Robotic Versus Laparoscopic Hepatectomy: a Systematic Review of Perioperative and Short-Term Oncologic Outcomes

Minimally invasive liver surgery (MILS) has progressively evolved from minor resections to technically demanding major hepatectomies. While laparoscopic hepatectomy is now widely established, robotic platforms have emerged as a promising alternative, potentially overcoming the ergonomic and technical limitations of conventional laparoscopy. This umbrella review synthesizes current comparative evidence to inform surgical decision-making.

An umbrella review of the literature was conducted in accordance with PRISMA guidelines. Systematic reviews, meta-analyses, and network meta-analyses evaluating robotic versus laparoscopic hepatectomy were identified through searches of PubMed, Embase and the Cochrane Library (2020-2025). Primary outcomes included operative time, estimated blood loss and conversion to open surgery. Secondary outcomes included postoperative morbidity, length of hospital stay and R0 resection rate. Data overlap across included secondary analyses was explicitly acknowledged; pooled estimates cited in this review are derived from the most comprehensive single source identified for each metric and are referenced accordingly. Studies including benign pathologies were noted, and oncologic metrics are reported separately for malignant subgroups where data permitted.

Nine high-quality systematic reviews and meta-analyses - including two network meta-analyses - published between 2020 and 2025 were included in this umbrella review. These secondary analyses draw upon overlapping pools of primary retrospective cohort studies, likely capturing a large but not fully independent population of patients. Robotic hepatectomy was consistently associated with significantly lower estimated blood loss (WMD -110 mL; 95% CI -142 to -78; p < 0.001) and reduced conversion to open surgery (OR 0.63; 95% CI 0.50-0.79; p < 0.001) compared with laparoscopy. Operative time was longer for robotic surgery (WMD +42 min; 95% CI +28 to +56; p < 0.001), although this difference attenuated after the learning curve. Overall morbidity and length of hospital stay were comparable. R0 resection rates were equivalent (>90% in both groups). Lymph node yield was significantly higher in robotic surgery among malignant cases (+1.1 nodes; 95% CI 0.3-1.9; p = 0.01).

Both robotic and laparoscopic hepatectomy are safe and effective minimally invasive techniques. Robotic surgery provides measurable perioperative advantages in blood loss control and conversion rates, particularly in complex resections. A statistically significant improvement in lymph node yield favoring robotic surgery was identified in oncologic cases and warrants further investigation. Long-term oncologic equivalence remains to be confirmed by prospective data.