compared to open surgery, both with moderate certainty. Conversely, no significant differences were observed in intraoperative blood loss (SMD = -0.61, 95% CI -1.29 to -0.07), postoperative hospital stay (SMD = -0.36, 95% CI -0.78 to 0.07), overall Clavien-Dindo grades 1-2 complications (OR = 0.68, 95% CI 0.40-1.15), grades 3-4 complications (OR = 1.33, 95% CI 0.44-3.99), or bile leakage incidence (OR = 0.83, 95% CI 0.28-2.47) for donors. For recipients, robotic surgery significantly reduced both grades 1-2 (OR = 0.70, 95% CI 0.53-0.94) and grades 3-4 complications (OR = 0.65, 95% CI 0.50-0.84), while showing comparable perioperative mortality (OR = 1.36, 95% CI 0.84-2.19), hepatic artery thrombosis (OR = 1.19, 95% CI 0.64-2.21), and biliary complications (OR = 1.01, 95% CI 0.52-1.97). Conclusion Robotic living donor right hepatectomy demonstrates comparable donor safety and superior effectiveness in reducing recipient complications.