Robotic‐assisted versus laparoscopic nephroureterectomy; a systematic review and meta‐analysis

Abstract

Background: Upper tract urothelial carcinoma (UTUC) is the malignant transformation of urothelial cells, from the renal calyces to the ureteral orifices. While the benefits of minimally invasive nephroureterectomy over their open counterpart have been established, the optimal technique remains a debate. We aimed to assess current evidence in the literature and compare outcomes between robotic-assisted (RANU) and laparoscopic nephroureterectomy (LNU).Methods: A systematic review of the literature was performed for studies comparing RANU and LNU for bladder cancer. Outcome measurements were recurrence rates (local and distal), positive margins, positive lymph node yield and perioperative outcomes. Meta-analysis was performed using Review Manager 5.Results: Our results demonstrate a significantly higher mortality rate in patients undergoing laparoscopic nephroureterectomy when compared with the roboticassisted approach for the treatment of UTUC (1.8% vs. 1.1%, p = 0.008); however, these results were inconsistent on sensitivity analysis and should therefore be interpreted with caution. No significant difference was observed for other outcomes. Conclusion:The ideal approach to minimally invasive radical nephroureterectomy remains undetermined. Future research, ideally prospective randomised studies, should focus on long-term outcomes, in particular recurrence, recurrence-free survival, overall survival and the correlation between surgical technique and survival.

Robotic Surgery of the Urothelial Carcinoma of the Upper Urinary Tract Single Surgeon Initial Experience, 66 consecutive cases

“…Finally, our study mortality rate at 24 months is 3% (2/66) patients. Our rate is higher than what has been reported by others (20). However, it is of note that our data relies on a real-life cohort and that the large con dence interval is not suited for comparability.…”

“…For example, the multicenter study by Campi et al relied on a total combined cohort of 81, with a highly variable robotic caseload (19). Moreover, similar to RARC patients UTUC patients represent a highly variable patient cohort, young and t patients vs. senior patients with high comorbidity burden and previous surgical interventions (20). Thus, we relied on a real world cohort without strict selection criteria with an adequate sample size and a single robotic-surgeon expert with a combined caseload of over 2000 combined robotic procedures (i.e RARP, RARCs and complete or partial nephrectomies).…”

Robot-assisted radical nephroureterectomy for upper urinary tract tumor: initial experience with the use of novel surgical robot system, hinotori

“…Since the first report in 2006 ( 15 ) and subsequent studies introducing technical refinements ( 16 - 20 ), RANU has been increasingly adopted in real-world clinical practice. As a result, several studies have reported the advantages of RANU over other surgical approaches ( 21 - 23 ). Veccia et al performed a systematic review and meta-analysis and reported that RANU could offer benefits as a minimally invasive approach without impairing oncological outcomes compared to open and laparoscopic nephroureterectomies ( 21 ).…”

“…Veccia et al performed a systematic review and meta-analysis and reported that RANU could offer benefits as a minimally invasive approach without impairing oncological outcomes compared to open and laparoscopic nephroureterectomies ( 21 ). However, accumulating findings with respect to RANU are still limited to studies performed with da Vinci ( 15 - 23 ). The present study summarizes the perioperative findings of the first series of eight patients undergoing RANU using hinotori.…”