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A Systematic Review of Robot-Assisted Simple Prostatectomy Outcomes by Prostate Volume - Beyond the Abstract

In the 20th century, new technologies were actively developing and many attempts were made to robotize several branches of life, including medicine. Initially, the main goal of introducing robots into surgery was to implement an opportunity to operate from a distance. Nevertheless, now robots are used predominantly to reduce the invasiveness of the surgery and thus to improve outcomes.



One of the first robots was PROROBOT, created in 1989 by urologist J. Wickham who is considered the «godfather» of robotic surgery, and the term «minimally invasive surgery» belongs to him. PROBOT was made to perform transurethral resection of the prostate (TURP), however, now robots find no place in transurethral surgery for benign prostatic hyperplasia (BPH). In contrast, robot-assisted simple prostatectomy (RASP) is on the rise. As different methods of surgical treatment for BPH develop, the idea of comparing them emerged. Of course, each option has its pros and cons.

Endoscopic enucleation of the prostate (EEP) is virtually the least invasive method: access is carried out through a natural orifice, so there is no need for another surgical incision, and neurovascular bundle damage is minimized. This technique does not depend on the initial prostate volume, the state of the hemostasis system, and detrusor function. However, movement of the endoscope increases the risk of the urethra damage. This surgery can lead to urethral stricture and bladder neck contracture.

RASP minimizes the risk of such complications. On the other hand, during robot-assisted surgeries, it is necessary to provide access to the prostate through the abdominal wall, which is a more invasive process, and the risk of damage to the important neurovascular bundles and other anatomical structures is higher. This procedure implies significant suturing and significantly more cutting and dissection compared to endoscopy.

Unfortunately, there are no articles with a direct comparison of RASP outcomes based on BPH volume within the same trials. So, we had to group the trials according to median BPH volume and compare RASP outcomes between these groups, as well as comparing RASP outcomes with other types of BPH treatment in different gland volumes.

In addition, such a term as «large prostate gland» does not have a clear definition. The EAU (European Association of Urology) traditionally considers the prostate volume >80 cm3 to be large, while the AUA (American Urological Association) divides the glands into large (80-150 cm3) and giant (>150 cm3). However, some authors use their own definitions.

We believe that further studies comparing RASP outcomes in subgroups divided by prostate volume will allow us to solve this data shortage problem. Therefore, this will help us to redefine the place of RASP among other types of surgical treatment of BPH.

Written by: Andrey Morozov,1 Svetlana Bogatova,2 Evgeny Bezrukov,1 Nirmish Singla,3 Jeremy Yuen-Chun Teoh,4 Leonid Spivak,1 Juan Gomes Rivas,5 Lukas Lusuardi,6 Vineet Gauhar,7 Bhaskar Somani,8 David Lifshitz,9,10 Jack Baniel,9,10 Thomas R W Herrmann,11,12,13 Dmitry Enikeev 14,15,16,17

  1. Institute for Urology and Reproductive Health, Sechenov University, Moscow, Russia.
  2. Institute for Clinical Medicine, Sechenov University, Moscow, Russia.
  3. Department of Urology, James Buchanan Brady Urological Institute, The Johns Hopkins University School of Medicine, Baltimore, USA.
  4. Department of Surgery, S.H. Ho Urology Centre, The Chinese University of Hong Kong, Hong Kong, China.
  5. Department of Urology, Hospital Clínico San Carlos, Madrid, Spain.
  6. Department of Urology, University Hospital Salzburg, Paracelsus Medical University, Salzburg, Austria.
  7. Ng Teng Fong General Hospital, NUH, Singapore, Singapore.
  8. Department of Urology, University Hospital Southampton NHS Trust, Southampton, UK.
  9. Department of Urology, Rabin Medical Center, Petach Tiqwa, Israel.
  10. Sackler Faculty of Medicine, Tel Aviv University, Tel Aviv, Israel.
  11. Department of Urology, Spital Thurgau AG, Kantonspital Frauenfeld, Frauenfeld, Switzerland.
  12. Division of Urology, Department of Surgical Sciences, Stellenbosch University, Western Cape, Stellenbosch, South Africa.
  13. Hannover Medical School, Hannover, Germany.
  14. Institute for Urology and Reproductive Health, Sechenov University, Moscow, Russia.
  15. Department of Urology, Rabin Medical Center, Petach Tiqwa, Israel.
  16. Department of Urology, Medical University of Vienna, Währinger Gürtel 18-20, Vienna, 1090, Austria.
  17. Sackler Faculty of Medicine, Tel Aviv University, Tel Aviv, Israel.
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