The impact of robotics in liver surgery: A worldwide systematic review and short-term outcomes meta-analysis on 2,728 cases

Ruben Ciria, Giammauro Berardi, Felipe Alconchel, Javier Briceño, Gi Hong Choi, Yao Ming Wu, Atsushi Sugioka, Roberto Ivan Troisi, Chady Salloum, Olivier Soubrane, Johann Pratschke, John Martinie, Allan Tsung, Raphael Araujo, Iswanto Sucandy, Chung N. Tang, Go Wakabayashi

Research output: Contribution to journalReview articlepeer-review

52 Citations (Scopus)


Background: The dissemination of robotic liver surgery is slow-paced and must face the obstacle of demonstrating advantages over open and laparoscopic (LLS) approaches. Our objective was to show the current position of robotic liver surgery (RLS) worldwide and to identify if improved short-term outcomes are observed, including secondary meta-analyses for type of resection, etiology, and cost analysis. Methods: A PRISMA-based systematic review was performed to identify manuscripts comparing RLS vs open or LLS approaches. Quality analysis was performed using the Newcatle-Ottawa score. Statistical analysis was performed after heterogeneity test and fixed- or random-effect models were chosen accordingly. Results: After removing duplications, 2728 RLS cases were identified from the final set of 150 manuscripts. More than 75% of the cases have been performed on malignancies. Meta-analysis from the 38 comparative reports showed that RLS may offer improved short-term outcomes compared to open procedures in most of the variables screened. Compared to LLS, some advantages may be observed in favour of RLS for major resections in terms of operative time, hospital stay and rate of complications. Cost analyses showed an increased cost per procedure of around US$5000. Conclusions: The advantages of RLS still need to be demonstrated although early results are promising. Advantages vs open approach are demonstrated. Compared to laparoscopic surgery, minor perioperative advantages may be observed for major resections although cost analyses are still unfavorable to the robotic approach.

Original languageEnglish
Pages (from-to)181-197
Number of pages17
JournalJournal of Hepato-Biliary-Pancreatic Sciences
Issue number2
Publication statusPublished - 02-2022

All Science Journal Classification (ASJC) codes

  • Surgery
  • Hepatology


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