Minimally invasive liver surgery for malignancy: A systematic review and meta-analysis comparing robotic and laparoscopic approaches.

BACKGROUND

Minimally invasive liver resection is increasingly used for hepatic malignancies, with laparoscopic liver resection (LLR) achieving outcomes similar to open surgery. Limitations of laparoscopy in complex resections have led to the growing adoption of robotic liver resection (RLR). This meta-analysis compares peri-operative outcomes between laparoscopic and robotic approaches in hepatic resections.

PATIENTS AND

METHODS

This Preferred Reporting Items for Systematic Reviews and Meta-Analyses-compliant meta-analysis was conducted with a comprehensive search in February 2025 across PubMed, Cochrane, Scopus, CINAHL and Google Scholar for studies comparing RLR and LLR in adults undergoing hepatic resection. Primary outcomes included R0 resection rate, major complications (Clavien-Dindo ≥III), and conversion to open surgery. Secondary outcomes included operative time, blood loss and length of stay.

RESULTS

Twenty-nine studies comprising 7678 patients (LLR: 5025 and RLR: 2653) were included. R0 resection and post-operative complications were comparable between approaches LLR was associated with a higher risk of conversion to open surgery (risk ratio: 1.83; 95% confidence interval [CI], 1.28-2.61) and shorter operative time (mean difference: -20.95 min; 95% CI, -40.53 to -1.38). RLR demonstrated lower intra-operative blood loss (mean difference: 68.22 mL; 95% CI, 38.05-98.38), while the length of hospital stay was similar between groups.

CONCLUSION

Robotic and LLRs yield comparable oncologic and peri-operative outcomes, with robotics showing lower conversion rates and less blood loss but longer operative times.