Single port robot-assisted radical and simple prostatectomy: a systematic review and meta-analysis

Antonio Franco; Francesco Ditonno; Celeste Manfredi; Antony A Pellegrino; Leslie Claire Licari; Eugenio Bologna; Carol Feng; Alessandro Antonelli; Marco De Sio; Cosimo De Nunzio; Francesco Porpiglia; Edward E Cherullo; Jihad Kaouk; Simone Crivellaro; Riccardo Autorino

doi:10.1038/s41391-024-00787-2

Single port robot-assisted radical and simple prostatectomy: a systematic review and meta-analysis

Prostate Cancer Prostatic Dis. 2024 Jan 23. doi: 10.1038/s41391-024-00787-2. Online ahead of print.

Authors

Antonio Franco^{1

2}, Francesco Ditonno^{1

3}, Celeste Manfredi^{1

4}, Antony A Pellegrino⁵, Leslie Claire Licari^{1

6}, Eugenio Bologna^{1

6}, Carol Feng¹, Alessandro Antonelli³, Marco De Sio⁴, Cosimo De Nunzio², Francesco Porpiglia⁷, Edward E Cherullo¹, Jihad Kaouk⁸, Simone Crivellaro⁵, Riccardo Autorino⁹

Affiliations

¹ Department of Urology, Rush University, Chicago, IL, USA.
² Department of Urology, Sant'Andrea Hospital, Sapienza University, Rome, Italy.
³ Department of Urology, University of Verona, Verona, Italy.
⁴ Urology Unit, "Luigi Vanvitelli" University, Naples, Italy.
⁵ Department of Urology, University of Illinois at Chicago, Chicago, IL, USA.
⁶ Department of Maternal-Child and Urological Sciences, Sapienza University Rome, Policlinico Umberto I Hospital, Rome, Italy.
⁷ Department of Oncology, Division of Urology, University of Turin, San Luigi Gonzaga Hospital, Orbassano, Italy.
⁸ Department of Urology, Glickman Institute, Cleveland Clinic, Cleveland, OH, USA.
⁹ Department of Urology, Rush University, Chicago, IL, USA. [email protected].

PMID: 38263281
DOI: 10.1038/s41391-024-00787-2

Abstract

Background: 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.

Methods: 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.

Results: 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.

Conclusions: 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.