Comparison Between Minimally Invasive Simple Prostatectomy and Open Simple Prostatectomy for Large Prostates: A Systematic Review and Meta-Analysis of Comparative Trials

Li, Jinze; Cao, Deliang; Peng, Lei; Ren, Zheng-Ju; Gou, Haocheng; Li, Yunxiang; Wang, Qiang

doi:10.1089/end.2019.0306

Cited by 35 publications

(38 citation statements)

References 34 publications

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“…Consequently, AEEP is a safer modality than RASP for the treatment of patients on anticoagulation [28,29]. Furthermore, our results echo the findings of other studies that show AEEP is associated with the least blood loss among the 3 modalities [8,30].…”

Section: Discussionsupporting

confidence: 87%

Perioperative Outcomes of Anatomic Endoscopic Enucleation of the Prostate, Robotic and Open Simple Prostatectomy From a Multi-Institutional Database

Labban¹,

Heidar²,

Misraï³

et al. 2021

Société Internationale D’Urologie Journal

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Objective: To compare the perioperative morbidity of robotic-assisted simple prostatectomy (RASP), anatomical endoscopic enucleation of the prostate (AEEP) and open simple prostatectomy (OSP) for the treatment of benign prostatic obstruction (BPO). Methods: The national surgical quality improvement program database was queried for AEEP, RASP, and OSPprocedures. Clavien-Dindo-graded complications, length of hospital stay (LOS), and operative time were compared among the procedures. To control for the potentially confounding variables, we first conducted a multivariate backward conditional logistic regression, and then resorted to propensity score matching. Results: We identified 2867 AEEP, 234 RASP, and 1492 OSP procedures. After matching, the risk of pulmonary, renal, infectious, and thromboembolic adverse events was lower after AEEP but not RASP in comparison with OSP (P < 0.05). In comparison with RASP, AEEP had lower cardiac and thromboembolic events (P < 0.05). When compared with OSP, AEEP had reduced odds of Clavien-Dindo grade I (OR = 0.12; 95% CI 0.10 to 0.16) and II (OR = 0.38; 95% CI 0.24 to 9.58) complications. Also, AEEP had lower odds for grade I and II as well as grade IV complications (OR = 0.30; 95% CI 0.19 to 0.48, and OR = 0.05; 95% CI 0.01 to 0.24, respectively) compared with RASP. Conclusion: AEEP and RASP were associated with fewer perioperative adverse events, a shorter LOS and a reduced risk of transfusion compared with OSP. AEEP was associated with overall lower complication rates than RASP and OSP.

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Section: Discussionsupporting

confidence: 87%

Perioperative Outcomes of Anatomic Endoscopic Enucleation of the Prostate, Robotic and Open Simple Prostatectomy From a Multi-Institutional Database

Labban¹,

Heidar²,

Misraï³

et al. 2021

Société Internationale D’Urologie Journal

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“…Minimally invasive approaches have several advantages including lower blood loss, lower transfusion rates, and shorter hospital stays. However, they usually have longer duration of operation compared to OP, especially in the treatment of large prostates [4, 10]. Prolonged operation time is associated with an increase in the risk of complications such as bleeding, surgical site infection, venous thromboembolism, or cardiac, neurologic, and respiratory problems, and this might be important especially in the treatment of comorbid patients [11].…”

Section: Discussionmentioning

confidence: 99%

“…There are many studies in the literature comparing these minimally invasive procedures with OP and highlighting their superior aspects [4][5][6][7][8][9]. However, longer duration of the operation is regarded to be the main disadvantage of minimally invasive procedures against OP [10]. Prolonged operative time was associated with an increase in the risk of complications [11].…”

Section: Introductionmentioning

confidence: 99%

Holmium Laser Enucleation, Laparoscopic Simple Prostatectomy, or Open Prostatectomy: The Role of the Prostate Volume in terms of Operation Time

Gunseren

Akdemir²,

Çiçek

et al. 2020

Urol Int

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Introduction: To compare the prostate removal speeds of 3 enucleation techniques and to evaluate how the operating times change depending on the prostate volume. Methods: Medical records of patients with 80-g or larger prostates who underwent holmium laser enucleation of the prostate (HoLEP), laparoscopic simple prostatectomy (LSP), or open prostatectomy (OP) due to medical treatment-resistant benign prostatic hyperplasia (BPH) were reviewed retrospectively. Patients were classified into 3 groups according to the surgical procedure. Age, BMI, prostate weights, total operation times, prostate removal speeds, hospitalization and catheterization days, complications, and improvements on functional outcomes in the 3rd month of follow-up were compared between groups. In addition, the association between prostate weight and total operation time was analyzed for each group. Results: HoLEP, LSP, and OP groups consisted of 60, 61, and 37 patients, respectively. While HoLEP was similar to OP in terms of prostate removal speed and total operation time, LSP was statistically slower and required more operation time than HoLEP and OP. There was a relationship between prostate weight and total operation time only in HoLEP. Conclusion: LSP, one of the enucleation techniques in the treatment of large prostates, was slower and required more operation time than HoLEP and OP in terms of total operation time and prostate removal speed. HoLEP seems going to be the fastest candidate for the rapid removal of large prostates in the future.

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“…Robotic surgery has become widely adopted in urological surgery, preserving the ability to perform complex procedures not otherwise feasible with traditional laparoscopy, while allowing for improved cosmesis and expedited convalescence [5]. The use of minimally invasive SP (MISP) is a recommended consideration for patients with large prostate glands [6,7] and the use of robot-assisted SP (RASP) has gained popularity as a minimally invasive alternative to OSP, both in the USA and internationally [8,9]. While cost is not the sole factor to consider in the decision about surgical approach, it is an important consideration in justifying additional expenditures associated with the initial investment and maintenance of the robotic system [5].…”

Section: Introductionmentioning

confidence: 99%

Perioperative outcomes and cost of robotic vs open simple prostatectomy in the modern robotic era: results from the National Inpatient Sample

et al. 2020

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To perform a comparative analysis of perioperative outcomes and hospitalisation cost between open (OSP) and robotassisted simple prostatectomy (RASP) for treatment of benign prostatic hyperplasia (BPH) using the National Inpatient Sample (NIS) in the contemporary robotic era. Materials and MethodsThe NIS was queried for cases of OSP and RASP for the treatment of BPH between 2013 and 2016. Perioperative complications, unadjusted hospital cost and length of stay (LOS) were compared between RASP and OSP. Smoothed linear regression curves comparing hospitalisation cost by increasing LOS was stratified by surgical approach to identify point of cost equivalency between RASP and OSP. Multivariable linear regression analysis was used to construct a hospitalisation cost model to examine the contribution of the robotic approach and LOS to hospitalisation cost. ResultsThe total analytical cohort included 2551 OSP and 704 RASP procedures. Patients undergoing RASP were younger, at a median (interquartile range [IQR]) age of 68 (63-73) vs 71 (65-77) years, and with less comorbidity (76.8% vs 86.5%, P < 0.01). RASP was associated with fewer total complications (11.1% vs 29.2%, P < 0.01) and a greater likelihood of routine discharge to home rather than another facility (88.9% vs 76.7%, P < 0.01). While LOS was shorter with RASP (median [IQR], 2 [1-3] vs 4 [3-6] days, P < 0.01), total unadjusted hospitalisation cost (in United States dollars) was greater

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Comparison Between Minimally Invasive Simple Prostatectomy and Open Simple Prostatectomy for Large Prostates: A Systematic Review and Meta-Analysis of Comparative Trials

Cited by 35 publications

References 34 publications

Perioperative Outcomes of Anatomic Endoscopic Enucleation of the Prostate, Robotic and Open Simple Prostatectomy From a Multi-Institutional Database

Perioperative Outcomes of Anatomic Endoscopic Enucleation of the Prostate, Robotic and Open Simple Prostatectomy From a Multi-Institutional Database

Holmium Laser Enucleation, Laparoscopic Simple Prostatectomy, or Open Prostatectomy: The Role of the Prostate Volume in terms of Operation Time

Perioperative outcomes and cost of robotic vs open simple prostatectomy in the modern robotic era: results from the National Inpatient Sample

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