Robot-assisted versus conventional laparoscopic radical prostatectomy - a systematic review

Abstract

The primary aim of the thesis is to compare effectiveness and safety of robot-assisted radical prostatectomies (RALRP) and conventional laparoscopic radical prostatectomies (LRP) using evidence based analyses. The secondary aim is to assess the current level of implementation of robotic surgical systems in prostate cancer treatment in Norwegian hospitals. Method A systematic review of studies that were comparing robot-assisted and conventional laparoscopic radical prostatectomy was conducted. The level of implementation of robotic surgical systems in prostatectomies was assessed by an open-ended questionnaire sent to five Norwegian hospitals via email. Results Two randomized clinical trials and seven non-randomized comparative studies were included in the review. Pooled data from two randomized trials revealed significantly higher number of potent and continent patients in the RALRP group compared to LRP cohort 12 months after surgery. The differences in the rates of complications, biochemical recurrence, and positive surgical margin were not statistically significant. The meta-analyses performed on the non-randomized studies were hampered by a high level of heterogeneity observed. Norwegian Radium Hospital in Oslo was the only institution who had answered the questionnaire. A total of 293 RALRPs were performed in this hospital in 2011, Conclusion More randomized clinical trials are needed in order to fully assess the effectiveness and safety of RALRP. The procedure in the hands of experienced surgeon might be beneficial for younger and preoperatively potent patients. The potential benefits from the RALRP are likely to occur in high-volume institutions such as Norwegian Radium Hospital.