Robotic versus laparoscopic hepatectomy: an umbrella review of systematic reviews and meta-analyses

Robotic hepatectomy (RH) is increasingly used as an alternative to laparoscopic hepatectomy (LH), but their comparative advantages remain unclear. This umbrella review synthesized evidence from published systematic reviews and meta-analyses comparing RH and LH for liver resection; PubMed, EMBASE and Web of Science were searched from inception to March 2024 to identify eligible studies, methodological quality was appraised using AMSTAR, and pooled odds ratios (ORs) or weighted mean differences (WMDs) with 95 % confidence intervals (CIs) for perioperative outcomes (complications, conversion to open surgery, operative time, blood loss, transfusion, R0 resection, length of stay, and costs) were extracted from each included meta-analysis. Twelve meta-analyses encompassing 152 primary studies and more than 15,000 patients were included, and the results showed that compared with LH, RH was associated with a lower rate of conversion to open surgery (OR = 0.70, 95 % CI 0.56-0.88) and a longer operative time (WMD = 29.51 min, 95 % CI 16.98-42.04), whereas other perioperative outcomes were generally comparable. The aggregated evidence suggests that, given comparable overall safety, RH may offer advantage over LH in reducing the conversion rate but has a longer operative time, while no significant differences were observed between the two techniques in overall complications, blood loss, transfusion rate, R0 resection rate, length of hospital stay, or costs. High quality prospective and randomized controlled studies are still required to further validate these findings.