Background: Robotic platform has been increasingly applied in major hepatectomy. However, the role or advantage of robotic approach comparing with laparoscopic approach in major hepatectomy remains controversial. This meta-analysis compares perioperative outcomes of robotic major hepatectomy (RMH) to laparoscopic major hepatectomy (LMH) for hepatic neoplasms. Methods: PubMed, Web of Science, EMBASE, and Cochrane Library were searched to identify comparative studies compared RMH versus LMH for hepatic neoplasms. The search timeframe was set before May 2023. Main outcomes were mortality, overall morbidities, serious complications, and conversion to open surgery. Secondary outcomes were operative time, intraoperative blood loss, blood transfusion, postoperative length of hospital stay, R0 resection, reoperation, and readmission. Studies were evaluated for quality by Cochrane risk of bias tool or Newcastle-Ottawa scale. Data were pooled as odds ratio (OR) or mean difference (MD). This study was registered at PROSPERO (CRD42023410951). Results: Twelve retrospective cohort studies concerning total 1657 patients (796 RMH, 861 LMH) were included. Meta-analyses showed no significant differences in mortality (OR=1.23, 95% CI=0.50–2.98, P=0.65), overall postoperative complications (OR=0.83, 95% CI=0.65–1.06, P=0.14), operative time (MD=6.47, 95% CI=−14.72 to 27.65, P=0.55), blood transfusion (OR=0.77, 95% CI=0.55–1.08, P=0.13), R0 resection (OR=1.45, 95% CI=0.91–2.31, P=0.12), reoperation (OR=0.76, 95% CI=0.31–1.88, P=0.56), and readmission (OR=0.63, 95% CI=0.28–1.44, P=0.27) between RMH and LMH. Incidence of serious complications (OR=0.60, 95% CI=0.40–0.90, P=0.01), conversion to open surgery (OR=0.41, 95% CI=0.27–0.63, P<0.0001), blood loss (MD=−91.42, 95% CI=−142.18 to −40.66, P=0.0004), and postoperative hospital stay (MD=−0.64, 95% CI=−0.78 to −0.49, P<0.00001) were reduced for RMH versus LMH. Conclusions: RMH is associated with comparable short-term surgical outcomes and oncologic adequacy compared to LMH when performed by experienced surgeons at large centres. RMH may result in reduced major morbidities, conversion rate, blood loss, and hospital stay, but these results were volatile. Further randomized studies should address the potential advantages of RMH over LMH.

Current mouse models of sleeve gastrectomy (SG) rely heavily on manual suturing -- a technically demanding procedure with prolonged operative times, high perioperative mortality, and a steep learning curve. This limits their accessibility to non-surgical researchers. To address this bottleneck, we developed a simplified SG protocol using disposable ligature clips, commonly employed in clinical gastrointestinal surgery. In diet-induced obese C57BL/6J mice, the clip-based approach reduced mean operative time by >50% (20.9 ± 3.2 vs. 43.9 ± 3.0 min) and significantly improved 12-week survival compared to traditional suturing. The method achieved equivalent metabolic outcomes, including sustained weight loss, improved glucose tolerance, enhanced insulin sensitivity, and reduced hepatic steatosis. Notably, the model requires no specialized microsurgical expertise or stapling devices, which are often unavailable for murine applications. We recommend this clip-based method for investigators, particularly those without advanced surgical training, who prioritize procedural efficiency and reproducibility in mechanistic studies of bariatric surgery. For surgeons seeking direct clinical translatability, suture-based techniques remain preferable, albeit with more stringent perioperative management.

Current mouse models of sleeve gastrectomy (SG) rely heavily on manual suturing -- a technically demanding procedure with prolonged operative times, high perioperative mortality, and a steep learning curve. This limits their accessibility to non-surgical researchers. To address this bottleneck, we developed a simplified SG protocol using disposable ligature clips, commonly employed in clinical gastrointestinal surgery. In diet-induced obese C57BL/6J mice, the clip-based approach reduced mean operative time by >50% (20.9 ± 3.2 vs. 43.9 ± 3.0 min) and significantly improved 12-week survival compared to traditional suturing. The method achieved equivalent metabolic outcomes, including sustained weight loss, improved glucose tolerance, enhanced insulin sensitivity, and reduced hepatic steatosis. Notably, the model requires no specialized microsurgical expertise or stapling devices, which are often unavailable for murine applications. We recommend this clip-based method for investigators, particularly those without advanced surgical training, who prioritize procedural efficiency and reproducibility in mechanistic studies of bariatric surgery. For surgeons seeking direct clinical translatability, suture-based techniques remain preferable, albeit with more stringent perioperative management.