Comparative effectiveness and safety of robotic versus laparoscopic liver resection for benign liver diseases: a systematic review and meta-analysis

Robotic liver resection (RLR) is increasingly used as an alternative to laparoscopic liver resection (LLR), but its comparative effectiveness and safety for benign liver diseases remain uncertain. We performed a systematic review and meta-analysis to compare perioperative outcomes between RLR and LLR. PubMed, Web of Science, Embase, Ovid MEDLINE, Cochrane Library, WanFang Data, VIP Database (CQVIP), and CNKI were searched from inception to November 2025. Studies comparing RLR with LLR for benign liver diseases were included. Weighted mean differences (WMDs) and relative risks (RRs) with 95% confidence intervals (CIs) were calculated for continuous and dichotomous outcomes, respectively. Subgroup analyses were performed according to disease type. Nine retrospective studies involving 790 patients (RLR, n = 268; LLR, n = 522) were included. Compared with LLR, RLR was associated with shorter setup-excluded operative time (WMD = -36.24 min, 95% CI = -52.88 to -19.60 min), lower intraoperative blood loss (WMD = -55.66 mL, 95% CI = -69.58 to -41.75 mL), a lower conversion rate to open surgery (RR = 0.27, 95% CI = 0.11 to 0.69), and shorter postoperative hospital stay (WMD = -0.68 days, 95% CI = -1.35 to -0.01 days). RLR was also associated with higher albumin levels on postoperative day (POD) 1 (WMD = 1.65 g/L, 95% CI = 0.41 to 2.88 g/L) and lower ALT levels on POD 1 (WMD = − 27.24 U/L, 95% CI = − 48.42 to − 6.05 U/L). Total operative time and postoperative complication rates were comparable between the two approaches. In subgroup analyses, RLR was associated with reduced intraoperative blood loss in both hepatolithiasis and hepatic hemangioma, with a numerically larger reduction in the latter subgroup; additionally, RLR was associated with lower conversion rates and shorter postoperative hospital stay in hepatolithiasis. RLR was associated with advantages in several specific perioperative outcomes compared with LLR for benign liver diseases, without an increase in postoperative complications. However, all available evidence was retrospective, and the clinical significance of modest postoperative biochemical differences remains uncertain. Large prospective multicenter studies are warranted to confirm these findings. PROSPERO CRD420251062434.