使用Hugo RAS和达芬奇手术机器人系统的机器人辅助根治性前列腺切除术：比较研究的系统评价和荟萃分析

Robot-assisted Radical Prostatectomy with the Hugo RAS and da Vinci Surgical Robotic Systems: A Systematic Review and Meta-analysis of Comparative Studies.

作者信息

Marino Filippo, Moretto Stefano, Rossi Francesco, Pio Bizzarri Francesco, Gandi Carlo, Filomena Giovanni Battista, Gavi Filippo, Russo Pierluigi, Campetella Marco, Totaro Angelo, Pierconti Francesco, Lentini Nicolò, Pastorino Roberta, Sacco Emilio

机构信息

Department of Urology, Fondazione Policlinico Universitario Agostino Gemelli IRCCS, Rome, Italy; Department of Medicine and Translational Surgery, Università Cattolica Del Sacro Cuore, Rome, Italy; Department of Urology, Addenbrooke's Hospital, Cambridge University Hospitals NHS Foundation Trust, Cambridge, UK.

Department of Urology, Humanitas Clinical and Research Center, Rozzano, Italy; Department of Biomedical Sciences, Humanitas University, Milan, Italy.

出版信息

Eur Urol Focus. 2024 Oct 24. doi: 10.1016/j.euf.2024.10.005.

DOI:10.1016/j.euf.2024.10.005

PMID:39455408

Abstract

BACKGROUND AND OBJECTIVE

The introduction of the Hugo RAS system represents a recent innovation in robotic surgery. The potential benefits and limitations of this system and its integration into clinical practice in urology have yet to be fully delineated. Our objective was to assess surgical, early oncological, and functional outcomes in studies comparing robot-assisted radical prostatectomy (RARP) performed with the new Hugo RAS system and the well-established da Vinci surgical system.

METHODS

We conducted a systematic review and meta-analysis using PubMed, Web of Science, Scopus, and Embase databases. Eligible studies compared RARP outcomes in adult males between the Hugo RAS and da Vinci systems. The main endpoints were analyzed using a random-effects model, including perioperative outcomes (surgical times, estimated blood loss, length of hospital stay, Clavien-Dindo grade ≥2 complications), oncological outcomes (positive surgical margins and postoperative prostate-specific antigen), and functional outcomes (continence status and erectile function).

KEY FINDINGS AND LIMITATIONS

Nine studies involving 1185 patients (478 Hugo RAS and 707 da Vinci) were included. Significant differences in pooled baseline characteristics included higher body mass index for the da Vinci cohort (p = 0.035) and a higher rate of palpable disease in the Hugo RAS cohort (p = 0.036). Docking time was significantly longer for the Hugo RAS, with a median difference of 6.1 min (95% confidence interval 3.9-8.2; I = 68.6%; p < 0.001; three studies). Overall, there were no significant differences in perioperative, oncological, and functional outcomes between the two systems.

CONCLUSIONS AND CLINICAL IMPLICATIONS

Despite the preliminary nature of the evidence, this systematic review and meta-analysis show comparable surgical and clinical outcomes for RARP performed with the Hugo RAS system and the da Vinci robotic platform.

PATIENT SUMMARY

We reviewed studies comparing the use of two different surgical robots for removal of the prostate. The results suggest that surgical and clinical outcomes with the new Hugo RAS robot are comparable to those with the established da Vinci robot for this procedure.

摘要

背景与目的

胡戈机器人辅助手术系统（Hugo RAS）的引入是机器人手术领域的一项最新创新。该系统的潜在益处和局限性及其在泌尿外科临床实践中的整合情况尚未得到充分阐明。我们的目的是在比较使用新型胡戈机器人辅助手术系统和成熟的达芬奇手术系统进行机器人辅助根治性前列腺切除术（RARP）的研究中，评估手术、早期肿瘤学及功能学结局。

方法

我们使用PubMed、科学网、Scopus和Embase数据库进行了系统评价和荟萃分析。符合条件的研究比较了胡戈系统和达芬奇系统在成年男性中RARP的结局。主要终点采用随机效应模型进行分析，包括围手术期结局（手术时间、估计失血量、住院时间、Clavien-Dindo≥2级并发症）、肿瘤学结局（手术切缘阳性和术后前列腺特异性抗原）以及功能学结局（控尿状态和勃起功能）。

主要发现与局限性

纳入了9项研究，共1185例患者（478例使用胡戈系统，707例使用达芬奇系统）。汇总的基线特征存在显著差异，包括达芬奇队列的体重指数较高（p = 0.035）以及胡戈系统队列中可触及病变的发生率较高（p = 0.036）。胡戈系统的对接时间明显更长，中位数差异为6.1分钟（95%置信区间3.9 - 8.2；I² = 68.6%；p < 0.001；3项研究）。总体而言，两个系统在围手术期、肿瘤学和功能学结局方面没有显著差异。