INFECTIOUS COMPLICATIONS OF CONVENTIONAL LAPAROSCOPIC VERSUS ROBOTIC LAPAROSCOPIC PROSTATECTOMY: A SYSTEMATIC LITERATURE REVIEW AND META-ANALYSIS.

Recent studies have shown that using minimally invasive surgical techniques (conventional laparoscopy or robotic) for prostatectomy is associated with lower peri-operative complication rates compared to open radical retropubic prostatectomy. However, differences in infectious complications between these minimally invasive approaches is not well characterized. To study this further, we performed a systematic review of the literature and meta-analysis of the infectious complications of prostatectomy, comparing robotic prostatectomy (RP) to conventional laparoscopic prostatectomy (LP).

We searched PubMed, CINAHL, CDSR, and EMBASE through September 2018 for studies evaluating minimally invasive prostatectomy and infectious complications. We employed random-effect models to obtain pooled odds ratio (pOR) estimates. Heterogeneity was evaluated with I2 estimation and the Cochran Q statistic. Pooled odds ratios were calculated separately based on the indication for prostatectomy.

Fifteen studies were included in the final review for the meta-analysis with 14,121 patients undergoing minimally invasive prostatectomy. There was no statistically significant difference in the number of infectious complication events between RP and LP (pOR 0.94; 95% CI 0.50-1.76). When we performed a stratified analysis, similar results were found with no statistically significant difference in infectious complications comparing RP to LP among patients with prostate cancer (pOR 0.73; 95% CI 0.43-1.24). We observed that infectious complications were nearly three-fold higher with the robotic approach in earlier studies (published between 2007 and 2012, pOR 2.81; 95%CI 1.07-7.39) but no significant difference was found in later studies (between 2013 and 2018, pOR 0.80, 95%CI 0.40-1.57).

The rate of infectious complications associated with robotic prostatectomy was no different than that associated with conventional laparoscopic prostatectomy.

Journal of endourology. 2019 Jan 11 [Epub ahead of print]

Alexandre R Marra, Mireia Puig-Asensio, Michael B Edmond, Marin L Schweizer, Kenneth G Nepple

University of Iowa Hospitals and Clinics, 21782, Internal Medicine , 200 Hawkins Dr , Iowa City, Iowa, United States , 52242-1009 ; ., University of Iowa Hospitals and Clinics, 21782, Internal Medicine, Iowa City, Iowa, United States ; ., University of Iowa Hospitals and Clinics, 21782, Internal Medicine, Iowa City, Iowa, United States ; ., University of Iowa Hospitals and Clinics, 21782, Internal Medicine, Iowa City, Iowa, United States ; ., University of Iowa, Department of Urology, Iowa City, Iowa, United States ; .

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