Robot-assisted laparoscopic liver resection: a systematic review and pooled analysis of minor and major hepatectomies

Background: Robotic surgery has been introduced to overcome the limitations of conventional laparoscopy. A systematic review and meta-analysis were performed to assess the safety and feasibility for three subgroups of robot-assisted laparoscopic liver resection: (i) minor resections of easily accessible segments: 2/3, 4B, 5, 6, (ii) minor resections of difficult located segments: 1, 4A, 7, 8 and (Hi) major resections: >= 4 segments. Methods: A systematic search was performed in PubMed, EMBASE and Cochrane Library. Results: Twelve observational, mostly retrospective studies reporting on 363 patients were included. Data were pooled and analyzed. For subgroup (i) (n = 81) the weighted mean operative time was 215 65 min. One conversion (1 %) to laparotomy was needed. Weighted mean operative time for subgroup (ii) (n = 17) was 220 +/- 60 min. No conversions were needed. For subgroup (Hi) (n = 99) the weighted mean operative time was 405 +/- 100 min. In this subgroup 8 robotic procedures (8%) were converted to open surgery. Conclusion: Data show that robot-assisted laparoscopic liver resection is feasible in minor resections of all segments and major resections. Larger, prospective studies are warranted to compare the possible advantages of robot-assisted surgery with conventional laparoscopy and open surgery.