Unit of Uro-oncology and Kidney Transplant, Department of Urology, Puigvert Foundation, Universitat Autònoma de Barcelona (UAB), Barcelona, Spain -
Unit of Uro-oncology and Kidney Transplant, Department of Urology, Puigvert Foundation, Universitat Autònoma de Barcelona (UAB), Barcelona, Spain.
Minerva Urol Nephrol. 2023 Apr;75(2):144-153. doi: 10.23736/S2724-6051.22.05160-6. Epub 2023 Feb 1.
The aim of this study was to compare the perioperative outcomes of routine drainage insertion vs. no drainage in patients undergoing robot-assisted radical prostatectomy (RARP), robot-assisted partial nephrectomy (RAPN), and robot-assisted radical cystectomy (RARC).
A literature search was conducted through April 2022 using PubMed/Medline, Embase, and Web of Science databases. Preferred Reporting Items for Systematic Reviews and Meta-analysis (PRISMA) guidelines were followed to identify eligible studies.
Eleven studies comprising 8447 RARPs and 1890 RAPNs met our inclusion criteria. Our search strategy did not identify any studies within the RARC framework. In RARP, patients without postoperative drainage had lower rate of postoperative ileus (OR 0.53, 95% CI: 0.38 to 0.74; P<0.001) and similar low-grade (Clavien 1-2, P=0.41) and high-grade (Clavien ≥3; P=0.85) complications, urinary leakage (P=0.07), pelvic hematoma (P=0.35), symptomatic lymphocele (P=0.13), fever (P=0.25), incisional hernia (P=0.31), reintervention (P=0.57), length of hospital stay (P=0.22), and readmission (P=0.74) compared with routinely drained patients. In RAPN, patients without postoperative drainage had shorter length of hospital stay (mean difference: -0.84 days, 95% CI: -1.06 to -0.63; P<0.001) and similar low-grade (P=0.94) and high-grade (P=0.31) complications, urinary leakage (P=0.49), hemorrhage (P=0.39), reintervention (P=0.69), and readmission (P=0.20) compared with routinely drained patients.
In our study, patients without drainage had similar perioperative course to patients with prophylactic drain insertion after RARP and RAPN. Omission of drain insertion was associated with a lower rate of postoperative ileus for RARP and a shorter hospital stay for RAPN. In the era of robotic surgery, routine drain placement is no longer indicated in unselected patients.
本研究旨在比较机器人辅助根治性前列腺切除术（RARP）、机器人辅助部分肾切除术（RAPN）和机器人辅助根治性膀胱切除术（RARC）中常规引流插入与无引流患者的围手术期结局。
通过 PubMed/Medline、Embase 和 Web of Science 数据库进行了截至 2022 年 4 月的文献检索。遵循系统评价和荟萃分析的首选报告项目（PRISMA）指南来确定合格的研究。
我们的检索策略未在 RARC 框架内发现任何研究。在 RARP 中，未接受术后引流的患者术后肠梗阻发生率较低（OR 0.53，95%CI：0.38 至 0.74；P<0.001），且低级（Clavien 1-2，P=0.41）和高级（Clavien≥3；P=0.85）并发症、尿漏（P=0.07）、盆腔血肿（P=0.35）、症状性淋巴囊肿（P=0.13）、发热（P=0.25）、切口疝（P=0.31）、再次干预（P=0.57）、住院时间（P=0.22）和再入院（P=0.74）与常规引流患者相似。在 RAPN 中，未接受术后引流的患者住院时间更短（平均差异：-0.84 天，95%CI：-1.06 至-0.63；P<0.001），且低级（P=0.94）和高级（P=0.31）并发症、尿漏（P=0.49）、出血（P=0.39）、再次干预（P=0.69）和再入院（P=0.20）与常规引流患者相似。
在我们的研究中，RARP 和 RAPN 后不放置引流管的患者围手术期过程与预防性放置引流管的患者相似。RARP 术后肠梗阻发生率降低，RAPN 住院时间缩短与不放置引流管有关。在机器人手术时代，常规引流放置不再适用于未选择的患者。
