Robotic versus laparoscopic hepatectomy: meta-analysis of propensity-score matched studies

Robotic techniques can theoretically overcome the limitations of laparoscopic liver resection and are currently recognized as safe options; however, it is not known which approach is better. The purpose of this study was to compare the advantages of robotic hepatectomy and laparoscopic hepatectomy.

Electronic databases (the Cochrane Library, PubMed (MEDLINE), Embase and Web of Science) were systematically searched from January 2000 to August 2023 for eligible studies that compared robotic hepatectomy and laparoscopic hepatectomy. Studies that met the inclusion criteria were then reviewed systematically. The reported data were aggregated statistically using RevMan 5.4 software. The parameters of interest included intraoperative, postoperative, survival and financial outcomes. Subgroup analysis was performed according to the type and difficulty level of hepatectomy and the study setting.

A total of 26 propensity-score matching comparative trials met the inclusion criteria, which comprised 9355 participants (robotic hepatectomy versus laparoscopic hepatectomy: 3938 versus 5417) in the meta-analysis. For surgical outcomes, lower blood loss, lower open conversion rate and higher R0 resection rate were observed in the robotic hepatectomy group compared with the laparoscopic hepatectomy group (mean difference (MD) -86.22, 95% c.i. -116.49 to -55.95, I² = 87%, P < 0.001; OR 0.51, 95% c.i. 0.38 to 0.69, I² = 40%, P < 0.001; OR 1.31, 95% c.i. 1.03 to 1.67, I² = 0%, P = 0.030 respectively). The lower blood loss (major hepatectomy group: MD -56.88, 95% c.i. -109.09 to -4.28, I² = 76%, P = 0.030; IWATE score (advanced/expert more than 80%) group: MD -0.61, 95% c.i. -1.14 to -0.08, I² = 95%, P < 0.001) and lower open conversion rate (major hepatectomy group: OR 0.41, 95% c.i. 0.30 to 0.56, I² = 0%, P < 0.001; IWATE score (advanced/expert less than 80%) group: OR 0.52, 95% c.i. 0.36 to 0.75, I² = 0%, P = 0.659) advantage persisted across subgroup analyses.

The robotic approach had advantages to laparoscopic in terms of lower blood loss and reduced rates of open conversion, especially in difficult hepatectomies.