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

Table 4 Recipients and economics (indirect evidence) - summary of findings and certainty (grading of recommendations assessment, development and evaluation): Economics (indirect)

Economic outcome	Contrast	Effect, MD (95%CI/CrI)	Source	Certainty (GRADE)	Notes
Total costs	RLR vs OLR	-243.82 (-326.46 to -162.78)	Network meta-analysis (Koh et al[23], 2024)	Low-moderate	1,2
Total costs	LLR vs OLR	-217.48 (-282.44 to -154.94)	Network meta-analysis (Koh et al[23], 2024)	Low-moderate	1,2
Procedure costs	RLR vs LLR	+2310.17 (+812.98 to +3808.74)	Network meta-analysis (Koh et al[23], 2024)	Low-moderate	1,2
Hospitalization costs	RLR vs OLR	-3527.20 (-5760.20 to -1367.50)	Network meta-analysis (Koh et al[23], 2024)	Low-moderate	1,2

¹Indirectness: Recipient outcomes and all economic contrasts derive from non-transplant liver resections; downgraded for indirectness in grading of recommendations assessment, development and evaluation.

²Economics: Costs are taken verbatim from the network meta-analysis without re-standardizing baskets; interpret as hypothesis-generating for transplant settings.

Table 4 (indirect): Economic evidence from non-transplant liver resections; hypothesis-generating for transplant. Absolute effects for dichotomous outcomes are shown when pooled baseline/comparator risks or pooled risk difference were available; otherwise “not estimable”. Heterogeneity: Extracted from Pilz da Cunha et al[22] and Koh et al[23]. Recipients (robotic vs laparoscopic resections): Overall morbidity I² = 24%; severe morbidity I² = 7%; 30-day mortality I² = 0%; operative time I² = 90%; length of stay I² = 41% (τ² not reported in the article text). Conversion: Number needed to treat ≈ 20; I² not reported in the article text/tables (likely in Supplementary material). Economics: The network meta-analysis reports comparative costs but does not provide standard I²/τ² for cost nodes; heterogeneity not estimable across cost categories. MD: Mean difference; GRADE: Grading of recommendations assessment, development and evaluation; USD: United States Dollars; RLR: Robotic liver resection; LLR: Laparoscopic resections; OLR: Open surgery.