Robotic-assisted donor and recipient hepatectomy in liver transplantation: An umbrella review of clinical outcomes, surgical performance, and cost-effectiveness

Table 2 Summary of findings - living liver donors (robotic vs open/Laparoscopic donor hepatectomy; direct evidence)

Outcome	Assumed risk (comparator per 1000)	Corresponding risk (robotic per 1000)	Effect [RR/OR/MD (95%CI)]	Number of studies (participants)	Certainty (GRADE)	Notes
Overall complications	Not estimable (baseline risk not reported)	Not estimable (requires baseline or pooled RD)	RR = 0.85 (0.72-0.99)	6 studies; 2168 donors	Low	1,2,4
Major complications (Clavien-Dindo ≥ III)	Not estimable (baseline risk not reported)	Not estimable (requires baseline or pooled RD)	RR = 0.80 (0.65-0.98)	6 studies; 2168 donors	Low	1,2,4
Minor complications (Clavien-Dindo I)	Not estimable (baseline risk not reported)	Not estimable (requires baseline or pooled RD)	OR = 5.14 (1.06-24.93) (open vs robotic)	2 studies; 216 donors	Low	1,3,4
Operative time (minutes)	N/A (continuous outcome)	N/A (continuous outcome)	MD = +105 (68142) minutes	6 studies; 2168 donors	Low	1,2
Blood loss (mL)	N/A (continuous outcome)	N/A (continuous outcome)	MD = -117 (-229 to -6) mL	6 studies; 2168 donors	Low	1,2
Length of stay (days)	N/A (continuous outcome)	N/A (continuous outcome)	MD = -0.60 (-1.14 to -0.10) days	6 studies; 2168 donors	Low	1,2

¹Risk of bias.

²Inconsistency/heterogeneity.

³Imprecision.

⁴Absolute effect not estimable from ratio-only data without a pooled baseline (or when risk difference was not reported).

Continuous outcomes use mean differences; absolute-risk columns are not applicable. Grading of recommendations assessment, development and evaluation downgrades reflect observational designs and heterogeneity in pooled estimates. Heterogeneity (Giglio et al[21]): Blood loss [open vs robotic weighted mean difference (WMD) 117.54 mL → -117.54 mL for robotic vs open]: I² = 98%; τ² = 18847.102. Operative time (open vs robotic WMD -105.34 minutes → +105.34 minutes): I² = 91%; τ² = 1772.424. Length of stay (open vs robotic WMD 0.63 days → -0.63 days): I² = 82%; τ² = 0.259. Donor complications were reported only as ratio measures without pooled baseline risks; absolute effects are not estimable. RR: Risk ratios; MD: Mean difference; OR: Odds ratio; RD: Risk difference; N/A: Not applicable; GRADE: Grading of recommendations assessment, development and evaluation.