Robotic repeat hepatectomy for recurrent liver tumors: a systematic review of contemporary evidence and technical strategies.

Repeat hepatectomy is a potentially curative treatment for selected patients with recurrent liver malignancies but is technically demanding because of adhesions, distorted anatomy, and limited operative working space. Robotic platforms may help address some of these challenges, but evidence on robotic repeat hepatectomy (RRH) is limited. This study critically reviews comparative perioperative evidence and repeat-hepatectomy-specific technical strategies. This review was performed in accordance with the PRISMA 2020 guidelines. PubMed/MEDLINE, Scopus, and the Cochrane Library were searched for studies reporting RRH in adults. The primary perioperative synthesis was restricted to four comparative cohort studies. One technical case series and four case reports were analyzed separately as technical and hypothesis-generating evidence. Risk of bias was assessed using ROBINS-I and Joanna Briggs Institute critical appraisal tools. Nine studies published from 2022 to 2026 were included: four comparative cohort studies, one technical case series, and four case reports. The comparative cohorts included 234 participants, of whom 133 underwent RRH; five additional RRH patients were described in technical reports, giving 138 RRH patients across all designs. In the comparative cohorts, operative time ranged from 152 to 349 min and estimated blood loss from 0 to 284 mL. Three cohorts reported no robotic conversions, while one reported 1/11 (9.1%). Major morbidity ranged from 0% to 8.9%, 30-day mortality was 0% where reported, and 90-day mortality ranged from 0% to 1.8%. Technical reports demonstrated feasibility in selected caudate, posterosuperior, and central resections but were not used to infer safety or comparative effectiveness. All comparative studies had serious overall risk of bias. In selected patients treated at experienced hepatopancreatobiliary centers, comparative cohorts support the feasibility of RRH with acceptable short-term outcomes. Current evidence does not establish the superiority of robotics or of any specific robotic strategy. The potential contribution of robotics may be an extension of minimally invasive indications to selected complex repeat resections, but this remains to be tested in adequately adjusted, multicenter comparative studies with standardized technical and oncological reporting.