Short Term Safety and Efficacy of Robotic Versus Laparoscopic Liver Resection: A Systematic Review and Meta Analysis

Abstract

Introduction: Laparoscopic liver resection (LLR) remains technically challenging with its use limited to experienced surgeons. Robotic liver resection (RLR) may potentially produce favorable peri- and postoperative outcomes when compared to LLR. Methods: MEDLINE, EMBASE, PubMed, and Cochrane CENTRAL databases were systematically reviewed to identify studies comparing robotic and laparoscopic partial hepatectomy (last search 5th August 2019). Quantitative comparative studies in English published since the introduction of RLR were identified for inclusion. Outcomes extracted include operative time (OT), estimated blood loss (EBL), conversion to open, perioperative transfusion requirement, post-operative complications, length of stay, R0 resection rate, and mortality. Sub-groups were defined as major, and minor resections. Meta-analysis and subgroup meta-analysis was carried out using a random effects model. Effect measures were odds ratio (OR) for dichotomous data and mean weighted difference (MWD) for continuous data. Results: Twenty-two non-randomised comparative studies with a total of 1890 patients (Robotic; n=836, Laparoscopic; n=1054) was included in analysis. Operative time was significantly longer for RLR [MWD=+39.8 minutes, 95% CI (21.1, 58.6), p< 0.001], but not significantly different in sub-group analysis. EBL, length of stay, conversion rate, transfusion, complication rate, R0 resection rate, and mortality was not significantly different between RLR and LLR nor in major or minor sub-groups [p>0.05]. Conclusion: RLR provides comparable peri- and postoperative outcomes to LLR, potentially being a preferable approach in complex and major liver resections due to the inherent advantages of the robotic platform. Further randomised controlled studies are required in establishing the role of robotics in liver resection.