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

Table 8 Summary of findings (grading of recommendations assessment, development and evaluation) - robotic-assisted hepatectomy vs comparators in liver transplantation: Economic/resource outcomes - robotic vs comparators (as reported in Koh et al[23], 2024)

Outcome	Effect estimate (MD/OR/NMA contrast)	Certainty (GRADE)	Comments/footnotes
Total costs	RLR vs OLR: MD -243.82 (-326.46 to -162.78)	Low-moderate	Less intraoperative blood loss with RLR vs OLR also reported
Total costs (LLR vs OLR)	MD -217.48 (-282.44 to -154.94)	Low-moderate	Koh et al[23], 2024 network meta-analysis
Procedure costs	RLR vs LLR: MD + 2310.17 (+812.98 to +3808.74)	Low-moderate	Downgrades: RoB (observational inputs); indirectness to transplant setting; currency/modeling heterogeneity1,2
Hospitalization costs	RLR vs OLR: MD -3527.20 (-5760.20 to -1367.50)	Low-moderate	Lower hospitalization costs for RLR vs OLR
Transfusion	RLR vs OLR: OR 0.34 (0.17-0.66)	Low-moderate	Koh et al[23], 2024 NMA
Overall morbidity	RLR vs OLR: OR 0.41 (0.26-0.59)	Low-moderate	Lower morbidity vs OLR

¹Risk of bias (observational comparative designs).

²Indirectness (non-transplant or mixed populations).

Grading of recommendations assessment, development and evaluation-compliant summary-of-findings table. Relative and absolute effects are reported where available. Continuous outcomes are presented as mean differences. For dichotomous outcomes, absolute risks per 1000 will be derived from the median comparator risk of contributing meta-analyses; cells are footnoted when baseline risk is pending. Donor meta-analytic lines from Giglio et al[21], 2025 (open vs robotic donor hepatectomy). Recipient effects from Pilz da Cunha et al[22], 2025 economic/resource contrasts from Koh et al[23], 2024 (network meta-analysis). GRADE: Grading of recommendations assessment, development and evaluation; OR: Odds ratio; MD: Mean differences; RLR: Robotic liver resection; OLR: Open surgery; RoB: Risk of bias; NMA: Network meta-analysis.