A Systematic Review of Costs, Resource Utilization, and Length of Stay

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ID: 315786
2026
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Abstract
Abstract Background Robotic liver resection (RLR) is increasingly adopted in hepatobiliary surgery due to perioperative advantages. However, its economic impact remains controversial, particularly in comparison with open liver resection (OLR) and laparoscopic liver resection (LLR). Aims This systematic review aimed to evaluate the existing evidence on costs, resource utilization, and length of stay associated with RLR in adult liver surgery. Methods A systematic review was conducted in accordance with PRISMA and AMSTAR-2 guidelines and registered with PROSPERO. MEDLINE, EMBASE, and the Cochrane Library were searched up to September 2025. Studies reporting cost analyses of RLR for benign or malignant liver disease were included. Primary outcomes were total hospital costs and length of stay (LOS). Secondary outcomes included intraoperative, postoperative, readmission, and indirect costs. Study quality was assessed using the Drummond checklist. Results Thirty-two observational studies comprising 17,016 patients were included. RLR was consistently associated with higher intraoperative costs compared with OLR and LLR, largely driven by consumables and robotic instrumentation. Despite this, most studies comparing RLR with OLR reported comparable or lower total costs for RLR, primarily due to reduced LOS, fewer complications, and lower readmission rates. Median postoperative LOS was shorter with RLR than OLR in nearly all studies. Comparisons between RLR and LLR showed more heterogeneous results, with laparoscopy generally associated with lower total costs, although selected high-volume centers reported cost equivalence or lower costs with RLR. Only 25% of studies incorporated indirect costs such as robotic platform acquisition and maintenance. Overall study quality was predominantly rated as average. Conclusion RLR incurs higher intraoperative costs but may achieve comparable or reduced total hospital costs relative to open surgery through reduced LOS and complication burden. Compared with laparoscopy, a consistent economic advantage for RLR is less evident and appears context dependent. Future high-quality economic evaluations incorporating indirect costs and standardized cost definitions are required to better define the cost-effectiveness of RLR within modern hepatobiliary practice.Figure 1For image description, please refer to the figure legend and surrounding text.
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openalex_W7163327697 Use this key to autocite in the manuscript while using SciMatic Manuscript Manager or Thesis Manager
Authors M Ibrahim, M Kowal, P Limani, P Lodge, P Kron
Journal the british journal of surgery
Year 2026
DOI
10.1093/bjs/znag055.030
URL
https://doi.org/10.1093/bjs/znag055.030
Keywords Keywords not found

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