Is Retzius-sparing robot-assisted radical prostatectomy associated with better functional and oncological outcomes? Literature review and meta-analysis

Objective:To evaluate the efficiency,safety and clinical outcomes of Retziussparing robot-assisted radical prostatectomy(RS-RARP)in comparison with the standard RARP.Methods:A systematic search from Web of Science,PubMed,EMBase,Cochrane Library and Google Scholar was performed using the terms“Retzius-sparing”,“Bocciardi approach”and“robot-assisted radical prostatectomy”.Video articles and abstract papers for academic conferences were excluded.Meta-analysis of interested outcomes such as positive surgical margins(PSMs)and continence recovery was undertaken.A comprehensive literature review of all studies regarding Retzius-sparing(RS)approach was conducted and summarized.Results:From 2010 to 2017,11 original articles about RS-RARP approach were retrieved.Of that,only four studies comparing the RS-RARP approach to the conventional RARP were comparable for meta-analysis.Faster overall continence recovery within 1 month after the surgery was noted in the RS group(61%vs.43%;pZ0.004).PSMs of pT2 and pT3 stages were not significantly different between the groups(10.0%vs.7.4%;p Z 0.39 and 13.1%vs.9.5%,p Z 0.56,respectively).Of all the studies,only one reported sexual recovery outcomes after RS treatment in which 40%of the participants achieved sexual intercourse within the first month.Conclusion:Though more technically demanding than the conventional RARP,the RS technique is a safe and feasible approach.This meta-analysis and literature review indicates that RS technique,as opposed to the conventional approach,is associated with a faster continence recovery while PSMs were comparable between the two groups.The limitations of observational studies and the small data in our meta-analysis may prevent an ultimate conclusion.Future well-designed RCTs are needed to validate and confirm our findings.

Robot-assisted laparoscopic ureteroneocystostomy in adults: A single surgeon experience and literature review

Objective:To present our experience and technique with robot-assisted uretero-neocystos tomy(RAUN)procedure in adults.Methods:Between February 2015 and August 2018,a total of 30(34 ureters)patients who un-derwent RAUN surgery under a single surgeon were retrospectively reviewed.Perioperative data such as age,sex,body mass index(BMI),American society of anesthes iologists score,esti-mated blood loss,surgical technique,operative time,complications,length of hospital stay,and stent removal time were recorded.During the follow-up,patients underwent renal func-tion test,urinalysis,and renal ultrasound examination for evaluation.Success was defined as symptomatic and radiologic relieve.Lastly,a literature search was conducted to review all published articles regarding RAUN surgery in adults.Results:The patients'mean age,BMI,EBL,operative time,and follow-up period were 45.4 years,23.1 kg/m^2,65.6 mL,182.9 min,and 21.3 months,respectively.The two most common indications for the surgery were benign ureteral strictures and ureteric injuries secondaryto a previous radical hysterectomy.Of the 34 cases,26(76.5%)and 8(23.5%)patients received pri-mary RAUN and RAUN with psoas hitch technique,respectively.Refluxing RAUN method was performed in all cases.No intraoperative complications were found.Two patients had a radio-logic and symptomatic recurrence;one was managed with a repeat surgery while the other received ureteral dilatation treatment.Conclusion:Both our study and the published literature showed that RAUN is a safe,less inva-sive,and effective surgical technique that can easily replicate the open ureteroneocystostomy for managing lower ureteral diseases.