Robotic recipient liver transplantation worldwide: a systematic review and meta-analysis of the first 93 patients, from feasibility to early outcomes

Background: Robotic liver transplantation (rLT) has emerged as a minimally-invasive approach to the liver transplant operation, but global experience remains limited and fragmented. A synthesis of existing data and outcomes is needed to define its current role and inform wider adoption. Methods: We conducted a systematic review and meta-analysis in accordance with PRISMA guidelines. PubMed, Embase, and Web of Science were searched for English-language human studies reporting rLT published between January 1, 2021, and October 31, 2025. Methodological quality was assessed using Joanna Briggs Institute tools (case reports/series) and the MINORS tool (observational cohorts). Pooled event rates and means with 95% confidence intervals (CI) were calculated using fixed- or random-effects models according to heterogeneity. Publication bias was assessed with Egger's test. This trial is registered with PROSPERO, number CRD420251111186. Findings: = 0% for all pooled complication endpoints). Conversion to open surgery occurred in 2.9% (0.6-13.1), major morbidity (Clavien-Dindo ≥3a) in 17.2% (9.9-28.2), and pooled 6-month survival was 98.0% (86.9-99.7). Interpretation: Robotic liver transplantation is technically feasible, associated with low perioperative morbidity, and has excellent short-term survival in carefully selected recipients treated at experienced centres. Multicentre registries, robust benchmarking against open LT, and standardised training pathways may accelerate implementation. Funding: No specific funding was received for this study.