Robotic versus laparoscopic liver resection: a propensity score-matched analysis adjusted for surgical difficulty

Robotic liver resection has gained increasing acceptance; however, its comparative benefits over laparoscopic liver resection remain debated, particularly after adjustment for surgical difficulty. This study compared short-term outcomes between robotic and laparoscopic liver resection using propensity score matching with the IWATE difficulty score.

We retrospectively analyzed patients who underwent minimally invasive liver resection between 2016 and 2025. Patients undergoing combined resection of other organs, except cholecystectomy, were excluded. Propensity score matching was performed using age, sex, body mass index, ASA physical status, diagnosis, multiple resection, repeat hepatectomy, and IWATE difficulty score. One-to-two nearest-neighbor matching without replacement with a caliper width of 0.2 of the standard deviation of the logit of the propensity score was applied. Analyses were conducted according to the initially planned surgical approach.

After matching, 260 patients were included (robotic: 90; laparoscopic: 170). The robotic group had a lower rate of postoperative complications (3.3 vs. 15.3%, p = 0.003) and less intraoperative blood loss, although operative time was longer (345 vs. 263 min, p < 0.001). Conversion rate, severe complications, and length of hospital stay were comparable.

Robotic liver resection was associated with lower postoperative complication rates and reduced intraoperative blood loss despite longer operative time, suggesting potential benefit when surgical difficulty is considered.