The document discusses robotic urology surgery and summarizes several studies comparing outcomes of radical prostatectomy performed through open, laparoscopic, and robotic-assisted methods. The meta-analysis found that robotic-assisted radical prostatectomy has lower positive surgical margin rates and fewer complications compared to open and laparoscopic approaches. Additionally, early studies suggest robotic pyeloplasty takes less time than standard laparoscopic techniques.

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Available online at www.sciencedirect.com
journal homepage: www.elsevier.com/locate/apme
Journal Scan
Robotic urology surgery
Arun Prasad*
Apollo Hospital, Department of Surgery, Room 1202, 2nd Floor B Wing, Sarita Vihar, New Delhi 110044, India
Positive surgical margin and perioperative complication rates of primary surgical treatments for prostate cancer: a sys-
tematic review and meta-analysis comparing retropubic, laparoscopic, and robotic prostatectomy. Ashutosh Tewari,
Prasanna Sooriakumaran, Daniel A. Bloch, Usha Seshadri-Kreaden, April E. Hebert, Peter Wiklund. Eur Urol. July
2012;62(1):e1ee30.
Abstract
Context: Radical prostatectomy (RP) approaches have rarely been compared adequately with regard to margin and peri-
operative complication rates.
Objective: Review the literature from 2002 to 2010 and compare margin and perioperative complication rates for open
retropubic RP (ORP), laparoscopic RP (LRP), and robot-assisted LRP (RALP).
Evidence acquisition: Summary data were abstracted from 400 original research articles representing 167,184 ORP, 57,303
LRP, and 62,389 RALP patients (total: 286,876). Articles were found through PubMed and Scopus searches and met a priori
inclusion criteria (eg, surgery after 1990, reporting margin rates and/or perioperative complications, study size > 25 cases).
The primary outcomes were positive surgical margin (PSM) rates, as well as total intra- and perioperative complication rates.
Secondary outcomes included blood loss, transfusions, conversions, length of hospital stay, and rates for specific individual
complications. Weighted averages were compared for each outcome using propensity adjustment.
Evidence synthesis: After propensity adjustment, the LRP group had higher positive surgical margin rates than the RALP
group but similar rates to the ORP group. LRP and RALP showed significantly lower blood loss and transfusions, and a shorter
length of hospital stay than the ORP group. Total perioperative complication rates were higher for ORP and LRP than for
RALP. Total intraoperative complication rates were low for all modalities but lowest for RALP. Rates for readmission,
reoperation, nerve, ureteral, and rectal injury, deep vein thrombosis, pneumonia, hematoma, lymphocele, anastomotic leak,
fistula, and wound infection showed significant differences between groups, generally favoring RALP. The lack of ran-
domized controlled trials, use of margin status as an indicator of oncologic control, and inability to perform cost compar-
isons are limitations of this study.
Conclusions: This meta-analysis demonstrates that RALP is at least equivalent to ORP or LRP in terms of margin rates and
suggests that RALP provides certain advantages, especially regarding decreased adverse events.
Take home message
Radical prostatectomy is generally a safe operation with few complications and low positive surgical margin rates. However,
robotic assistance appears to provide superior outcomes in this regard compared with open retropubic and conventional lapa-
roscopic approaches for most surgeons.
* Tel.: þ91 11 29871202.
E-mail address: surgerytimes@gmail.com.
0976-0016/$ e see front matter
http://dx.doi.org/10.1016/j.apme.2013.01.001

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A comparison of laparoscopic pyeloplasty performed with the daVinci robotic system versus standard laparoscopic tech-
niques: initial clinical results. Matthew T Gettman, Reinhard Peschel, Richard Neururer, Georg Bartsch. Eur Urol. November
2002;42(5):417e532.
Abstract
Purpose: Laparoscopic pyeloplasty is an accepted therapy for primary ureteropelvic junction obstruction (UPJO), however
difficulty associated with intracorporeal suturing has limited widespread clinical application. We report our initial expe-
rience of laparoscopic pyeloplasty performed with the daVinci robotic system matched to procedures performed with
standard laparoscopic techniques.
Patients and Methods: From June 2001 until August 2001, six patients underwent definitive management of primary UPJO
using the daVinci robotic system. In four patients an AndersoneHynes pyeloplasty was performed, while in two patients
Fengerplasty was performed. Using demographic and preoperative information, each patient in the daVinci-assisted group
was matched to a corresponding patient with primary UPJO undergoing laparoscopic pyeloplasty with standard techniques
between November 1999 and June 2001. Perioperative results and follow-up data were subsequently compared.
Results: Treatment groups were identical with regard to surgical procedure, gender, and side of UPJO. The length of hos-
pitalization was 4 days for all patients, regardless of treatment group. Estimated blood loss was <50 cc in all cases. For
AndersoneHynes pyeloplasty, the mean overall operative and suturing times were 140 and 70 min using the daVinci system
and 235 and 120 min using standard techniques, respectively. For the Fengerplasty, the mean overall operative and suturing
times were 78 and 13 min using the daVinci system and 100 and 28 min using standard techniques, respectively. No
complications were observed and there were no open conversions.
Conclusion: AndersoneHynes pyeloplasty and Fengerplasty are feasible using either conventional laparoscopic techniques
or the daVinci robotic system. In this initial pilot study, procedures performed with the daVinci robotic system resulted in
overall decreased operative time, however factors responsible for the decreased operative time remain to be defined. Long-
term prospective follow-up of procedures performed with or without the daVinci robotic system for surgeons with limited
experience in laparoscopic management of UPJO is warranted to delineate the true efficacy of the device.
Albert Einstein is credited with saying, ‘‘Not everything that can be counted counts, and not everything that counts can be
counted.’’ Many nuances of robotic surgery cannot be counted, but Tewari and colleagues have done an extraordinary job of
counting what can be counted.

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