Retropubic, Laparoscopic, and Robot-Assisted Radical Prostatectomy: A Systematic Review and Cumulative Analysis of Comparative Studies

Ficarra, Vincenzo; Novara, Giacomo; Artibani, Walter; Cestari, Andrea; Galfano, Antonio; Graefen, Markus; Guazzoni, G.; Guillonneau, Bertrand; Menon, Mani; Montorsi, Francesco; Patel, Vipul; Rassweiler, Jens; Poppel, Hendrik Van

doi:10.1016/j.eururo.2009.01.036

Cited by 928 publications

(629 citation statements)

References 99 publications

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“…In general, the urologic literature demonstrates a similar overall complication rate for ORP and RALP, although there is some minimal disagreement among the studies (Table 1)[15]. In a comprehensive review of the literature comparing open, robotic, and traditional laparoscopic RP, Ficarra et al found no difference between RALP and ORP (relative risk: 1.33; 95% CI: 0.64–2.74; p = 0.44) in their cumulative analysis of overall complications.…”

Section: Comparison and Discussion Of Orp And Ralpmentioning

confidence: 99%

“…In a comprehensive review of the literature comparing open, robotic, and traditional laparoscopic RP, Ficarra et al found no difference between RALP and ORP (relative risk: 1.33; 95% CI: 0.64–2.74; p = 0.44) in their cumulative analysis of overall complications. When the two recently published population-based comparative effectiveness studies[12,17] are considered with the findings from Ficarra and associates[15], there appear to be minimal differences in overall perioperative complication rates between ORP and RALP. The difference in the rate of complications between surgeons seems larger than that between surgical approaches.…”

Section: Comparison and Discussion Of Orp And Ralpmentioning

confidence: 99%

“…Kordan and colleagues showed a statistically significant advantage for RALP over ORP in transfusion requirements (0.8 vs. 3.4%, p = 0.002)[24]. In reviewing the literature through January 2008, Ficarra and colleagues analyzed six comparative studies and found that ORP patients had a relative risk of receiving a blood transfusion four times higher than RALP patients ( p = 0.01)[15]. …”

Section: Comparison and Discussion Of Orp And Ralpmentioning

confidence: 99%

“…Although conceding that the quality of the available comparative studies was not excellent, Ficarra et al, in their cumulative analysis of studies reporting surgical-margin rates for RALP and ORP, found that RALP had a statistically significant advantage over ORP (relative risk 1.58; 95% CI: 1.29–1.94; p < 0.001)[15]. Even when limiting their analysis to prospective studies and those with pathologically localized tumors, RALP continued to obtain a lower positive surgical-margin rate than ORP.…”

Section: Comparison and Discussion Of Orp And Ralpmentioning

confidence: 99%

“…In addition, many urologists are unfamiliar with the quality grading and interpretation of the published literature[14]. Two contemporary reviews highlight the shortcomings in studies comparing ORP with RALP and question whether evidence-based medicine is driving RP practice patterns within the U.S.[15,16]. The intent of our review is to provide a critical analysis of ORP and RALP in terms of perioperative, oncologic, functional, and economic outcomes.…”

Section: Introductionmentioning

confidence: 99%

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Evidence-Based Comparison of Robotic and Open Radical Prostatectomy

Lowrance

Tarin

Shariat

2010

The Scientific World JOURNAL

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The rapid adoption of robotic-assisted laparoscopic radical prostatectomy (RALP) has occurred despite a lack of high-quality evidence demonstrating its oncologic advantages, safety, or cost effectiveness compared with open radical retropubic prostatectomy (ORP). This review examines the current literature comparing ORP and RALP, focusing on perioperative, oncologic, functional, and economic outcomes.

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Section: Comparison and Discussion Of Orp And Ralpmentioning

confidence: 99%

Section: Comparison and Discussion Of Orp And Ralpmentioning

confidence: 99%

Section: Comparison and Discussion Of Orp And Ralpmentioning

confidence: 99%

Section: Comparison and Discussion Of Orp And Ralpmentioning

confidence: 99%

Section: Introductionmentioning

confidence: 99%

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Evidence-Based Comparison of Robotic and Open Radical Prostatectomy

Lowrance

Tarin

Shariat

2010

The Scientific World JOURNAL

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Diffusion of Surgical Innovations, Patient Safety, and Minimally Invasive Radical Prostatectomy

et al. 2014

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IMPORTANCE Surgical innovations disseminate in the absence of coordinated systems to ensure their safe integration into clinical practice, potentially exposing patients to increased risk for medical error. OBJECTIVE To investigate associations of patient safety with the diffusion of minimally invasive radical prostatectomy (MIRP) resulting from the development of the da Vinci robot. DESIGN, SETTING, AND PARTICIPANTS A cohort study of 401 325 patients in the Nationwide Inpatient Sample who underwent radical prostatectomy during MIRP diffusion between January 1, 2003, and December 31, 2009. MAIN OUTCOMES AND MEASURES We used Agency for Healthcare Research and Quality Patient Safety Indicators (PSIs), which measure processes of care and surgical provider performance. We estimated the prevalence of MIRP among all prostatectomies and compared PSI incidence between MIRP and open radical prostatectomy in each year during the study. We also collected estimates of MIRP incidence attributed to the manufacturer of the da Vinci robot. RESULTS Patients who underwent MIRP were more likely to be white (P = .004), have fewer comorbidities (P = .02), and have undergone surgery in higher-income areas (P = .005). The incidence of MIRP was substantially lower than da Vinci manufacturer estimates. Rapid diffusion onset occurred in 2006, when MIRP accounted for 10.4% (95% CI, 10.2-10.7) of all radical prostatectomies in the United States. In 2005, MIRP was associated with an increased adjusted risk for any PSI (adjusted odds ratio, 2.0; 95% CI, 1.1-3.7; P = .02) vs open radical prostatectomy. Stratification by hospital status demonstrated similar patterns: rapid diffusion onset among teaching hospitals occurred in 2006 (11.7%; 95% CI, 11.3-12.0), with an increased risk for PSI for MIRP in 2005 (adjusted odds ratio, 2.7; 95% CI, 1.4-5.3; P = .004), and onset among nonteaching hospitals occurred in 2008 (27.1%; 95% CI, 26.6-27.7), with an increased but nonsignificant risk for PSI in 2007 (adjusted odds ratio, 2.0; 95% CI, 0.8-5.2; P = .14). CONCLUSIONS AND RELEVANCE During its initial national diffusion, MIRP was associated with diminished perioperative patient safety. To promote safety and protect patients, the processes by which surgical innovations disseminate into clinical practice require refinement.

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