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

Table 7 Summary of findings (grading of recommendations assessment, development and evaluation) - robotic-assisted hepatectomy vs comparators in liver transplantation: Transplant recipients - robotic vs laparoscopic

Outcome	Assumed risk (comparator per 1000)	Corresponding risk (robotic per 1000)	Effect [RR/MD (95%CI)]	Number of studies (participants)	Certainty (GRADE)	Comments/footnotes
Conversion to open	RD pooled (no baseline required)	-50 per 1000	RR 0.41 (0.32-0.52); RD -0.05 (-0.07 to -0.03)	24 studies; participants NR	Low-moderate	Pilz da Cunha et al[22], 2025; NNT = 20
Overall morbidity (any complication)	RD pooled (no baseline required)	-20 per 1000	RR 0.92 (0.84-1.00); RD -0.02 (-0.03 to 0.00)	20 studies; participants NR	Low	Pilz da Cunha et al[22], 2025 (overall morbidity section)
Severe morbidity (Clavien-Dindo ≥ III)	RD pooled (no baseline required)	-10 per 1000	RR 0.81 (0.70, 0.94); RD ≈ -0.01 (NNT = 100)	21 studies; participants NR	Low-moderate	Pilz da Cunha et al[22], 2025; NNT = 100 overall; subgroup major RD -0.03
R0 resection rate	Not estimable (RD not provided)	Not estimable	RR 1.02 (1.01-1.03)	NR (multi-study)	Low	Pilz da Cunha et al[22], 2025 (counts not explicit in text extraction)
Readmission	RD pooled (no baseline required)	+10 per 1000	RR 1.24 (1.09-1.41); RD +0.01 (0.00-0.01)	20 studies; participants NR	Low	Pilz da Cunha et al[22], 2025
Length of stay (days)	N/A (continuous outcome)	N/A (continuous outcome)	MD -0.27 (-0.67 to 0.12)	26 studies; participants NR	Low	Pilz da Cunha et al[22], 2025
30-day or in-hospital mortality	Not estimable (RD not provided)	Not estimable (requires baseline risk)	RR 0.77 (0.51-1.15)	20 studies; participants NR	Low	Pilz da Cunha et al[22], 2025 (30-day mortality)
Blood loss (mL)	N/A (continuous outcome)	N/A (continuous outcome)	No significant difference (overall)	NR	Low	Pilz da Cunha et al[22], 2025 (overall non-significant; subgroup differences exist)
Operative time (minutes)	N/A (continuous outcome)	N/A (continuous outcome)	MD +8.8 (-4.8 to 22)	23 studies; participants NR	Low	Pilz da Cunha et al[22], 2025; high heterogeneity (I2 ≈ 90%)

NR: Not reported; N/A: Not applicable; NNT: Number needed to treat; GRADE: Grading of recommendations assessment, development and evaluation; RR: Risk ratios; MD: Mean differences; RD: Risk difference.