Economic impact of robotic liver resection: systematic review of costs, resource utilization, and hospital stay

Background

The robotic approach is being increasingly utilized for liver resections. Patient benefits from robotic liver resection (RLR) have been observed; however, their cost–benefit is yet to be confirmed. This systematic review aimed to determine the costs of RLR compared to laparoscopic (LLR) or open liver resections (OLR).

Method

A systematic search of MEDLINE, EMBASE, and Cochrane databases was performed in October 2025. Non-randomized studies of adult patients undergoing RLR were included. The narrative data synthesis focused on total, intraoperative and indirect costs, and length of stay (LOS). Where study heterogeneity was deemed acceptable (I2 < 75%), meta-analyses were performed. Quality assessment was performed using ROBINS-I and the Drummond economic evaluation checklist.

Results

32 studies were included, involving a total of 16,592 patients. In RLR vs. OLR comparisons, most studies (n = 13/18, 72.2%) reported equivalent or lower total costs for RLR. In RLR vs. LLR comparisons, most studies (n = 10/18, 55.6%) reported higher total costs for RLR, confirmed by meta-analysis (+ 5,250 PPP-adjusted USD, 95% CI + 3,360 to + 7,150). A minority of studies (n = 8/32, 25%) addressed indirect costs or costs adjusted for case volume or complexity. When assessed, cost differences between RLR and LLR decreased in high-volume centers. No study performed a formal cost-effectiveness analysis.

Conclusion

Available evidence suggests laparoscopy remains the least costly approach. The cost of RLR may decrease in high-volume centers, complex resections, and with increasing diversity of robotic platforms. Standardization of cost reporting and quality of health economic analyses must be improved to provide definitive cost-effectiveness evaluations.