Extraperitoneal versus transperitoneal approach for robot-assisted radical prostatectomy: a contemporary systematic review and meta-analysis
We aim to evaluate the differences in peri-operative characteristics, surgical complications, and oncological and functional control between the extraperitoneal RARP (EP-RARP) and transperitoneal RARP (TP-RARP). A comprehensive database search was performed up to March 2021 for eligible studies comp...
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| Veröffentlicht in: | Journal of robotic surgery 2022-04, Vol.16 (2), p.257-264 |
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| creator | Uy, Michael Cassim, Raees Kim, Jaehoon Hoogenes, Jen Shayegan, Bobby Matsumoto, Edward D. |
| description | We aim to evaluate the differences in peri-operative characteristics, surgical complications, and oncological and functional control between the extraperitoneal RARP (EP-RARP) and transperitoneal RARP (TP-RARP). A comprehensive database search was performed up to March 2021 for eligible studies comparing outcomes between EP-RARP versus TP-RARP. This study was conducted in accordance with the Preferred Reporting Items for Systematic Reviews and Meta-Analyses guidelines and was registered with PROSPERO. A leave-one-out sensitivity analysis was performed to control for heterogeneity and risk of bias. A total of 16 studies were included with 3897 patients, including 2201 (56.5%) EP-RARPs and 1696 (43.5%) TP-RARPs. When compared to TP-RARP, EP-RARP offers faster operative time (MD − 14.4 min; 95% CI − 26.3, − 2.3), decreased length of post-operative stay (MD − 0.9 days, 95% CI − 1.3, − 0.4), and decreased rates of post-operative ileus (RR 0.2, 95% CI 0.1, 0.7) and inguinal hernia formation (RR 0.2, 95% CI 0.1, 0.5). There were no significant differences in total complications, estimated blood loss, positive surgical margins, or continence at 6 months. In this review, EP-RARP delivered similar oncological and functional outcomes, while also offering faster operative time, decreased length of post-operative stay, and decreased rates of post-operative ileus and inguinal hernia formation when compared to TP-RARP. These findings provide evidence-based data for surgical approach optimization and prompts future research to examine whether these findings hold true with recent advances in single-port RARP and outpatient RARP. |
| doi_str_mv | 10.1007/s11701-021-01245-0 |
| format | Article |
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A comprehensive database search was performed up to March 2021 for eligible studies comparing outcomes between EP-RARP versus TP-RARP. This study was conducted in accordance with the Preferred Reporting Items for Systematic Reviews and Meta-Analyses guidelines and was registered with PROSPERO. A leave-one-out sensitivity analysis was performed to control for heterogeneity and risk of bias. A total of 16 studies were included with 3897 patients, including 2201 (56.5%) EP-RARPs and 1696 (43.5%) TP-RARPs. When compared to TP-RARP, EP-RARP offers faster operative time (MD − 14.4 min; 95% CI − 26.3, − 2.3), decreased length of post-operative stay (MD − 0.9 days, 95% CI − 1.3, − 0.4), and decreased rates of post-operative ileus (RR 0.2, 95% CI 0.1, 0.7) and inguinal hernia formation (RR 0.2, 95% CI 0.1, 0.5). There were no significant differences in total complications, estimated blood loss, positive surgical margins, or continence at 6 months. In this review, EP-RARP delivered similar oncological and functional outcomes, while also offering faster operative time, decreased length of post-operative stay, and decreased rates of post-operative ileus and inguinal hernia formation when compared to TP-RARP. These findings provide evidence-based data for surgical approach optimization and prompts future research to examine whether these findings hold true with recent advances in single-port RARP and outpatient RARP.</description><identifier>ISSN: 1863-2483</identifier><identifier>EISSN: 1863-2491</identifier><identifier>DOI: 10.1007/s11701-021-01245-0</identifier><identifier>PMID: 33905056</identifier><language>eng</language><publisher>London: Springer London</publisher><subject>Body mass index ; Cohort analysis ; Comparative studies ; Hernias ; Heterogeneity ; Humans ; Length of stay ; Lymphatic system ; Male ; Margins of Excision ; Medicine ; Medicine & Public Health ; Meta-analysis ; Minimally Invasive Surgery ; Prostate ; Prostatectomy - adverse effects ; Review Article ; Risk management ; Robotic Surgical Procedures - methods ; Robotics ; Sensitivity analysis ; Software ; Surgeons ; Surgery ; Surgical anastomosis ; Systematic review ; Treatment Outcome ; Urological surgery ; Urology ; Variables</subject><ispartof>Journal of robotic surgery, 2022-04, Vol.16 (2), p.257-264</ispartof><rights>The Author(s), under exclusive licence to Springer-Verlag London Ltd., part of Springer Nature 2021</rights><rights>2021. The Author(s), under exclusive licence to Springer-Verlag London Ltd., part of Springer Nature.</rights><rights>The Author(s), under exclusive licence to Springer-Verlag London Ltd., part of Springer Nature 2021.</rights><lds50>peer_reviewed</lds50><woscitedreferencessubscribed>false</woscitedreferencessubscribed><citedby>FETCH-LOGICAL-c375t-517359b388bafeba98f9ffbd63db5f4fcad707600154c7897d68478f348d2aba3</citedby><cites>FETCH-LOGICAL-c375t-517359b388bafeba98f9ffbd63db5f4fcad707600154c7897d68478f348d2aba3</cites><orcidid>0000-0001-9426-7360</orcidid></display><links><openurl>$$Topenurl_article</openurl><openurlfulltext>$$Topenurlfull_article</openurlfulltext><thumbnail>$$Tsyndetics_thumb_exl</thumbnail><linktopdf>$$Uhttps://link.springer.com/content/pdf/10.1007/s11701-021-01245-0$$EPDF$$P50$$Gspringer$$H</linktopdf><linktohtml>$$Uhttps://www.proquest.com/docview/2918717317?pq-origsite=primo$$EHTML$$P50$$Gproquest$$H</linktohtml><link.rule.ids>314,776,780,21368,21369,27903,27904,33509,33510,33723,33724,41467,42536,43638,43784,51298,64362,64364,64366,72216</link.rule.ids><backlink>$$Uhttps://www.ncbi.nlm.nih.gov/pubmed/33905056$$D View this record in MEDLINE/PubMed$$Hfree_for_read</backlink></links><search><creatorcontrib>Uy, Michael</creatorcontrib><creatorcontrib>Cassim, Raees</creatorcontrib><creatorcontrib>Kim, Jaehoon</creatorcontrib><creatorcontrib>Hoogenes, Jen</creatorcontrib><creatorcontrib>Shayegan, Bobby</creatorcontrib><creatorcontrib>Matsumoto, Edward D.</creatorcontrib><title>Extraperitoneal versus transperitoneal approach for robot-assisted radical prostatectomy: a contemporary systematic review and meta-analysis</title><title>Journal of robotic surgery</title><addtitle>J Robotic Surg</addtitle><addtitle>J Robot Surg</addtitle><description>We aim to evaluate the differences in peri-operative characteristics, surgical complications, and oncological and functional control between the extraperitoneal RARP (EP-RARP) and transperitoneal RARP (TP-RARP). A comprehensive database search was performed up to March 2021 for eligible studies comparing outcomes between EP-RARP versus TP-RARP. This study was conducted in accordance with the Preferred Reporting Items for Systematic Reviews and Meta-Analyses guidelines and was registered with PROSPERO. A leave-one-out sensitivity analysis was performed to control for heterogeneity and risk of bias. A total of 16 studies were included with 3897 patients, including 2201 (56.5%) EP-RARPs and 1696 (43.5%) TP-RARPs. When compared to TP-RARP, EP-RARP offers faster operative time (MD − 14.4 min; 95% CI − 26.3, − 2.3), decreased length of post-operative stay (MD − 0.9 days, 95% CI − 1.3, − 0.4), and decreased rates of post-operative ileus (RR 0.2, 95% CI 0.1, 0.7) and inguinal hernia formation (RR 0.2, 95% CI 0.1, 0.5). There were no significant differences in total complications, estimated blood loss, positive surgical margins, or continence at 6 months. In this review, EP-RARP delivered similar oncological and functional outcomes, while also offering faster operative time, decreased length of post-operative stay, and decreased rates of post-operative ileus and inguinal hernia formation when compared to TP-RARP. These findings provide evidence-based data for surgical approach optimization and prompts future research to examine whether these findings hold true with recent advances in single-port RARP and outpatient RARP.</description><subject>Body mass index</subject><subject>Cohort analysis</subject><subject>Comparative studies</subject><subject>Hernias</subject><subject>Heterogeneity</subject><subject>Humans</subject><subject>Length of stay</subject><subject>Lymphatic system</subject><subject>Male</subject><subject>Margins of Excision</subject><subject>Medicine</subject><subject>Medicine & Public Health</subject><subject>Meta-analysis</subject><subject>Minimally Invasive Surgery</subject><subject>Prostate</subject><subject>Prostatectomy - adverse effects</subject><subject>Review Article</subject><subject>Risk management</subject><subject>Robotic Surgical Procedures - methods</subject><subject>Robotics</subject><subject>Sensitivity analysis</subject><subject>Software</subject><subject>Surgeons</subject><subject>Surgery</subject><subject>Surgical anastomosis</subject><subject>Systematic review</subject><subject>Treatment Outcome</subject><subject>Urological surgery</subject><subject>Urology</subject><subject>Variables</subject><issn>1863-2483</issn><issn>1863-2491</issn><fulltext>true</fulltext><rsrctype>article</rsrctype><creationdate>2022</creationdate><recordtype>article</recordtype><sourceid>EIF</sourceid><sourceid>ABUWG</sourceid><sourceid>AFKRA</sourceid><sourceid>BENPR</sourceid><sourceid>CCPQU</sourceid><sourceid>DWQXO</sourceid><recordid>eNp9kc9OFTEUxhujEbj6AixMEzduRtvpdNphRwiiCYkbWDdn-geGzEyHtoPed_ChOXoBDQuSNm1Of9_X036EHHL2mTOmvmTOFeMVq3HyupEVe0X2uW5FVTcdf_2012KPHOR8w5hUUvC3ZE-Ijkkm233y-_RXSbD4NJQ4exjpnU95zRSLc_6vDMuSIthrGmKiKfaxVJDzkIt3NIEbLDJI5ALF2xKn7REFauNc_LTEBGlL8xbhCcpgafJ3g_9JYXZ08gUqmGHcotk78ibAmP37h3VDLr-eXpx8q85_nH0_OT6vrFCyVJIrIbteaN1D8D10OnQh9K4VrpehCRacYqpljMvGKt0p1-pG6SAa7WroQWzIp50vdny7-lzMNGTrxxFmH9dsaslRxbq2RvTjM_Qmrgn7RarjWmErODak3lEWvyAnH8yShglfbTgzf7Iyu6wMZmX-ZmUYij48WK_95N2T5DEcBMQOyHg0X_n07-4XbO8BuxyjUQ</recordid><startdate>20220401</startdate><enddate>20220401</enddate><creator>Uy, Michael</creator><creator>Cassim, Raees</creator><creator>Kim, Jaehoon</creator><creator>Hoogenes, Jen</creator><creator>Shayegan, Bobby</creator><creator>Matsumoto, Edward D.</creator><general>Springer London</general><general>Springer Nature B.V</general><scope>CGR</scope><scope>CUY</scope><scope>CVF</scope><scope>ECM</scope><scope>EIF</scope><scope>NPM</scope><scope>AAYXX</scope><scope>CITATION</scope><scope>3V.</scope><scope>7X7</scope><scope>7XB</scope><scope>8FE</scope><scope>8FG</scope><scope>8FI</scope><scope>8FJ</scope><scope>8FK</scope><scope>ABJCF</scope><scope>ABUWG</scope><scope>AFKRA</scope><scope>BENPR</scope><scope>BGLVJ</scope><scope>CCPQU</scope><scope>DWQXO</scope><scope>FYUFA</scope><scope>GHDGH</scope><scope>HCIFZ</scope><scope>K9.</scope><scope>L6V</scope><scope>M0S</scope><scope>M7S</scope><scope>PQEST</scope><scope>PQQKQ</scope><scope>PQUKI</scope><scope>PTHSS</scope><scope>7X8</scope><orcidid>https://orcid.org/0000-0001-9426-7360</orcidid></search><sort><creationdate>20220401</creationdate><title>Extraperitoneal versus transperitoneal approach for robot-assisted radical prostatectomy: a contemporary systematic review and meta-analysis</title><author>Uy, Michael ; 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A comprehensive database search was performed up to March 2021 for eligible studies comparing outcomes between EP-RARP versus TP-RARP. This study was conducted in accordance with the Preferred Reporting Items for Systematic Reviews and Meta-Analyses guidelines and was registered with PROSPERO. A leave-one-out sensitivity analysis was performed to control for heterogeneity and risk of bias. A total of 16 studies were included with 3897 patients, including 2201 (56.5%) EP-RARPs and 1696 (43.5%) TP-RARPs. When compared to TP-RARP, EP-RARP offers faster operative time (MD − 14.4 min; 95% CI − 26.3, − 2.3), decreased length of post-operative stay (MD − 0.9 days, 95% CI − 1.3, − 0.4), and decreased rates of post-operative ileus (RR 0.2, 95% CI 0.1, 0.7) and inguinal hernia formation (RR 0.2, 95% CI 0.1, 0.5). There were no significant differences in total complications, estimated blood loss, positive surgical margins, or continence at 6 months. In this review, EP-RARP delivered similar oncological and functional outcomes, while also offering faster operative time, decreased length of post-operative stay, and decreased rates of post-operative ileus and inguinal hernia formation when compared to TP-RARP. These findings provide evidence-based data for surgical approach optimization and prompts future research to examine whether these findings hold true with recent advances in single-port RARP and outpatient RARP.</abstract><cop>London</cop><pub>Springer London</pub><pmid>33905056</pmid><doi>10.1007/s11701-021-01245-0</doi><tpages>8</tpages><orcidid>https://orcid.org/0000-0001-9426-7360</orcidid></addata></record> |
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| subjects | Body mass index Cohort analysis Comparative studies Hernias Heterogeneity Humans Length of stay Lymphatic system Male Margins of Excision Medicine Medicine & Public Health Meta-analysis Minimally Invasive Surgery Prostate Prostatectomy - adverse effects Review Article Risk management Robotic Surgical Procedures - methods Robotics Sensitivity analysis Software Surgeons Surgery Surgical anastomosis Systematic review Treatment Outcome Urological surgery Urology Variables |
| title | Extraperitoneal versus transperitoneal approach for robot-assisted radical prostatectomy: a contemporary systematic review and meta-analysis |
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