Franco Antonio, Ditonno Francesco, Manfredi Celeste, Pellegrino Antony A, Licari Leslie Claire, Bologna Eugenio, Feng Carol, Antonelli Alessandro, De Sio Marco, De Nunzio Cosimo, Porpiglia Francesco, Cherullo Edward E, Kaouk Jihad, Crivellaro Simone, Autorino Riccardo
Department of Urology, Rush University, Chicago, IL, USA.
Department of Urology, Sant'Andrea Hospital, Sapienza University, Rome, Italy.
Prostate Cancer Prostatic Dis. 2025 Mar;28(1):117-128. doi: 10.1038/s41391-024-00787-2. Epub 2024 Jan 23.
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.
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.
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.
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.
我们研究的目的是回顾目前关于单孔机器人辅助根治性前列腺切除术（SP-RARP）和单孔机器人辅助单纯前列腺切除术（SP-RASP）的证据。
2023年7月在多个数据库进行了全面的文献检索。纳入的研究需评估分别接受SP-RARP或SP-RASP的非转移性前列腺癌患者或良性前列腺增生手术候选者（P），（I），与其他手术技术进行或未进行比较（C），评估围手术期、肿瘤学或功能结局（O）。纳入前瞻性和回顾性原始文章（S）。对SP-RARP和MP-RARP之间的比较研究进行了荟萃分析。
我们的系统评价共纳入了21项研究，涉及1400例患者，其中18项与SP-RARP相关，3项与SP-RASP相关。只有8项比较研究符合荟萃分析的条件。平均随访时间为8.1（±5.8）个月。在手术时间、导尿时间、疼痛评分、并发症发生率、控尿和性功能恢复率、手术切缘阳性率以及生化复发方面，SP-RARP和MP-RARP的结果相似。敏感性分析后，SP组的住院时间较短（加权均数差-0.58，95%置信区间-1.17至-0.9，p<0.05）。经腹膜外途径的亚组分析未显示任何统计学差异，除了与MP-RARP相比，SP腹膜外技术的手术切缘阳性率较低。总体而言，与其他技术相比，SP-RASP的住院时间较短，新发尿失禁发生率较低，而在术后国际前列腺症状评分、残余尿量和最大尿流率方面未报告差异。
使用SP平台可实现总体相当的肿瘤学、功能和围手术期结局。不同途径的亚组分析未显示结局有显著差异。然而，研究的回顾性性质、有限的随访以及所选中心相对较小的样本量可能会影响这些结果。
