Robotic-assisted versus open simple prostatectomy: Results from a systematic review and meta-analysis of comparative studies

Scarcella, Simone; Castellani, Daniele; Gauhar, Vineet; Teoh, Jeremy Yuen‐Chun; Giulioni, Carlo; Piazza, Pietro; Bravi, Carlo Andrea; Groote, Ruben De; Naeyer, Geert De; Puliatti, Stefano; Galosi, Andrea Benedetto; Mottrie, Alexandre

doi:10.4111/icu.20210297

Cited by 18 publications

(4 citation statements)

References 27 publications

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“…60 In comparison to OSP, the length of stay (LOS) and EBL are significantly lower for RASP. 61 Finally, catheterization time and LOS are longer with RASP compared to laser enucleation of the prostate. 60 We recommend LSP or RASP as an alternative surgical therapy for men with moderate to severe MLUTS/BPS and enlarged prostate volume >80 cc in centers where there are surgeons with high level expertise in robotics or laparoscopy (conditional recommendation, evidence level B).…”

Section: Minimally Invasive Simple Prostatectomymentioning

confidence: 99%

UPDATE – 2022 Canadian Urological Association guideline on male lower urinary tract symptoms/benign prostatic hyperplasia (MLUTS/BPH)

Aubé-Peterkin

Evans

Elmansy

et al. 2022

CUAJ

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These guidelines are directed toward the typical male patient over 50 years of age, presenting with LUTS and benign prostatic enlargement (BPE) and/or benign prostatic obstruction (BPO). It is recognized that men with LUTS associated with causes other than BPO may require more extensive diagnostic workup and different treatment considerations. We acknowledge that not all patients identify as male. These guidelines should also be applicable to non-binary people, transwomen, and any patients who may have anatomical features of a cis-male genitourinary tract such as a prostate. It is our intent to make these guidelines inclusive to all persons experiencing lower urinary tract symptoms or an enlarged prostate.In this document, we will address both diagnostic and treatment issues. Diagnostic guidelines are described in the following terms as: mandatory, recommended, optional, or not recommended. The recommendations for diagnostic guidelines and principles of treatment were developed on the basis of clinical principle (widely agreed upon by Canadian urologists) and/or expert opinion (consensus of committee and reviewers). The grade of recommendation will not be offered for diagnostic recommendations. Guidelines for treatment are described using the GRADE approach 4 for summarizing the evidence and making recommendations Diagnostic guidelinesThe committee recommended minor revisions in regard to diagnostic considerations as outlined in the 2018 CUA BPH guideline. 1 MandatoryIn the initial evaluation of a man presenting with LUTS, the evaluation of symptom severity and bother is essential. Medical history should include relevant prior and current illnesses, as well as prior surgery and trauma. Current medication, including over-the-counter drugs and phytotherapeutic agents, must be reviewed. A focused physical examination, including a digital rectal exam (DRE), is also mandatory. Urinalysis is required to rule out diagnoses other than BPH that may cause LUTS and may require additional diagnostic tests. [1][2][3]5,6,7 -History -Physical examination including DRE -Urinalysis Recommended Symptom inventory (should include bother assessment)A formal symptom inventory (e.g., International Prostate Symptom Score [IPSS] or AUA Symptom Index [AUA-SI]) is recommended for an objective assessment of symptoms at CUAJ -CUA Guideline Elterman et al CUA guideline: BPH/LUTS 3

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Section: Minimally Invasive Simple Prostatectomymentioning

confidence: 99%

UPDATE – 2022 Canadian Urological Association guideline on male lower urinary tract symptoms/benign prostatic hyperplasia (MLUTS/BPH)

Aubé-Peterkin

Evans

Elmansy

et al. 2022

CUAJ

View full text Add to dashboard Cite

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“…The theoretical advantages of robotic surgery are the enhanced three-dimensional and magnified views of closed spaces that can be obtained as well as increased dexterity with fine precision surgical instruments, which make it ideal for operating in confined anatomical spaces such as the pelvis. Considering the great complexity of pelvic anatomy, robotic surgery has been reported to be feasible and related to beneficial outcomes in urological malignancy including prostatectomy [39] and nodal dissections [40], rectal [41], and exenterative pelvic surgery [42]. Recently, robotic esophagectomy is reported as an extension of this technology to the thoracic cavity [43][44][45].…”

Section: Intraoperative Electron Radiation Therapy and Robotic-assist...mentioning

confidence: 99%

Clinical feasibility of combining intraoperative electron radiation therapy with minimally invasive surgery: a potential for electron-FLASH clinical development

et al. 2022

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Background Local cancer therapy by combining real-time surgical exploration and resection with delivery of a single dose of high-energy electron irradiation entails a very precise and effective local therapeutic approach. Integrating the benefits from minimally invasive surgical techniques with the very precise delivery of intraoperative electron irradiation results in an efficient combined modality therapy. Methods Patients with locally advanced disease, who are candidates for laparoscopic and/or thoracoscopic surgery, received an integrated multimodal management. Preoperative treatment included induction chemotherapy and/or chemoradiation, followed by laparoscopic surgery and intraoperative electron radiation therapy. Results In a period of 5 consecutive years, 125 rectal cancer patients were treated, of which 35% underwent a laparoscopic approach. We found no differences in cancer outcomes and tolerance between the open and laparoscopic groups. Two esophageal cancer patients were treated with IOeRT during thoracoscopic resection, with the resection specimens showing intense downstaging effects. Two oligo-recurrent prostatic cancer patients (isolated nodal progression) had a robotic-assisted surgical resection and post-lymphadenectomy electron boost on the vascular and lateral pelvic wall. Conclusions Minimally invasive and robotic-assisted surgery is feasible to combine with intraoperative electron radiation therapy and offers a new model explored with electron-FLASH beams.

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“…Minimally invasive techniques have been widely adopted in gastro-intestinal surgery, and have markedly improved patient outcomes in a wide array of procedures [ 1 – 3 ]. Robotic surgery, representing the latest advancement in surgical technology, is increasingly being adopted and has been associated with improved recovery rates for patients and better ergonomics for surgeons in colorectal and urological procedures [ 4 , 5 ].…”

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confidence: 99%

Proctored adoption of robotic hiatus hernia surgery: outcomes and learning curves in a high-volume UK centre

et al. 2023

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Background The adoption of new surgical technologies is inevitably accompanied by a learning curve. With the increasing adoption of robotic techniques in benign foregut surgery, it is imperative to define optimal learning pathways, to ensure a clinically safe introduction of such a technique. The aim of this study was to assess the learning curve for robotic hiatal hernia repair with a pre-defined adoption process and proctoring. Methods The learning curve was assessed in four surgeons in a high-volume tertiary referral centre, performing over a 100 hiatal hernia repairs annually. The robotic adoption process included simulation-based training and a multi-day wet lab-based course, followed by robotic operations proctored by robotic upper GI experts. CUSUM analysis was performed to assess changes in operating time in sequential cases. Results Each surgeon (A, B, C and D) performed between 22 and 32 cases, including a total of 109 patients. Overall, 40 cases were identified as ‘complex’ (36.7%), including 16 revisional cases (16/109, 14.7%). With CUSUM analysis inflection points for operating time were seen after 7 (surgeon B) to 15 cases (surgeon B). Conclusion The learning curve for robotic laparoscopic fundoplication may be as little as 7–15 cases in the setting of a clearly organized learning pathway with proctoring. By integrating these organized learning pathways learning curves may be shortened, ensuring patient safety, preventing detrimental outcomes due to longer learning curves, and accelerating adoption and integration of novel surgical techniques.

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Robotic-assisted versus open simple prostatectomy: Results from a systematic review and meta-analysis of comparative studies

Cited by 18 publications

References 27 publications

UPDATE – 2022 Canadian Urological Association guideline on male lower urinary tract symptoms/benign prostatic hyperplasia (MLUTS/BPH)

UPDATE – 2022 Canadian Urological Association guideline on male lower urinary tract symptoms/benign prostatic hyperplasia (MLUTS/BPH)

Clinical feasibility of combining intraoperative electron radiation therapy with minimally invasive surgery: a potential for electron-FLASH clinical development

Proctored adoption of robotic hiatus hernia surgery: outcomes and learning curves in a high-volume UK centre

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