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JSLS : Journal of the Society of... 2022Laparoscopic instruments and techniques are constantly improving, as the ability to perform minimally invasive surgery is crucial in modern medicine. The progression... (Review)
Review
INTRODUCTION
Laparoscopic instruments and techniques are constantly improving, as the ability to perform minimally invasive surgery is crucial in modern medicine. The progression from open surgery to minimally invasive surgery over the years eventually led to the use of robotic devices to either assist or completely replace patient-side surgery with a separate console. Though robotic surgery has been praised for its surgical outcomes, certain situations limit its use, such as cost-effectiveness or physical space constraints. The objectives of this review were to perform a search and discuss the trends in the literature.
METHODS
A literature search using keywords ((laparoscopic) OR (laparoscopy) OR (minimally invasive)) AND ((instrument) OR (instrumentation) OR (tool) OR (device) OR (apparatus)) AND ((advancement) OR (upgrade)) AND ((hysterectomy) OR (prostatectomy) OR (transoral) OR (cholecystectomy)) AND (robot) in PubMed, looking for trends in advancements or appeals for change.
RESULTS
This search provides a framework for these trends to facilitate discussion of ways in which laparoscopic surgery can be improved using the benefits of robotic surgical systems. This allows others to approach the successes of the current robotic systems for laparoscopic surgery with the intention of deriving advancements toward traditional laparoscopic surgery.
Topics: Female; Humans; Hysterectomy; Laparoscopy; Male; Minimally Invasive Surgical Procedures; Prostatectomy; Robotic Surgical Procedures
PubMed: 35655469
DOI: 10.4293/JSLS.2022.00002 -
The Cochrane Database of Systematic... Sep 2017Prostate cancer is commonly diagnosed in men worldwide. Surgery, in the form of radical prostatectomy, is one of the main forms of treatment for men with localised... (Meta-Analysis)
Meta-Analysis Review
BACKGROUND
Prostate cancer is commonly diagnosed in men worldwide. Surgery, in the form of radical prostatectomy, is one of the main forms of treatment for men with localised prostate cancer. Prostatectomy has traditionally been performed as open surgery, typically via a retropubic approach. The advent of laparoscopic approaches, including robotic-assisted, provides a minimally invasive alternative to open radical prostatectomy (ORP).
OBJECTIVES
To assess the effects of laparoscopic radical prostatectomy or robotic-assisted radical prostatectomy compared to open radical prostatectomy in men with localised prostate cancer.
SEARCH METHODS
We performed a comprehensive search using multiple databases (CENTRAL, MEDLINE, EMBASE) and abstract proceedings with no restrictions on the language of publication or publication status, up until 9 June 2017. We also searched bibliographies of included studies and conference proceedings.
SELECTION CRITERIA
We included all randomised controlled trials (RCTs) with a direct comparison of laparoscopic radical prostatectomy (LRP) and robotic-assisted radical prostatectomy (RARP) to ORP, including pseudo-RCTs.
DATA COLLECTION AND ANALYSIS
Two review authors independently classified studies and abstracted data. The primary outcomes were prostate cancer-specific survival, urinary quality of life and sexual quality of life. Secondary outcomes were biochemical recurrence-free survival, overall survival, overall surgical complications, serious postoperative surgical complications, postoperative pain, hospital stay and blood transfusions. We performed statistical analyses using a random-effects model and assessed the quality of the evidence according to GRADE.
MAIN RESULTS
We included two unique studies with 446 randomised participants with clinically localised prostate cancer. The mean age, prostate volume, and prostate-specific antigen (PSA) of the participants were 61.3 years, 49.78 mL, and 7.09 ng/mL, respectively. Primary outcomes We found no study that addressed the outcome of prostate cancer-specific survival. Based on data from one trial, RARP likely results in little to no difference in urinary quality of life (MD -1.30, 95% CI -4.65 to 2.05) and sexual quality of life (MD 3.90, 95% CI -1.84 to 9.64). We rated the quality of evidence as moderate for both quality of life outcomes, downgrading for study limitations. Secondary outcomes We found no study that addressed the outcomes of biochemical recurrence-free survival or overall survival.Based on one trial, RARP may result in little to no difference in overall surgical complications (RR 0.41, 95% CI 0.16 to 1.04) or serious postoperative complications (RR 0.16, 95% CI 0.02 to 1.32). We rated the quality of evidence as low for both surgical complications, downgrading for study limitations and imprecision.Based on two studies, LRP or RARP may result in a small, possibly unimportant improvement in postoperative pain at one day (MD -1.05, 95% CI -1.42 to -0.68 ) and up to one week (MD -0.78, 95% CI -1.40 to -0.17). We rated the quality of evidence for both time-points as low, downgrading for study limitations and imprecision. Based on one study, RARP likely results in little to no difference in postoperative pain at 12 weeks (MD 0.01, 95% CI -0.32 to 0.34). We rated the quality of evidence as moderate, downgrading for study limitations.Based on one study, RARP likely reduces the length of hospital stay (MD -1.72, 95% CI -2.19 to -1.25). We rated the quality of evidence as moderate, downgrading for study limitations.Based on two study, LRP or RARP may reduce the frequency of blood transfusions (RR 0.24, 95% CI 0.12 to 0.46). Assuming a baseline risk for a blood transfusion to be 8.9%, LRP or RARP would result in 68 fewer blood transfusions per 1000 men (95% CI 78 fewer to 48 fewer). We rated the quality of evidence as low, downgrading for study limitations and indirectness.We were unable to perform any of the prespecified secondary analyses based on the available evidence. All available outcome data were short-term and we were unable to account for surgeon volume or experience.
AUTHORS' CONCLUSIONS
There is no high-quality evidence to inform the comparative effectiveness of LRP or RARP compared to ORP for oncological outcomes. Urinary and sexual quality of life-related outcomes appear similar.Overall and serious postoperative complication rates appear similar. The difference in postoperative pain may be minimal. Men undergoing LRP or RARP may have a shorter hospital stay and receive fewer blood transfusions. All available outcome data were short-term, and this study was unable to account for surgeon volume or experience.
Topics: Humans; Laparoscopy; Male; Middle Aged; Organ Size; Prostate; Prostate-Specific Antigen; Prostatectomy; Prostatic Neoplasms; Quality of Life; Randomized Controlled Trials as Topic; Robotic Surgical Procedures; Sexual Behavior; Urination
PubMed: 28895658
DOI: 10.1002/14651858.CD009625.pub2 -
The Canadian Journal of Urology Oct 2015Benign prostatic hyperplasia (BPH) is arguably the most common benign disease of mankind. As men age, the prostate inexorably grows often causing troubling symptoms... (Review)
Review
INTRODUCTION
Benign prostatic hyperplasia (BPH) is arguably the most common benign disease of mankind. As men age, the prostate inexorably grows often causing troubling symptoms causing them to seek out care. While traditionally treated by transurethral resection or open surgical removal of the hypertrophied adenoma, today the urologist has numerous medical, surgical and minimally invasive techniques available. In this supplement The Canadian Journal of Urology provides a review of the various techniques and medications available today.
MATERIALS AND METHODS
As an introduction to the supplement, the aim of this article is to review the epidemiology and economy of BPH as well as its natural history and diagnosis. A systematic review of available literature was looking for articles on BPH and its epidemiology, economics, natural history and management using PubMed database.
RESULTS
The prevalence of this condition is increasing with the population aging and so does the economic burden. The exact etiology of this condition is unknown, but some risk factors have been identified. The diagnostic and treatment of this very common disease should rely on a strong collaboration between primary care physician and urologist.
CONCLUSION
There are multiple options in treating BPH including medical, surgical and newer minimally invasive options. The challenge with having a variety of options is to review them with the patient and help the patient select the best treatment option for their condition.
Topics: Age Factors; Aged; Biopsy, Needle; Health Care Costs; Humans; Immunohistochemistry; Incidence; Lower Urinary Tract Symptoms; Male; Prostatectomy; Prostatic Hyperplasia; Risk Assessment; Severity of Illness Index; Treatment Outcome; United States
PubMed: 26497338
DOI: No ID Found -
European Urology Nov 2021Radical prostatectomy reduces mortality among patients with localised prostate cancer. Evidence on whether different surgical techniques can affect mortality rates is...
BACKGROUND
Radical prostatectomy reduces mortality among patients with localised prostate cancer. Evidence on whether different surgical techniques can affect mortality rates is lacking.
OBJECTIVE
To evaluate functional and oncological outcomes 8 yr after robot-assisted laparoscopic prostatectomy (RALP) and open retropubic radical prostatectomy (RRP).
DESIGN, SETTING, AND PARTICIPANTS
We enrolled 4003 patients in a prospective, controlled, nonrandomised trial comparing RALP and RRP in 14 Swedish centres between 2008 and 2011. Data for functional outcomes were assessed via validated patient questionnaires administered preoperatively and at 12 and 24 mo and 8 yr after surgery.
OUTCOME MEASUREMENTS AND STATISTICAL ANALYSIS
The primary endpoint was urinary incontinence. Functional outcomes at 8 yr were analysed using the modified Poisson regression approach.
RESULTS AND LIMITATIONS
Urinary incontinence was not significantly different at 8 yr after surgery between RALP and RRP (27% vs 29%; adjusted risk ratio [aRR] 1.05, 95% confidence interval [CI] 0.90-1.23). Erectile dysfunction was significantly lower in the RALP group (66% vs 70%; aRR 0.93, 95% CI 0.87-0.99). Prostate cancer-specific mortality (PCSM) was significantly lower in the RALP group at 8 yr after surgery (40/2699 vs 25/885; aRR 0.56, 95% CI 0.34-0.93). Differences in oncological outcomes were mainly seen in the group with high D'Amico risk, with a lower risk of positive surgical margins (21% vs 34%), biochemical recurrence (51% vs 69%), and PCSM (14/220 vs 11/77) for RALP versus RRP. The main limitation is the nonrandomised design.
CONCLUSIONS
In this prospective multicentre controlled trial, PCSM at 8 yr after surgery was lower for RALP in comparison to RRP. A causal relationship between surgical technique and mortality cannot be inferred, but the result confirms that RALP is oncologically safe. Taken together with better short-term results reported elsewhere, our findings confirm that implementation of RALP may continue.
PATIENT SUMMARY
Our study comparing two surgical techniques for removal of the prostate for localised prostate cancer shows that a robot-assisted minimally invasive technique is safe in the long term. Together with previous results showing some better short-term effects with this approach, our findings support continued use of robot-assisted surgery.
Topics: Aged; Erectile Dysfunction; Follow-Up Studies; Humans; Laparoscopy; Male; Middle Aged; Postoperative Complications; Prospective Studies; Prostate; Prostatectomy; Prostatic Neoplasms; Robotic Surgical Procedures; Treatment Outcome; Urinary Incontinence
PubMed: 34538508
DOI: 10.1016/j.eururo.2021.07.025 -
Anaesthesia, Critical Care & Pain... Aug 2021The aim of this review was to update the recommendations for optimal pain management after open and laparoscopic or robotic prostatectomy. Optimal pain management is... (Review)
Review
The aim of this review was to update the recommendations for optimal pain management after open and laparoscopic or robotic prostatectomy. Optimal pain management is known to influence postoperative recovery, but patients undergoing open radical prostatectomy typically experience moderate dynamic pain in the immediate postoperative day. Robot-assisted and laparoscopic surgery may be associated with decreased pain levels as opposed to open surgery. We performed a systematic review using Preferred Reporting Items for Systematic Reviews and Meta-Analysis (PRISMA) with PROcedure SPECific Postoperative Pain ManagemenT (PROSPECT) methodology. Randomised controlled trials (RCTs) published in English language, from January 2015 until March 2020, assessing postoperative pain, using analgesic, anaesthetic and surgical interventions, were identified from MEDLINE, EMBASE and Cochrane Databases. Of the 1797 studies identified, 35 RCTs and 3 meta-analyses met our inclusion criteria. NSAIDs and COX-2 selective inhibitors proved to lower postoperative pain scores. Continuous intravenous lidocaine reduced postoperative pain scores during open surgery. Local wound infiltration showed positive results in open surgery. Bilateral transversus abdominis plane (TAP) block was performed at the end of surgery and lowered pain scores in robot-assisted procedures, but results were conflicting for open procedures. Basic analgesia for prostatic surgery should include paracetamol and NSAIDs or COX-2 selective inhibitors. TAP block should be recommended as the first-choice regional analgesic technique for laparoscopic/robotic radical prostatectomy. Intravenous lidocaine should be considered for open surgeries.
Topics: Abdominal Muscles; Humans; Male; Neoplasms; Nerve Block; Pain Management; Pain, Postoperative; Practice Guidelines as Topic; Prostatectomy
PubMed: 34197976
DOI: 10.1016/j.accpm.2021.100922 -
Medicine May 2019To perform a systematic review and meta-analysis evaluating the perioperative, functional, and oncological outcomes and cost of robot-assisted radical prostatectomy... (Comparative Study)
Comparative Study Meta-Analysis
Robot-assisted and laparoscopic vs open radical prostatectomy in clinically localized prostate cancer: perioperative, functional, and oncological outcomes: A Systematic review and meta-analysis.
BACKGROUND
To perform a systematic review and meta-analysis evaluating the perioperative, functional, and oncological outcomes and cost of robot-assisted radical prostatectomy (RARP), or laparoscopic radical prostatectomy (LRP) comparing with open radical prostatectomy (ORP) in men with clinically localized prostate cancer through all prospective comparative studies.
METHODS
A comprehensive literature search was performed in August 2018 using the Pubmed, Medline, Embase, and Cochrane databases. Only randomized controlled trials (RCTs) and prospective studies including patients with clinically localized prostate cancer were eligible for study inclusion. Cumulative analysis was conducted using Review Manager v. 5.3 software.
RESULTS
Two RCTs and 9 prospective studies were included in this systematic review. There were no significant differences between RARP/LRP and ORP in overall complication rate, major complication rate, overall positive surgical margin (PSM) rate, ≤pT2 tumor PSM rate, ≥pT3 tumor PSM rate. Moreover, RARP/LRP and ORP showed similarity in biochemical recurrence (BCR) rate at 3, 12, 24 months postoperatively. Urinary continence and erectile function at 12 months postoperatively between RARP and ORP are also comparable. RARP/LRP were associated with significantly lower estimated blood loss [mean difference (MD) -749.67, 95% CI -1038.52 to -460.82, P = .001], lower transfusion rate (OR 0.17, 95% CI 0.10 to 0.30, P < .001) and less hospitalization duration (MD -1.18, 95% CI -2.18 to -0.19, P = .02). And RARP/LRP required more operative time (MD 50.02, 95% CI 6.50 to 93.55, P = .02) and cost.
CONCLUSION
RARP/LRP is associated with lower blood loss, transfusion rate and less hospitalization duration. The available data were insufficient to prove the superiority of any surgical approach in terms of postoperative complications, functional and oncologic outcomes.
Topics: Adult; Aged; Humans; Laparoscopy; Male; Margins of Excision; Middle Aged; Operative Time; Postoperative Complications; Prostatectomy; Prostatic Neoplasms; Robotic Surgical Procedures; Treatment Outcome
PubMed: 31145297
DOI: 10.1097/MD.0000000000015770 -
Ugeskrift For Laeger Apr 2023The treatment of benign prostatic hyperplasia includes a variety of options ranging from medication to open prostatectomy. Several newer technologies have been... (Review)
Review
The treatment of benign prostatic hyperplasia includes a variety of options ranging from medication to open prostatectomy. Several newer technologies have been developed. Transurethral resection of the prostate remains the gold standard among surgical procedures for prostates less than 80 cc whereas enucleation and simple open prostatectomy are most documented for larger prostates. This review has focus on the status of treatment available in Denmark at the moment. Thorough evaluation of the patients before treatment and shared decision-making with regard to treatment options is essential.
Topics: Male; Humans; Prostatic Hyperplasia; Transurethral Resection of Prostate; Prostatectomy; Prostate; Laser Therapy
PubMed: 37057701
DOI: No ID Found -
The Canadian Journal of Urology Oct 2015Prostatectomy for benign disease, also known as a 'simple prostatectomy', is neither simple in indication nor approach. In the post-Medical Therapy of Prostatic Symptoms... (Comparative Study)
Comparative Study Review
INTRODUCTION
Prostatectomy for benign disease, also known as a 'simple prostatectomy', is neither simple in indication nor approach. In the post-Medical Therapy of Prostatic Symptoms (MTOPS), NCT00021814 trial era, the medical management of benign prostatic hyperplasia (BPH) and consequent bladder outlet obstruction (BOO) has shifted surgical intervention to those patients who are medical-non responders, present with advanced signs of BOO and obstructive uropathy, and those with prostate gland volumes beyond the size normally approachable with standard transurethral resection of the prostate (TURP). Simple prostatectomy through an open surgical approach is associated with improvements in BOO and lower urinary tract symptoms (LUTS) but at the expense of considerable surgical and perioperative morbidity. Advances in technology have made it possible for patients to be offered standard open surgical approaches as well as transurethral approaches with photon-based energy sources (i.e. laser prostatectomy) and laparoscopic simple prostatectomy. A review of the historical challenges of BPH and the standard-of-care of open prostatectomy will put into perspective the potential advantages and disadvantages of laparoscopic and robotic prostatectomy for the treatment of benign BOO due to BPH.
MATERIALS AND METHODS
A careful review of the literature was performed utilizing PubMed and ClinicalKey searches to identify relevant articles. Search terms 'simple prostatectomy', 'robotic simple prostatectomy' and 'laparoscopic simple prostatectomy'.
RESULTS
Over 14 series of open simple prostatectomies and over 20 minimally invasive series were identified and used as a reference. Additionally, several review articles were identified and incorporated.
CONCLUSIONS
Simple prostatectomy may be performed safely in appropriately selected patients utilizing either open or minimally invasive approaches. Clinical criteria should be used to determine the appropriateness of either retropubic versus transvesical approach.
Topics: Aged; Aged, 80 and over; Follow-Up Studies; Humans; Laparoscopy; Laparotomy; Length of Stay; Male; Minimally Invasive Surgical Procedures; Operative Time; Postoperative Complications; Prostatectomy; Prostatic Hyperplasia; Reoperation; Risk Assessment; Robotic Surgical Procedures; Survival Rate; Treatment Outcome
PubMed: 26497345
DOI: No ID Found -
Journal of Comparative Effectiveness... May 2013Prostate cancer is the second leading cause of cancer death among men in the USA. Use of robot-assisted radical prostatectomy (RARP) for the management of localized... (Comparative Study)
Comparative Study Review
Prostate cancer is the second leading cause of cancer death among men in the USA. Use of robot-assisted radical prostatectomy (RARP) for the management of localized prostate cancer has increased dramatically in recent years. This review focuses on comparing quality of life following RARP versus retropubic radical prostatectomy. RARP is associated with improved perioperative outcomes, such as reduced blood loss and fewer transfusions. In addition, cancer control after RARP versus retropubic radical prostatectomy is equivalent, with similar incidences of positive surgical margins and comparable early oncological outcomes. RARP appears to provide advantages in recovery of continence, potency and quality of life compared with retropubic radical prostatectomy; however, methodological limitations exist in current literature.
Topics: Comparative Effectiveness Research; Disease-Free Survival; Erectile Dysfunction; Humans; Laparoscopy; Male; Neoplasm Recurrence, Local; Organ Sparing Treatments; Prostatectomy; Prostatic Neoplasms; Quality of Life; Robotics; Treatment Outcome; Urinary Incontinence
PubMed: 24236628
DOI: 10.2217/cer.13.23 -
The Canadian Journal of Urology Oct 2015
Topics: Cystectomy; Humans; Male; Prostatectomy; Prostatic Neoplasms; Robotic Surgical Procedures; Urinary Bladder Neoplasms
PubMed: 26432961
DOI: No ID Found