Drobot Rafał B, Lipa Marcin, Zahorska Weronika A, Ludwiczak Daniel, Antoniewicz Artur A
Urology Department, Institute of Medical Sciences, Faculty of Medicine, Collegium Medicum, Cardinal Stefan Wyszyński University in Warsaw, Bursztynowa St. 2, 04-479 Warsaw, Poland.
Department of Urology and Urological Oncology, Multidisciplinary Hospital in Warsaw-Miedzylesie, Bursztynowa St. 2, 04-479 Warsaw, Poland.
J Pers Med. 2024 Oct 11;14(10):1053. doi: 10.3390/jpm14101053.
: This article juxtaposes case series with a systematic review to evaluate the feasibility, safety, and clinical outcomes of concurrent robotic multisite urological surgeries, specifically robot-assisted radical prostatectomy (RARP) and robot-assisted partial nephrectomy (RAPN), for synchronous prostate and kidney cancers. : The aims of this study were to evaluate the feasibility, safety, and clinical outcomes of urological concurrent robotic multisite surgeries through a comparison of institutional findings with the existing literature. : A retrospective analysis was conducted on eight institutional cases of concurrent robotic multisite surgeries performed between 2021 and 2024. The primary outcomes measured were operative time, blood loss, and postoperative complications. A systematic review of the literature was performed, searching PubMed, Embase, and Cochrane Library databases, with the last search conducted on 1 July 2024. Studies were included if they reported on concurrent robotic surgeries corresponding to the procedures performed at the institution, including RARP with RAPN, RARP with robotic transabdominal preperitoneal inguinal hernia repair (RTAPPIHR), and other multisite robotic surgeries. Risk of bias was assessed using the modified Newcastle-Ottawa Scale. Descriptive statistics were used to analyze operative time and blood loss, with confidence intervals (CIs) calculated to assess precision. Categorical variables, including postoperative complications, were summarized using frequencies and percentages. Heterogeneity was assessed using the I statistic, with values above 50% indicating substantial heterogeneity. A random effects model was applied when necessary, and sensitivity analyses excluded studies with high risk of bias. : We describe a unique docking technique employed in our procedures, which allows for atraumatic transitions between surgeries using the same port sites. Our institutional cases demonstrated the feasibility and safety of concurrent robotic multisite surgery, with a mean operative time of 315 min (95% CI: 290-340) and mean blood loss of 300 mL (95% CI: 250-350). There were no significant intraoperative complications reported. These findings are consistent with the literature, where mean operative times range from 390 to 430 min and blood loss ranges from 200 to 330 mL. Notably, no positive surgical margins or declines in postoperative renal function were observed in our cases. The systematic review included nine retrospective studies involving 40 cases of concurrent RARP and RAPN, as well as eleven studies including 392 cases of RARP combined with RTAPPIHR. The findings from these studies support the feasibility and safety of concurrent surgeries, showing similar rates of operative time, blood loss, and postoperative complications. Concurrent robotic multisite surgeries, such as RARP combined with RAPN or RTAPPIHR, appear to be safe and feasible. Our data suggest these procedures are non-inferior to separate surgeries in terms of safety and complication rates. Potential benefits, including reduced operative times, shorter hospital stays, and more efficient resource use, may translate into cost savings, although no formal cost-effectiveness analysis was conducted. Limitations include the small sample size, retrospective design, and lack of long-term follow-up. Prospective trials are needed to validate these findings and further refine the techniques. this review did not receive any external funding. this review was not registered in any public protocol registry due to its comparative retrospective nature.
本文将病例系列与系统评价相结合，以评估同步进行机器人多部位泌尿外科手术的可行性、安全性和临床结果，具体为机器人辅助根治性前列腺切除术（RARP）和机器人辅助部分肾切除术（RAPN）用于同步前列腺癌和肾癌的情况。本研究的目的是通过将机构研究结果与现有文献进行比较，评估泌尿外科同期机器人多部位手术的可行性、安全性和临床结果。对2021年至2024年期间进行的8例机构同期机器人多部位手术病例进行了回顾性分析。测量的主要结果是手术时间、失血量和术后并发症。对文献进行了系统评价，检索了PubMed、Embase和Cochrane图书馆数据库，最后一次检索于2024年7月1日进行。如果研究报告了与该机构进行的手术相对应的同期机器人手术，包括RARP与RAPN、RARP与机器人经腹腹膜前腹股沟疝修补术（RTAPPIHR）以及其他多部位机器人手术，则纳入研究。使用改良的纽卡斯尔-渥太华量表评估偏倚风险。使用描述性统计分析手术时间和失血量，并计算置信区间（CIs）以评估精确性。包括术后并发症在内的分类变量使用频率和百分比进行总结。使用I统计量评估异质性，I值高于50%表明存在实质性异质性。必要时应用随机效应模型，敏感性分析排除了偏倚风险高的研究。我们描述了我们手术中采用的一种独特的对接技术，该技术允许在使用相同端口部位的手术之间进行无创伤转换。我们机构的病例证明了同期机器人多部位手术的可行性和安全性，平均手术时间为315分钟（95%CI：290 - 340），平均失血量为300毫升（95%CI：250 - 350）。未报告重大术中并发症。这些发现与文献一致，文献中平均手术时间为390至430分钟，失血量为200至330毫升。值得注意的是，我们的病例中未观察到阳性手术切缘或术后肾功能下降。系统评价包括9项涉及40例同期RARP和RAPN的回顾性研究，以及11项包括392例RARP联合RTAPPIHR的研究。这些研究的结果支持同期手术的可行性和安全性，显示出相似的手术时间、失血量和术后并发症发生率。同期机器人多部位手术，如RARP联合RAPN或RTAPPIHR，似乎是安全可行的。我们的数据表明，这些手术在安全性和并发症发生率方面不劣于单独手术。潜在的益处，包括缩短手术时间、缩短住院时间和更有效地利用资源，可能转化为成本节约，尽管未进行正式的成本效益分析。局限性包括样本量小、回顾性设计和缺乏长期随访。需要进行前瞻性试验来验证这些发现并进一步完善技术。本综述未获得任何外部资金。由于其比较性回顾性质，本综述未在任何公共方案注册库中注册。
