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J Endourol. 2019 Mar;33(3):179-188. doi: 10.1089/end.2018.0815. Epub 2019 Feb 8.

Infectious Complications of Conventional Laparoscopic vs Robotic Laparoscopic Prostatectomy: A Systematic Literature Review and Meta-Analysis.

Author information

1
1 Office of Clinical Quality, Safety and Performance Improvement, University of Iowa Hospitals and Clinics, Iowa City, Iowa.
2
2 Division of General Internal Medicine, Department of Internal Medicine, Carver College of Medicine, Iowa City, Iowa.
3
3 Division of Medical Practice, Hospital Israelita Albert Einstein, São Paulo, Brazil.
4
4 Division of Infectious Diseases, Department of Internal Medicine, University of Iowa Carver College of Medicine, Iowa City, Iowa.
5
5 The Center for Comprehensive Access and Delivery Research and Evaluation, Iowa City Veterans Affairs Health Care System, Iowa City, Iowa.
6
6 Department of Urology, University of Iowa Carver College of Medicine, Iowa City, Iowa.

Abstract

BACKGROUND:

Recent studies have shown that using minimally invasive surgical techniques (conventional laparoscopy or robotic) for prostatectomy is associated with lower perioperative complication rates compared with open radical retropubic prostatectomy. However, differences in infectious complications between these minimally invasive approaches are 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) with conventional laparoscopic prostatectomy (LP).

METHODS:

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. pORs were calculated separately based on the indication for prostatectomy.

RESULTS:

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 with LP among patients with prostate cancer (pOR 0.73; 95% CI 0.43, 1.24). We observed that infectious complications were nearly threefold 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).

CONCLUSIONS:

The rate of infectious complications associated with RP was no different than that associated with conventional LP.

KEYWORDS:

infectious complication; laparoscopy; minimally invasive technique; prostatectomy; robotic

PMID:
30632396
DOI:
10.1089/end.2018.0815

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