Comparison of Retzius-sparing robot-assisted laparoscopic radical prostatectomy vs standard robot-assisted radical prostatectomy: a meta-analysis

Jiang, Yu-Li; Zheng, Gaofeng; Jiang, ZePeng; Zhen-li,; Zhou, Xin; Zhou, Jin; Ye, Chun-Hua; Wang, Kang-Er

doi:10.1186/s12894-020-00685-4

Cited by 12 publications

(11 citation statements)

References 31 publications

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“…Umari et al found that at 12 months, there was no benefit to Retzius-sparing RARP over anterior approach [19], where as we found that Retzius-sparing RARP continued to provide improved pad-free continence at 12 months. Overall, this paper supports recent literature reviews and meta-analysis [20,21] and [17] suggesting that a Retzius-sparing approach demonstrates better continence rates compared to the standard approach to RARP with no negative effect on oncological outcomes at 12 months.…”

Section: Discussionsupporting

confidence: 85%

Incremental modification of robotic prostatectomy technique can lead to aggregated marginal gains to significantly improve functional outcomes without compromising oncological control

et al. 2021

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Introduction and objectivesSurgeons should aim for continuous quality improvement. The aim of this study was to evaluate the impact of incremental changes to Robot Assisted Radical Prostatectomy (RARP) technique on intra-operative and early post-operative outcomes. Patients and methods All cases of RARP performed by a single surgeon in a tertiary institution over a 2-year period were included in this evaluation. Routine clinical data were collected. Cases were retrospectively allocated to four groups depending on key technical steps (1 = standard anterior approach; 2 = anterior approach with preservation of endopelvic fascia, puboprostatic fascia and urachus; 3 = posterior approach for nerve spare, with preservation of endopelvic fascia, puboprostatic fascia and urachus; 4 = Retzius-sparing posterior approach). Results 187 patients were allocated to groups: 1 = 22, 2 = 53, 3 = 90, 4 = 22. There were no significant differences in preoperative characteristics, except age: 1 = 62.5, 2 = 62, 3 = 62.5, 4 = 58.5 (p = 0.02). Intra-operative differences were found in console time: 1 = 195, 2 = 167, 3 = 195 4 = 136.5 min (p < 0.001); and proportion of non-nerve sparing cases: 1 = 36%, 2 = 17%, 3 = 13%, 4 = 0% (p = 0.044). No significant differences were found in lymph node dissections, blood loss or complications. Post-operatively, no differences were found in length of stay, pathological characteristics, margin status, lymph node yield, complications or PSA levels. Significant differences were seen in pad-free continence at 6 weeks: 1 = 23%, 2 = 23%, 3 = 34%, 4 = 73% (p < 0.01); and social continence (using 1 pad) at 6-weeks: 1 = 59%, 2 = 87%, 3 = 81%, 4 = 95% (p = 0.01). Significant differences in pad-free continence persisted at 12 months: 1 = 63%, 2 = 81%, 3 = 78%, 4 = 100% (p = 0.019). Conclusion Our results suggest that aggregated marginal gains from incremental modification of RARP leads to significantly improved continence outcomes without compromising patient safety or oncological control.

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Section: Discussionsupporting

confidence: 85%

Incremental modification of robotic prostatectomy technique can lead to aggregated marginal gains to significantly improve functional outcomes without compromising oncological control

et al. 2021

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“…To our knowledge, our meta-analysis is the most up-to-date and comprehensive. Due to the inclusion of several recent high-quality works of literature ( 19 – 24 ), we have obtained some more stable results in some outcome indicators that were different from the previous meta-analyses ( 18 , 29 , 30 ). In addition, we are the first study to include the PLND rate in the meta-analysis, and also the first study to conduct the subgroup analysis based on the population.…”

Section: Discussionmentioning

confidence: 73%

“…To our knowledge, our meta-analysis is the most up-to-date and comprehensive. Due to the inclusion of several recent high-quality works of literature (19)(20)(21)(22)(23)(24), we have obtained some more stable results in some outcome indicators that were different from the previous meta-analyses (18,29,30).…”

Section: Discussionmentioning

confidence: 81%

“…Despite the better outcomes in urinary continence, several studies have shown that RS-RARP has a higher positive rate of a surgical margin than c-RARP ( 11 – 13 , 15 , 17 ). However, a recent meta-analysis found the opposite ( 18 ). Due to the small sample size of the previous studies and the few references included in the previous meta-analyses, the safety and efficacy of RS-RARP compared with c-RARP are not clear at present.…”

Section: Introductionmentioning

confidence: 97%

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Comparison of Retzius-Sparing Robot-Assisted Radical Prostatectomy vs. Conventional Robot-Assisted Radical Prostatectomy: An Up-to-Date Meta-Analysis

Yin

2021

Front. Surg.

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Background: The Retzius space-sparing robot-assisted radical prostatectomy (RS-RARP) has shown better results in urinary continence, but its efficacy and safety compared to conventional robot-assisted radical prostatectomy (c-RARP) remain controversial.Material and Methods: A research was conducted in Medline via PubMed, Cochrane Library, EMBASE, and Web of Science up to January 4, 2021, to identify studies comparing RS-RARP to c-RARP. We used RevMan 5.3 and STATA 14.0 for meta-analysis.Results: A total of 14 studies involving 3,129 participants were included. Meta-analysis showed no significant difference in positive surgical margins (PSMs), but the RS-RARP group had significantly higher PSM rates in the anterior site [odds ratio (OR) = 2.25, 95% CI: 1.22–4.16, P = 0.01]. Postoperative continence in RS-RARP group at 1 month (OR = 5.72, 95% CI: 3.56–9.19, P < 0.01), 3 months (OR = 6.44, 95% CI: 4.50–9.22, P < 0.01), 6 months (OR = 8.68, 95% CI: 4.01–18.82, P < 0.01), and 12 months (OR = 2.37, 95% CI: 1.20–4.70, P = 0.01) was significantly better than that in the c-RARP group. In addition, the RS-RARP group had a shorter console time (mean difference = −16.28, 95% CI: −27.04 to −5.53, P = 0.003) and a lower incidence of hernia (OR = 0.35, 95% CI: 0.19–0.67, P = 0.001). However, there were no significant differences in estimated blood loss, pelvic lymph node dissection rate, postoperative complications, 1-year-biochemical recurrence rate, and postoperative sexual function.Conclusions: Compared with c-RARP, RS-RARP showed better recovery of continence, shorter console time, and lower incidence of hernia. Although there was no significant difference in overall PSM, we suggest that the surgeon should be more careful if the lesion is in the anterior prostate.

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“…Furthermore, stretching of Hesselbach's ligament contributes to a decrease in strength of the internal ring [2,8,9]. Minimally invasive and Retzius-sparing techniques seem to decrease the risk of an inguinal hernia by minimizing damage to the region of the myopectineal orifice (MPO) [6,9,21]. Several prophylactic measures have been proposed to minimize the risk of inguinal hernia after transabdominal prostatectomy, including a ligation and transection of the processus vaginalis, blunt dissection of the peritoneum close to the internal ring with an isolation of the spermatic cord, or the placement of additional stitches to close the internal ring [6,[22][23][24].…”

Section: Discussionmentioning

confidence: 99%

Robotic-assisted laparoscopic inguinal hernia repair after previous transabdominal prostatectomy

et al. 2021

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Background Transabdominal prostatectomy results in scarring of the retropubic space and this might complicate subsequent preperitoneal dissection and mesh placement during minimally invasive inguinal hernia repair. Therefore, it suggested that an open anterior technique should be used rather than a minimally invasive posterior technique in these patients. Methods In this single-center study, a retrospective analysis of a prospectively maintained database was performed. All patients undergoing inguinal hernia repair after previous transabdominal prostatectomy were included in this analysis, and the feasibility, safety, and short-term outcomes of open and robotic-assisted laparoscopic inguinal hernia repair were compared. Results From 907 inguinal hernia operations performed between March 2015 and March 2020, 45 patients met the inclusion criteria. As the number of patients treated with conventional laparoscopy was very low (n = 2), their data were excluded from statistical analysis. An open anterior repair with mesh (Lichtenstein) was performed in 21 patients and a robotic-assisted laparoscopic posterior transabdominal repair (rTAPP) in 22. Patient characteristics between groups were comparable. A transurethral urinary catheter was placed during surgery in 17 patients, most often in the laparoscopic cases (15/22, 68.2%). In the rTAPP group, a higher proportion of patients was treated for a bilateral inguinal hernia (50%, vs 19% in the Lichtenstein group). There were no intraoperative complications and no conversions from laparoscopy to open surgery. No statistically significant differences between both groups were observed in the outcome parameters. At 4 weeks follow-up, more patients who underwent rTAPP had an asymptomatic seroma (22.7% vs 5% in the Lichtenstein group) and two patients were treated postoperatively for a urinary tract infection (4.7%). Conclusion A robotic-assisted laparoscopic approach to inguinal hernia after previous transabdominal prostatectomy seems safe and feasible and might offer specific advantages in the treatment of bilateral inguinal hernia repairs.

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Comparison of Retzius-sparing robot-assisted laparoscopic radical prostatectomy vs standard robot-assisted radical prostatectomy: a meta-analysis

Cited by 12 publications

References 31 publications

Incremental modification of robotic prostatectomy technique can lead to aggregated marginal gains to significantly improve functional outcomes without compromising oncological control

Incremental modification of robotic prostatectomy technique can lead to aggregated marginal gains to significantly improve functional outcomes without compromising oncological control

Comparison of Retzius-Sparing Robot-Assisted Radical Prostatectomy vs. Conventional Robot-Assisted Radical Prostatectomy: An Up-to-Date Meta-Analysis

Robotic-assisted laparoscopic inguinal hernia repair after previous transabdominal prostatectomy

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