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Single port robot-assisted radical and simple prostatectomy: a systematic review and meta-analysis

Prostate Cancer and Prostatic Diseases (2024)Cite this article

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Abstract

Background

Aim of our study was to review the current evidence on single port robot-assisted radical prostatectomy (SP-RARP) and SP robot-assisted simple prostatectomy (SP-RASP) procedures.

Methods

A comprehensive bibliographic search on multiple databases was conducted in July 2023. Studies were included if they assessed patients with non-metastatic prostate cancer or candidate for benign prostatic hyperplasia surgery (P) who underwent SP-RARP or SP-RASP, respectively, (I), compared or not with other surgical techniques (C), evaluating perioperative, oncological, or functional outcomes (O). Prospective and retrospective original articles were included (S). A meta-analysis of comparative studies between SP-RARP and MP-RARP was performed.

Results

A total of 21 studies investigating 1400 patients were included in our systematic review, 18 were related to SP-RARP while 3 to SP-RASP. Only 8 comparative studies were eligible for meta-analysis. Mean follow-up was 8.1 (±5.8) months. Similar outcomes were observed for SP-RARP and MP-RARP in terms of operative time, catheterization time, pain score, complications rate, continence and potency rates, positive surgical margin, and biochemical recurrence. Length of hospital stay was shorter in the SP group after sensitivity analysis (WMD −0.58, 95% IC −1.17 to −0.9, p < 0.05). Subgroup analysis by extraperitoneal approach did not show any statistical difference, except for a lower positive margins rate in the SP extraperitoneal technique compared to MP-RARP. Overall, SP-RASP exhibited shorter hospital stay and lower rate of de novo urinary incontinence when compared to other techniques, while no differences were reported in terms of postoperative International Prostate Symptom Score, post void residual and maximum flow.

Conclusions

Overall comparable oncological, functional, and perioperative outcomes can be achieved with SP platform. Subgroup analysis by different approaches did not reveal significant variations in outcomes. However, the retrospective nature of the studies, the limited follow-up, and the relatively small sample size of selected Centers may impact these results.

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Fig. 1: PRISMA diagram.
Fig. 2: SP-RARP techniques.
Fig. 3: Perioperative Outcomes.
Fig. 4: Functional and Oncological Outcomes.
Fig. 5: Risk of bias assessment.

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Data availability

Sheets containing raw data (extracted variables, statistical analyses) are available upon request to the corresponding author.

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Authors and Affiliations

  1. Department of Urology, Rush University, Chicago, IL, USA

    Antonio Franco, Francesco Ditonno, Celeste Manfredi, Leslie Claire Licari, Eugenio Bologna, Carol Feng, Edward E. Cherullo & Riccardo Autorino

  2. Department of Urology, Sant’Andrea Hospital, Sapienza University, Rome, Italy

    Antonio Franco & Cosimo De Nunzio

  3. Department of Urology, University of Verona, Verona, Italy

    Francesco Ditonno & Alessandro Antonelli

  4. Urology Unit, “Luigi Vanvitelli” University, Naples, Italy

    Celeste Manfredi & Marco De Sio

  5. Department of Urology, University of Illinois at Chicago, Chicago, IL, USA

    Antony A. Pellegrino & Simone Crivellaro

  6. Department of Maternal-Child and Urological Sciences, Sapienza University Rome, Policlinico Umberto I Hospital, Rome, Italy

    Leslie Claire Licari & Eugenio Bologna

  7. Department of Oncology, Division of Urology, University of Turin, San Luigi Gonzaga Hospital, Orbassano, Italy

    Francesco Porpiglia

  8. Department of Urology, Glickman Institute, Cleveland Clinic, Cleveland, OH, USA

    Jihad Kaouk

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Contributions

Conceptualization and supervision: RA, SC; Study screening, article selection, data extraction, and risk of bias assessment: AF, AP; Data analysis and interpretation: FD, CM; Manuscript drafting: FD, CM, AF; Statistical review: AC; Scientific and grammatical review: AA, CDN, MDS. All authors approved the final version of the manuscript.

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Correspondence to Riccardo Autorino.

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Jhiad Kaouk: Speaker, Intuitive; Consultant to Method AI and VTI; Research sponsorship PI, Medtronics

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Franco, A., Ditonno, F., Manfredi, C. et al. Single port robot-assisted radical and simple prostatectomy: a systematic review and meta-analysis. Prostate Cancer Prostatic Dis (2024). https://doi.org/10.1038/s41391-024-00787-2

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