Perioperative outcomes after robotic repeat hepatectomy: A systematic review

Background Robotic liver resection has widely spread in hepatopancreatobiliary surgery, with growing evidence even in challenging scenarios. However, the results of robotic hepatectomy in patients who have had previous liver operations (repeat Robotic Liver Resections, r-RLR) have not been deeply investigated so far. Methods A systematic review of the MEDLINE and SCOPUS databases was performed, including studies published until April 2025. Results A total of 4 studies including 118 patients met the inclusion criteria. Nineteen patients (16.1 %) had received 2 or more previous liver resections, with 92.4 % (n = 109) of the r-RLR that were performed for malignant lesions. Colorectal liver metastases represented the most common malignant indication (40.7 %), followed by recurrent hepatocellular carcinoma (36.4 %). Tumor size varied between 10 and 33 mm in the largest diameter. The weighted mean operative time was 200.8 min (SD: 112.3), and the weighted mean estimated blood loss was 134.3 mL (SD: 121.9). The weighted mean hospital length of stay was 4.7 days (SD: 4.7). One case of open conversion was reported (0.8 %). Six patients experienced major complications (5 %), with 1 (0.8 %) postoperative death. Conclusion Few retrospective studies investigating the outcomes of r-RLR are currently available in the literature. From published data, it may be a safe and feasible alternative to open and laparoscopic redo hepatectomy in selected patients in referral HPB centers. Further studies with larger sample sizes are needed to confirm such preliminary findings.