Urology Unit, Azienda Ospedaliero-Universitaria "Ospedali Riuniti di Ancona", Università Politecnica delle Marche, Ancona, Italy.
Department of Urology, Ng Teng Fong General Hospital, NUHS, Jurong East, Singapore.
Investig Clin Urol. 2021 Nov;62(6):631-640. doi: 10.4111/icu.20210297.
To review safety and efficacy of robotic-assisted simple prostatectomy (RASP) compared to open simple prostatectomy (OP).
A comprehensive literature search was performed to assess the differences in perioperative course and functional outcomes in patients with benign prostatic hyperplasia and surgical indication. The incidences of complications were pooled using the Cochran-Mantel-Haenszel Method and expressed as odds ratio (OR), 95% confidence interval (CI), and p-values. Perioperative course and functional outcomes were pooled using the inverse variance of the mean difference (MD), 95% CI, and p-values. Analyses were two-tailed and the significance was set at p<0.05.
Eight studies were accepted. Meta-analysis showed significantly longer surgical time (MD, 43.72; 95% CI, 30.57-56.88; p<0.00001) with a significantly lower estimated blood loss (MD, -563.20; 95% CI, -739.95 to -386.46; p<0.00001) and shorter postoperative stay (MD, -2.85; 95% CI, -3.72 to -1.99; p<0.00001) in RASP. Catheterization time did not differ (MD, 0.65; 95% CI, -2.17 to 3.48; p=0.65). The risk of blood transfusion was significantly higher in OP (OR, 0.23; 95% CI, 0.17-0.33; p<0.00001). The risk of recatheterization (OR, 1.96; 95% CI, 0.32-11.93; p=0.47), postoperative urinary infections (OR, 0.89; 95% CI, 0.23-3.51; p=0.87) and 30-day readmission rate (OR, 0.96; 95% CI, 0.61-1.51; p=0.86) did not differ. At 3-month follow-up, functional outcomes were similar.
RASP demonstrated a better perioperative outcome and equal early functional outcomes as compared to OP. These findings should be balanced against the longer operative time and higher cost of robotic surgery.
回顾机器人辅助单纯前列腺切除术（RASP）与开放性单纯前列腺切除术（OP）相比的安全性和疗效。
进行了全面的文献检索，以评估患有良性前列腺增生且具有手术指征的患者在围手术期过程和功能结果方面的差异。使用 Cochran-Mantel-Haenszel 方法汇总并发症发生率，并表示为比值比（OR）、95%置信区间（CI）和 p 值。使用均值差（MD）的逆方差、95%CI 和 p 值汇总围手术期过程和功能结果。分析为双侧，显著性水平设定为 p<0.05。
接受了八项研究。荟萃分析显示，RASP 的手术时间明显更长（MD，43.72；95%CI，30.57-56.88；p<0.00001），估计失血量明显减少（MD，-563.20；95%CI，-739.95 至-386.46；p<0.00001），术后住院时间明显缩短（MD，-2.85；95%CI，-3.72 至-1.99；p<0.00001）。导尿管留置时间无差异（MD，0.65；95%CI，-2.17 至 3.48；p=0.65）。OP 中输血的风险明显更高（OR，0.23；95%CI，0.17-0.33；p<0.00001）。再导尿的风险（OR，1.96；95%CI，0.32-11.93；p=0.47）、术后尿路感染的风险（OR，0.89；95%CI，0.23-3.51；p=0.87）和 30 天再入院率（OR，0.96；95%CI，0.61-1.51；p=0.86）无差异。在 3 个月随访时，功能结果相似。
与 OP 相比，RASP 显示出更好的围手术期结果和同等的早期功能结果。这些发现应该与机器人手术更高的手术时间和成本相平衡。
