Robotic versus laparoscopic liver resection: a systematic review and meta-analysis of comparative studies

BACKGROUND: The technical advantages of robotic platforms may facilitate minimally invasive liver resections, improving outcomes over the laparoscopic approach. This meta-analysis aimed to compare outcomes of robotic liver resection (RLR) versus laparoscopic liver resection (LLR). MATERIALS AND METHODS: A systematic literature search identified matched cohort studies and randomized controlled trials comparing RLR and LLR from 2003 to 2024. Studies concerning transplant hepatectomy and retrospective studies with fewer than 50 patients per group were excluded. Perioperative outcomes were analyzed in a meta-analysis, with subgroup analyses for minor anterolateral (AL), minor posterosuperior (PS), and major resections. RESULTS: Overall, 31 studies with 8989 patients undergoing RLR and 43 474 LLR were included, with 8207 RLRs and 9763 LLRs after matching. RLR was associated with lower conversion (RR 0.41 95% CI, 0.32-0.52), overall morbidity (RR 0.92 95% CI, 0.84-1.00), and severe morbidity rate (RR 0.81 95% CI, 0.70-0.94), as well as higher rates of R0 resection (RR 1.02 95% CI, 1.01-1.03) and readmission (RR 1.24 95% CI, 1.09-1.41). There were no significant differences in blood loss, transfusion, Pringle use, operative time, hospital stay, and mortality. RLR reduced blood loss in minor AL and PS resections, with fewer transfusions also observed in minor AL. RLR was associated with shorter hospital stays in minor PS resections. Notably, RLR was associated with less overall morbidity in minor AL and less severe morbidity in major resections. Available results on long-term oncological outcomes were not suitable for meta-analysis. CONCLUSIONS: RLR demonstrates advantages in several key perioperative outcomes compared to LLR across the full spectrum of liver resection complexity.