ArticleEClinicalMedicine2026
Robotic recipient liver transplantation worldwide: a systematic review and meta-analysis of the first 93 patients, from feasibility to early outcomes.
Article in EClinicalMedicine, 2026. The graph could read no effect estimate from its abstract, so it casts no vote on the map. Not yet cited in PubMed.
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20 authors.
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Abstract
Background: Robotic liver transplantation (rLT) has emerged as a minimally-invasive approach to the liver transplant operation, but global experience remains limited and fragmented. A synthesis of existing data and outcomes is needed to define its current role and inform wider adoption. Methods: We conducted a systematic review and meta-analysis in accordance with PRISMA guidelines. PubMed, Embase, and Web of Science were searched for English-language human studies reporting rLT published between January 1, 2021, and October 31, 2025. Methodological quality was assessed using Joanna Briggs Institute tools (case reports/series) and the MINORS tool (observational cohorts). Pooled event rates and means with 95% confidence intervals (CI) were calculated using fixed- or random-effects models according to heterogeneity. Publication bias was assessed with Egger's test. This trial is registered with PROSPERO, number CRD420251111186. Findings: Ten studies published between 2021 and 2025, encompassing 93 rLT procedures from five countries, met inclusion criteria; three larger series were eligible for meta-analysis. Most cases were living-donor right lobe grafts performed with the Da Vinci Xi platform in highly selected, low-to-intermediate MELD (Model for End-Stage Liver Disease) recipients without severe portosystemic shunting. Pooled rates were 7.0% (95% CI 3.0-15.8) for bleeding, 3.1% (0.6-13.9) for wound infection, 9.2% (4.3-18.5) for acute kidney injury, 8.5% (3.9-17.7) for biliary complications, 3.2% (0.8-12.0) for portal vein events, and 4.3% (1.4-12.4) for hepatic artery thrombosis, with no detected statistical heterogeneity (I Interpretation: Robotic liver transplantation is technically feasible, associated with low perioperative morbidity, and has excellent short-term survival in carefully selected recipients treated at experienced centres. Multicentre registries, robust benchmarking against open LT, and standardised training pathways may accelerate implementation. Funding: No specific funding was received for this study.
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