Robotic Versus Laparoscopic Anatomic Liver Resection: Comparison of Perioperative Outcomes—A Systematic Review and Meta-Analysis

Aim: Minimally invasive anatomic liver resection (AR) is technically demanding, and the efficacy of robotic surgery in AR remains unestablished. This systematic review aims through a meta-analysis to compare surgical outcomes between robotic (RAR) and conventional laparoscopic (LAR) AR. Methods: A systematic literature search of relevant studies published between 2001 and 2024 in PubMed/MEDLINE, Embase and Cochrane Library was carried out, and 15 studies were selected. Meta-analysis was performed to compare perioperative outcomes between RAR and LAR. Results: A total of 4171 patients comprising 2042 RAR and 2129 LAR patients who underwent major hepatectomy or liver parenchyma-sparing AR (PSAR) were included. All included studies were retrospective comparative studies, including eight using propensity score-matched analysis. Meta-analysis demonstrated that as primary outcomes, the 30-day and 90-day mortalities and postoperative overall morbidity were comparable between RAR and LAR, while RAR had significantly less morbidity≥Clavien-Dindo grade II and a lower rate of open conversion. As secondary outcomes, compared to LAR, RAR showed significantly less blood loss and shorter postoperative hospital stay, while RAR had a higher rate of postoperative 30-day readmission. Operative time, blood transfusion, Pringle maneuver, R0 resection, and reoperation were comparable. Subgroup meta-analyses showed a lower rate of blood transfusion in robotic PSAR and a lower rate of open conversion in RAR in the right cranial regions. Conclusion: This large-scale meta-analysis of minimally invasive AR suggests that RAR can confer comparable or partly better perioperative outcomes as compared to LAR, indicating potential advantages of the robotic approach to AR.