Introduction: Robot-assisted radical prostatectomy (RARP) is a technological evolution of laparoscopic radical prostatectomy (LRP) and have been compared using different levels of evidence. However, most studies were based on retrospective analyses and debatable levels of evidence. This review aimed to apply a new methodology called Reverse Systematic Review to compare perioperative outcomes between LRP and RARP by critical subgroup analysis.

Methods: A systematic search for Systematic Review (SR) from 01/01/2000 to 05/12/2020 on radical prostatectomy was performed. From 80 eligible SR's, all 910 studies included in these reviews were cataloged in a database called EVIDENCE. For this study, a subgroup analysis of 34 studies that compared perioperative outcomes between LRP and RARP was performed.

Results: Thirty-four studies were included for analysis regarding 6,450 patients undergoing LRP and 6,280 patients undergoing RARP. The preoperative clinical characteristics were similar. RARP was, on average, 30 minutes shorter than LRP. Estimated blood loss of LRP is, on average, 180 mL higher than RARP, resulting in a transfusion rate more than twice as high in LRP, without impacting conversion rates, length of stay and catheter time. Regarding complication rates, there is a higher overall rate in LRP, at the expense of minor complications, specifically Clavien 1, but without repercussions on major ones.

Conclusion: RARP presented a shorter operative time, bleeding rate, transfusion and minor complication rates than LRP, but without a clinically significant impact on major complication rates. The heterogeneity generated by the EVIDENCE database and the population-based nature increase the representativeness of the results in different clinical scenarios, but caution should be taken when comparing with more specific conditions.

Keywords

Prostate cancer, radical prostatectomy, robotic, laparoscopic, perioperative outcomes, systematic review

At the beginning of the 21^st century, the standardization of minimally invasive surgery represented a major paradigm shift for the treatment of prostate carcinoma, represented by laparoscopic radical prostatectomy (LRP) and, sequentially, by the robot assisted radical prostatectomy tech nique (RARP) [1, 2].
The classic laparoscopic approach spread rapidly worldwide, mainly in the USA-Europe axis, and several centers began to improve it in order to reduce the difficulties inherent to the learning curve [3-5]. However, with the emergence of RARP, the laparoscopic technique was quickly replaced, mainly in North American centers, since the technical difficulties of LRP were overcome by the technology incorporated into the surgical robot [6, 7].
Despite the facilitation of movements provided by the robot, the global urological community needed to compare such techniques through scientific evidence in order to justify the high financial investment associated with robotic technology. Thus, many studies were generated with different levels of evidence, whether the lowest, such as an expert's opinion, or the highest, represented by Systematic Reviews (SR) [8].
This discussion made more sense in a period of commercial exclusivity of the main robotic platform (Da Vinci^TM, Intuitive Inc.), where the costs of implementing robotic surgery could be questioned in the face of cheaper LRP consumables. With the emergence of new robotic platforms and greater accessibility, even in developing countries [9, 10], the comparison with the laparoscopic technique has become less evidence-based in the scientific scenario. In view of this new era of robotic surgery, it is of great importance to retrospectively evaluate the importance of this scientific dispute in the development of surgical treatment of prostate cancer.
Therefore, in order to assess how the best evidence based on RS compared LRP and RARP in just over two decades, a reverse systematic review was carried out which brought together all the comparative studies used in the RS on the subject, with a critical analysis of the results [11].

This study is a critical review of comparative studies (randomized or not) between LRP and RARP, from a database called EVIDENCE, generated by a new methodology called Reverse Systematic Review, and previously described by the authors (Moretti, TBC e Reis, LO) [12-18].

Figure 1 represents the path of evidence in the classic SR and RSR. Colored circles represent the primary studies available (T1, T2…, T8) and blue circles represent SR available in the literature (R1, R2…, R6).

In classic SR, the search starts at the center, through the selection of studies that answer specific questions (PICO), generating a corresponding systematic review, with the centrifugal direction, that is, from the center to the periphery.
In the RSR, the evidence is captured in a centripetal way. It starts with a search for all systematic reviews on different subjects and returns to the primary studies that were chosen by these reviews, composing a heterogeneous and population-based database (P).Thus, to create the EVIDENCE database, a systematic search was carried out for SRs published between 01/01/2000 and 05/12/2020 related to radical prostatectomy in 8 databases (PubMed, Cochrane, Web of Science, Embase, Scopus, ProQuest, CINAHL, BVS/Bireme), resulting in 634 SR's (Supplementary 1). Sequentially, off-topic and duplicate studies were excluded, electing 80 SRs for analysis (Supplementary 2). After reading all these reviews, 2,356 baseline studies were found and, again, after excluding duplicates or off-topic studies, 910 studies were selected to compose the final database (Supplementary 3). All studies were read and outcomes were catalogued in a general database called EVIDENCE, which encompasses open, laparoscopic and robotic techniques.
For this specific study, an analysis of perioperative outcomes was performed in a subset of EVIDENCE, specifically only studies that directly compared LRP and RARP techniques, resulting in 34 studies (Figure 2).

As it is a critical review based on an unconventional search methodology, without the criteria of a classic systematic review, it became incompatible with registration in PROSPERO and PRISMA checklist.
The results were presented using the weighted mean and standard error of the mean of the central tendency values (mean or median) of the outcomes in order to establish the accuracy of the population mean. A statistical comparison test was not performed given the great heterogeneity of the studies, making its applicability unfeasible.

Thirty-four studies were included for analysis with two cohorts each, resulting in 68 cohorts representing 6,450 patients undergoing LRP and 6,280 patients undergoing RARP [7, 19-51].
Among the preoperative variables, the volume of operated cases from both a global and annual perspective were similar between the two techniques, with RARP presenting an average of 10 more surgeries per year compared to LRP. Among the clinical aspects, there is equivalence among other variables described in Table 1, demonstrating that the comparative studies included in the review are balanced in the selection of patients, allowing future comparisons.

Regarding perioperative variables, robotic surgery was, on average, 30 minutes shorter than LARP. Regarding the levels of preservation and lymphadenectomies performed, there is a similarity in the profile of the techniques. Even so, estimated blood loss (EBL) of LRP is, on average, 180 mL higher than robotic surgery, resulting in a transfusion rate more than twice as high in laparoscopic surgery, without impacting conversion rates, length of stay and catheter time (Table 2).

Regarding complication rates, there is a higher overall rate in LRP, at the expense of minor complications, specifically Clavien 1, but without repercussions on major ones (Table 3).

The natural history of radical prostatectomy has been one of the main topics of scientific discussion over the last 20 years, since the three main techniques (open, laparoscopic and robotic) began to coexist. Technological development has accelerated and driven scientists to generate substrates for scientific discussions through evidence. Among the secondary studies, 14 types of review studies were described, with SRs with meta-analysis providing the greatest evidence, especially if come from RCT's [8]. This study is the first to apply a new review methodology, called Reverse Systematic Review, in order to compare comparative studies between LRP and RARP from the largest evidence in the literature.
Our study demonstrated that LRP presented a longer mean operative time, with a higher rate of bleeding and transfusion than RARP, but without clinically significant repercussions on perioperative major complication rates.
Considering the highest level of evidence, we do not have systematic reviews of RTCs (Level of Evidence: 1a) comparing LRP and RARP. At the level below, only two studies were randomized (Level of evidence: 1b) by Porpiglia et al. which demonstrated no difference among perioperative outcomes evaluated comparing 60 patients in each arm [41, 48].
In 2009, Ficarra et al. produced the most robust systematic review of homogeneous studies (level of evidence: 3a) comparing LRP vs. RARP [52]. There was no difference in operative time after overcoming the learning curve, especially in a center with experience in LRP [19, 22]. Among the studies that provided data for analysis, there was no difference in operative time (WMD: -19.39 min; 95% CI of WMD: -49.34–88.13; P = 0.58) and blood loss (WMD: 19.45; 95% CI of WMD: -112.53–106.73; P = 0.96) respectively for LRP and RALP. The same overlapping results were found for the rates of bleeding, blood transfusion and perioperative complications (RR: 1.83; 95% CI of RR: 0.78–4.31; P = 0.16). However, only 4 studies were included for the analysis described above, compared with the 34 in our study, which demonstrated a higher EBL rate and transfusion in LRP.
In 2020, a critical review of the literature carried out by Coelho et al. gathered studies that considered highvolume centers (studies with more than 250 patients) did not perform statistical tests like our study and, through the weighted average, only showed a longer hospital stay with LRP (mean: 4.87 days) in relation to RARP (mean: 1.43 days) with a similar finding of longer operative time for LRP compared to RARP (205 min vs. 162.6 min) [53].
Considering different phases of the surgeon, a study by Rassweiler et al. in 2003, evaluated the impact of experience through the learning curve on perioperative outcomes in the evolution of the Heilbronn LRP technique [54]. The first group, relating to the first 150 patients, was compared with the last 150 ones. Operative time was shorter in the more experienced group (mean OR time: 211.4 versus 304.6 min), as well as the transfusion rate (11.3% versus 38.6%), conversion to open (0.7% versus 3.3%) and complications (8 % versus 19.3%).
On the other hand, a similar study proposed by Zorn et al. in 2007 compared the learning curve in RARP between the first group of patients 0-50 and the last group of patients 101-150 [55]. The last group had shorter operative time (247 min versus 343 min), lower EBL (197 mL versus 312 mL), lower transfusion rate (0% versus 2.2%), lower conversion to open (0% versus 8%) and fewer complications (12 % versus 19.6%) compared to the first one. These two studies described above demonstrate how LRP results are quickly achieved by RARP with a smaller number of patients (about 50), with better results over a learning curve of 150 patients. Obviously, the studies cited included surgeons who were part of a context of migration from the LRP to RARP technique, which was very common between the years 2000 and 2010, mainly in a European context.
The Reverse Systematic Review provided a new perspective on the evidence, allowing the heterogeneity of scenarios between different studies to increase the representativeness and external validation of the results. In addition, the weighting by the large number of patients allowed a greater dilution of the results and approximation to the population mean. The results presented in the tables can serve as reference values for individual comparisons by the reader and for future studies, since the narrow standard error of the mean increases precision with the population mean.
The limitations of the study are inherent to the methodology itself, since there is no control over heterogeneity. However, we know that greater heterogeneity can increase the representativeness of different clinical scenarios and proximity to the real world. Furthermore, the data are a global summary of the best that the urological community has produced over 20 years and probably come from centers with recognized scientific production and extensive experience, which limits extrapolations to less favored scenarios. This argument may be more valid for studies comparing open radical prostatectomy, but between LRP and RARP, most of the studies came from the same centers, but at different stages of technological and scientific development, as part of a natural history of radical prostatectomy [56].
These results, inserted in the current context of the robotic surgery era, where current knowledge is created from patients undergoing RARP, as well as the exclusive interest of major scientific journals and opinion makers in the robotic technique, means that LRP is limited to a transitional technique from open to robotic. However, in a heterogeneous global scenario with many countries still performing open surgery, LRP is certainly a less costly alternative and a well-established, mature and effective minimally invasive technique option, which was once considered the new gold standard [57], this time led by RARP [58].
It is worth mentioning that the discussion regarding functional and oncological outcomes were not considered in this study and, especially the latter, long-term outcomes must be analyzed with caution and have space for discussion.

The Reverse Systematic Review of comparative studies between LRP and RARP demonstrated a small clinical and practical difference in perioperative outcomes, mainly in relation to operative time, EBL and blood transfusion, favoring RARP. Although it is a small difference, within an evolutionary context of minimally invasive surgery, it demonstrates the improvement of techniques and the search for better scientifically proven results.
The laparoscopic technique has reached maturity and is an equivalently safe treatment option compared to RARP. It is important to emphasize that the robotic technique has become the most widely accepted LRP modality in the world and drives science and new technologies. New studies regarding long-term oncological safety are still needed within this comparison.

Author contributions

Moretti, TBC: development of methodology, reading of studies and composition of the database, statistical analysis and presentation of results, writing and discussion. Reis, LO: development of methodology, supervision. Maes, KU: paper design, supervision, writing, discussion.

Availability of data and materials

Not applicable.

Financial support and sponsorship

Moretti, TBC: Not applicable. Reis, LO: National Council for Scientific and Technological Development–CNPq, Research Productivity: 304747/2018-1 and 310135/2022-2. The funder was not involved in study design, data collection, data analysis, manuscript preparation, and/or publication decisions. Maes, KU: Not applicable.

Conflicts of interest

All authors declare that they have no competing interests.

Ethical approval and informed consent

Not applicable.

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61. Rocco B, Cozzi G, Spinelli MG, et al. Posterior musculofascial reconstruction after radical prostatectomy: A systematic review of the literature. Article. European Urology. 2012;62(5):779-790. doi:10.1016/j.eururo.2012.05.041
62. Sandoval Salinas C, González Rangel AL, Cataño Cataño JG, Fuentes Pachón JC, Castillo Londoño JS. Efficacy of Robotic-Assisted Prostatectomy in Localized Prostate Cancer: A Systematic Review of Clinical Trials. Adv Urol. 2013;2013doi:10.1155/2013/105651
63. Seo HJ, Lee NR, Son SK, Kim DK, Rha KH, Lee SH. Comparison of robot-assisted radical prostatectomy and open radical prostatectomy outcomes: A systematic review and meta-analysis. Article. Yonsei Medical Journal. 2016;57(5):1165-1177. doi:10.3349/ymj.2016.57.5.1165
64. Srougi V, Bessa J, Baghdadi M, et al. Surgical method influences specimen margins and biochemical recurrence during radical prostatectomy for high-risk prostate cancer: a systematic review and meta-analysis. Review. World journal of urology. 2017;35(10):1481-1488. doi:10.1007/s00345-017-2021-9
65. Steffens D, Thanigasalam R, Leslie S, Maneck B, Young JM, Solomon M. Robotic Surgery in Uro-oncology: A Systematic Review and Meta-analysis of Randomized Controlled Trials. Urology. 2017;106(1):9-17. doi:10.1016/j.urology.2017.03.015
66. Tai TE, Wu CC, Kang YN, Wu JC. Effects of Retzius sparing on robot-assisted laparoscopic prostatectomy: a systematic review with meta-analysis. Surg Endosc. Oct 2019;doi:10.1007/s00464-019-07190-2
67. Tal R, Alphs HH, Krebs P, Nelson CJ, Mulhall JP. Erectile function recovery rate after radical prostatectomy: a meta-analysis. J Sex Med. Sep 2009;6(9):2538-46. doi:10.1111/j.1743-6109.2009.01351.x
68. Tan A, Ashrafian H, Scott AJ, et al. Robotic surgery: disruptive innovation or unfulfilled promise? A systematic review and meta-analysis of the first 30 years. Review. Surgical Endoscopy and Other Interventional Techniques. Oct 2016;30(10):4330-4352. doi:10.1007/s00464-016-4752-x
69. Tewari A, Sooriakumaran P, Bloch DA, Seshadri-Kreaden U, Hebert AE, Wiklund P. Positive surgical margin and perioperative complication rates of primary surgical treatments for prostate cancer: A systematic review and meta-analysis comparing retropubic, laparoscopic, and robotic prostatectomy. Review. European Urology. 2012;62(1):1-15. doi:10.1016/j.eururo.2012.02.029
70. Tooher R, Swindle P, Woo H, Miller J, Maddern G. Laparoscopic radical prostatectomy for localized prostate cancer: a systematic review of comparative studies. J Urol. Jun 2006;175(6):2011-7. doi:10.1016/S0022-5347(06)00265-5
71. Touijer K, Guillonneau B. Laparoscopic radical prostatectomy: a critical analysis of surgical quality. Eur Urol. Apr 2006;49(4):625-32. doi:10.1016/j.eururo.2006.01.018
72. Trinh QD, Bjartell A, Freedland SJ, et al. A Systematic Review of the Volume–Outcome Relationship for Radical Prostatectomy. Eur Urol. Nov 2013;64(5):786-98. doi:10.1016/j.eururo.2013.04.012
73. Veccia A, Antonelli A, Francavilla S, et al. Minimally Invasive Radical Prostatectomy after Previous Bladder Outlet Surgery: A Systematic Review and Pooled Analysis of Comparative Studies. J Urol. 09 2019;202(3):511-517. doi:10.1097/JU.0000000000000312
74. Wang L, Wang B, Ai Q, et al. Long-term cancer control outcomes of robot-assisted radical prostatectomy for prostate cancer treatment: a meta-analysis. Int Urol Nephrol. 2017/02 2017;49(6):995-1005.
75. Weng H, Zeng XT, Li S, et al. Intrafascial versus interfascial nerve sparing in radical prostatectomy for localized prostate cancer: a systematic review and meta-analysis. Article. Scientific Reports. Sep 2017;7doi:10.1038/s41598-017-11878-7
76. Whiting PF, Moore THM, Jameson CM, et al. Symptomatic and quality-of-life outcomes after treatment for clinically localised prostate cancer: a systematic review. Review. Bju International. Aug 2016;118(2):193-204. doi:10.1111/bju.13499
77. Wilt TJ, MacDonald R, Rutks I, Shamilyan TA, Taylor BC, Kane RL. Systematic review: Comparative effectiveness and harms of treatments for clinically localized prostate cancer. Review. Annals of Internal Medicine. Mar 2008;148(6):435-448. doi:10.7326/0003-4819-148-6-200803180-00209
78. Yossepowitch O, Bjartell A, Eastham JA, et al. Positive surgical margins in radical prostatectomy: outlining the problem and its long-term consequences. Eur Urol. Jan 2009;55(1):87-99. doi:10.1016/j.eururo.2008.09.051
79. Yossepowitch O, Briganti A, Eastham JA, et al. Positive surgical margins after radical prostatectomy: A systematic review and contemporary update. Review. European Urology. 2014;65(2):303-313. doi:10.1016/j.eururo.2013.07.039
80. Yuh B, Artibani W, Heidenreich A, et al. The role of robot-assisted radical prostatectomy and pelvic lymph node dissection in the management of high-risk prostate cancer: A systematic review. Review. European Urology. 2014;65(5):918-927. doi:10.1016/j.eururo.2013.05.026

Selected studies for analysis are listed below (C^1-910):
1. Abbou CC, Hoznek A, Salomon L, et al. Laparoscopic radical prostatectomy with a remote controlled robot. J Urol. Jun 2001;165(6 Pt 1):1964-6. doi:10.1097/00005392-200106000-00027.
2. Abbou CC, Salomon L, Hoznek A, et al. Laparoscopic radical prostatectomy: preliminary results. Urology. May 2000;55(5):630-4.
3. Abdel Raheem A, Kim DK, Santok GD, et al. Stratified analysis of 800 Asian patients after robot-assisted radical prostatectomy with a median 64 months of follow up. Int J Urol. 09 2016;23(9):765-74. doi:10.1111/iju.13151
4. Abdollah F, Budäus L, Sun M, et al. Impact of caseload on total hospital charges: a direct comparison between minimally invasive and open radical prostatectomy--a population based study. J Urol. Mar 2011;185(3):855-61. doi:10.1016/j.juro.2010.10.051
5. Abdollah F, Dalela D, Sood A, et al. Intermediate-term cancer control outcomes in prostate cancer patients treated with robotic-assisted laparoscopic radical prostatectomy: a multi-institutional analysis. World J Urol. Oct 2016;34(10):1357-66. doi:10.1007/s00345-016-1781-y
6. Abdollah F, Sun M, Suardi N, et al. Prediction of functional outcomes after nerve-sparing radical prostatectomy: results of conditional survival analyses. Eur Urol. Jul 2012;62(1):42-52. doi:10.1016/j.eururo.2012.02.057
7. Abdollah F, Sun M, Suardi N, et al. A novel tool to assess the risk of urinary incontinence after nerve-sparing radical prostatectomy. BJU Int. May 2013;111(6):905-13. doi:10.1111/j.1464-410X.2012.11560.x
8. Abraham NE, Makarov DV, Laze J, Stefanovics E, Desai R, Lepor H. Patient centered outcomes in prostate cancer treatment: predictors of satisfaction up to 2 years after open radical retropubic prostatectomy. J Urol. Nov 2010;184(5):1977-81. doi:10.1016/j.juro.2010.06.099
9. Adam C, Salomon G, Walther S, et al. Photodynamic diagnosis using 5-aminolevulinic acid for the detection of positive surgical margins during radical prostatectomy in patients with carcinoma of the prostate: a multicentre, prospective, phase 2 trial of a diagnostic procedure. Eur Urol. Jun 2009;55(6):1281-8. doi:10.1016/j.eururo.2009.02.027
10. Afzal MZ, Tobert CM, Bulica E, Noyes SL, Lane BR. Modification of Technique for Suprapubic Catheter Placement After Robot-assisted Radical Prostatectomy Reduces Catheter-associated Complications. Urology. Aug 2015;86(2):401-6. doi:10.1016/j.urology.2015.02.078
11. Agarwal PK, Sammon J, Bhandari A, et al. Safety profile of robot-assisted radical prostatectomy: a standardized report of complications in 3317 patients. Eur Urol. May 2011;59(5):684-98. doi:10.1016/j.eururo.2011.01.045
12. Ahlering TE, Eichel L, Chou D, Skarecky DW. Feasibility study for robotic radical prostatectomy cautery-free neurovascular bundle preservation. Urology. May 2005;65(5):994-7. doi:10.1016/j.urology.2004.11.023
13. Ahlering TE, Eichel L, Edwards RA, Lee DI, Skarecky DW. Robotic radical prostatectomy: a technique to reduce pT2 positive margins. Urology. Dec 2004;64(6):1224-8. doi:10.1016/j.urology.2004.08.021
14. Ahlering TE, Eichel L, Edwards R, Skarecky DW. Impact of obesity on clinical outcomes in robotic prostatectomy. Urology. Apr 2005;65(4):740-4. doi:10.1016/j.urology.2004.10.061
15. Ahlering TE, Eichel L, Skarecky D. Rapid communication: early potency outcomes with cautery-free neurovascular bundle preservation with robotic laparoscopic radical prostatectomy. J Endourol. 2005 Jul-Aug 2005;19(6):715-8. doi:10.1089/end.2005.19.715
16. Ahlering TE, Eichel L, Skarecky D. Evaluation of long-term thermal injury using cautery during nerve sparing robotic prostatectomy. Urology. Dec 2008;72(6):1371-4. doi:10.1016/j.urology.2007.11.101
17. Ahlering TE, Kaplan AG, Yee DS, Skarecky DW. Prostate weight and early potency in robot-assisted radical prostatectomy. Urology. Dec 2008;72(6):1263-8. doi:10.1016/j.urology.2008.05.055
18. Ahlering TE, Rodriguez E, Skarecky DW. Overcoming obstacles: nerve-sparing issues in radical prostatectomy. J Endourol. Apr 2008;22(4):745-50. doi:10.1089/end.2007.9834
19. Ahlering TE, Skarecky D, Lee D, Clayman RV. Successful transfer of open surgical skills to a laparoscopic environment using a robotic interface: initial experience with laparoscopic radical prostatectomy. J Urol. Nov 2003;170(5):1738-41. doi:10.1097/01.ju.0000092881.24608.5e
20. Ahlering TE, Woo D, Eichel L, Lee DI, Edwards R, Skarecky DW. Robot-assisted versus open radical prostatectomy: a comparison of one surgeon's outcomes. Urology. May 2004;63(5):819-22. doi:10.1016/j.urology.2004.01.038
21. Akand M, Celik O, Avci E, Duman I, Erdogru T. Open, laparoscopic and robot-assisted laparoscopic radical prostatectomy: comparative analysis of operative and pathologic outcomes for three techniques with a single surgeon's experience. Eur Rev Med Pharmacol Sci. Feb 2015;19(4):525-31.
22. Al-Shaiji TF, Kanaroglou N, Thom A, et al. A cost-analysis comparison of laparoscopic radical prostatectomy versus open radical prostatectomy: the McMaster Institute of Urology experience. Can Urol Assoc J. Aug 2010;4(4):237-41. doi:10.5489/cuaj.09166
23. Albers P, Schäfers S, Löhmer H, de Geeter P. Seminal vesicle-sparing perineal radical prostatectomy improves early functional results in patients with low-risk prostate cancer. BJU Int. Nov 2007;100(5):1050-4. doi:10.1111/j.1464-410X.2007.07123.x
24. Albisinni S, Aoun F, LE Dinh D, et al. Comparing conventional laparoscopic to robotic-assisted extended pelvic lymph node dissection in men with intermediate and high-risk prostate cancer: a matched-pair analysis. Minerva Urol Nefrol. 02 2017;69(1):101-107. doi:10.23736/S0393-2249.16.02799-5
25. Alemozaffar M, Duclos A, Hevelone ND, et al. Technical refinement and learning curve for attenuating neurapraxia during robotic-assisted radical prostatectomy to improve sexual function. Eur Urol. Jun 2012;61(6):1222-8. doi:10.1016/j.eururo.2012.02.053
26. Alessandro S, Alessandro G, Susanna C, et al. Laparoscopic versus open radical prostatectomy in high prostate volume cases: impact on oncological and functional results. Int Braz J Urol. 2016 Mar-Apr 2016;42(2):223-33.
27. Alibhai SM, Leach M, Tomlinson G. Impact of hospital and surgeon volume on mortality and complications after prostatectomy. J Urol. Jul 2008;180(1):155-62; discussion 162-3. doi:10.1016/j.juro.2008.03.040
28. Allaf ME, Palapattu GS, Trock BJ, Carter HB, Walsh PC. Anatomical extent of lymph node dissection: impact on men with clinically localized prostate cancer. J Urol. Nov 2004;172(5 Pt 1):1840-4. doi:10.1097/01.ju.0000140912.45821.1d
29. Allaparthi SB, Hoang T, Dhanani NN, Tuerk IA. Significance of prostate weight on peri and postoperative outcomes of robot assisted laparoscopic extraperitoneal radical prostatectomy. Can J Urol. Oct 2010;17(5):5383-9.
30. Alvin LW, Gee SH, Hong HH, et al. Oncological outcomes following robotic-assisted radical prostatectomy in a multiracial Asian population. J Robot Surg. Sep 2015;9(3):201-9. doi:10.1007/s11701-015-0516-1
31. Anastasiadis AG, Salomon L, Katz R, Hoznek A, Chopin D, Abbou CC. Radical retropubic versus laparoscopic prostatectomy: a prospective comparison of functional outcome. Urology. Aug 2003;62(2):292-7.
32. Anceschi U, Gaffi M, Molinari C, Anceschi C. Posterior reconstruction and outcomes of laparoscopic radical prostatectomy in a high-risk setting. JSLS. 2013 Oct-Dec 2013;17(4):535-42. doi:10.4293/108680813X13794522666365
33. C A, B A, R I, et al. Extraperitoneal robot-assisted radical prostatectomy: Comparison with transperitoneal technique. World J Clin Urol. Jul 24, 2013 2013;2(2):3-9. doi:10.5410/wjcu.v2.i2.3
34. Anderson JE, Chang DC, Parsons JK, Talamini MA. The first national examination of outcomes and trends in robotic surgery in the United States. J Am Coll Surg. Jul 2012;215(1):107-14; discussion 114-6. doi:10.1016/j.jamcollsurg.2012.02.005
35. Antiphon P, Hoznek A, Benyoussef A, et al. Complete solo laparoscopic radical prostatectomy: initial experience. Urology. Apr 2003;61(4):724-8; discussion 728-9.
36. Arai Y, Egawa S, Terachi T, et al. Morbidity of laparoscopic radical prostatectomy: summary of early multi-institutional experience in Japan. Int J Urol. Aug 2003;10(8):430-4.
37. Arai Y, Egawa S, Tobisu K, et al. Radical retropubic prostatectomy: time trends, morbidity and mortality in Japan. BJU Int. Feb 2000;85(3):287-94. doi:10.1046/j.1464-410x.2000.00468.x
38. Arslan M, Tuncel A, Aslan Y, Kozacioglu Z, Gunlusoy B, Atan A. Comparison of the urethrovesical anastomoses with polyglecaprone (Monocryl®) and bidirectional barbed (V-Loc 180®) running sutures in laparoscopic radical prostatectomy. Arch Ital Urol Androl. Jun 2014;86(2):90-4. doi:10.4081/aiua.2014.2.90
39. Artibani W, Fracalanza S, Cavalleri S, et al. Learning curve and preliminary experience with da Vinci-assisted laparoscopic radical prostatectomy. Urol Int. 2008;80(3):237-44. doi:10.1159/000127333
40. Artibani W, Grosso G, Novara G, et al. Is laparoscopic radical prostatectomy better than traditional retropubic radical prostatectomy? An analysis of peri-operative morbidity in two contemporary series in Italy. Eur Urol. Oct 2003;44(4):401-6.
41. Asawabharuj K, Ramart P, Nualyong C, et al. Comparison of urinary continence outcome between robotic assisted laparoscopic prostatectomy versus laparoscopic radical prostatectomy. J Med Assoc Thai. Apr 2014;97(4):393-8.
42. Asimakopoulos AD, Annino F, D'Orazio A, et al. Complete periprostatic anatomy preservation during robot-assisted laparoscopic radical prostatectomy (RALP): the new pubovesical complex-sparing technique. Eur Urol. Sep 2010;58(3):407-17. doi:10.1016/j.eururo.2010.04.032
43. Asimakopoulos AD, Miano R, Di Lorenzo N, Spera E, Vespasiani G, Mugnier C. Laparoscopic versus robot-assisted bilateral nerve-sparing radical prostatectomy: comparison of pentafecta rates for a single surgeon. Surg Endosc. Nov 2013;27(11):4297-304. doi:10.1007/s00464-013-3046-9
44. Asimakopoulos AD, Pereira Fraga CT, Annino F, Pasqualetti P, Calado AA, Mugnier C. Randomized comparison between laparoscopic and robot-assisted nerve-sparing radical prostatectomy. J Sex Med. May 2011;8(5):1503-12. doi:10.1111/j.1743-6109.2011.02215.x
45. Asimakopoulos AD, Topazio L, De Angelis M, et al. Retzius-sparing versus standard robot-assisted radical prostatectomy: a prospective randomized comparison on immediate continence rates. Surg Endosc. 07 2019;33(7):2187-2196. doi:10.1007/s00464-018-6499-z
46. Atug F, Castle EP, Srivastav SK, Burgess SV, Thomas R, Davis R. Positive surgical margins in robotic-assisted radical prostatectomy: impact of learning curve on oncologic outcomes. Eur Urol. May 2006;49(5):866-71; discussion 871-2. doi:10.1016/j.eururo.2006.02.054
47. Atug F, Castle EP, Srivastav SK, Burgess SV, Thomas R, Davis R. Prospective evaluation of concomitant lymphadenectomy in robot-assisted radical prostatectomy: preliminary analysis of outcomes. J Endourol. Jul 2006;20(7):514-8. doi:10.1089/end.2006.20.514
48. Atug F, Castle EP, Woods M, Srivastav SK, Thomas R, Davis R. Transperitoneal versus extraperitoneal robotic-assisted radical prostatectomy: is one better than the other? Urology. Nov 2006;68(5):1077-81. doi:10.1016/j.urology.2006.07.008
49. Atug F, Kural AR, Tufek I, Srivastav S, Akpinar H. Anterior and posterior reconstruction technique and its impact on early return of continence after robot-assisted radical prostatectomy. J Endourol. Apr 2012;26(4):381-6. doi:10.1089/end.2010.0654
50. Augustin H, Hammerer P, Graefen M, et al. Intraoperative and perioperative morbidity of contemporary radical retropubic prostatectomy in a consecutive series of 1243 patients: results of a single center between 1999 and 2002. Eur Urol. Feb 2003;43(2):113-8. doi:10.1016/s0302-2838(02)00495-5
51. Augustin H, Pummer K, Daghofer F, Habermann H, Primus G, Hubmer G. Patient self-reporting questionnaire on urological morbidity and bother after radical retropubic prostatectomy. Eur Urol. Aug 2002;42(2):112-17. doi:10.1016/s0302-2838(02)00259-2
52. Awad H, Santilli S, Ohr M, et al. The effects of steep trendelenburg positioning on intraocular pressure during robotic radical prostatectomy. Anesth Analg. Aug 2009;109(2):473-8. doi:10.1213/ane.0b013e3181a9098f
53. Ayyathurai R, Manoharan M, Nieder AM, Kava B, Soloway MS. Factors affecting erectile function after radical retropubic prostatectomy: results from 1620 consecutive patients. BJU Int. Apr 2008;101(7):833-6. doi:10.1111/j.1464-410X.2007.07409.x
54. Badani KK, Kaul S, Menon M. Evolution of robotic radical prostatectomy: assessment after 2766 procedures. Cancer. Nov 2007;110(9):1951-8. doi:10.1002/cncr.23027
55. Ball AJ, Gambill B, Fabrizio MD, et al. Prospective longitudinal comparative study of early health-related quality-of-life outcomes in patients undergoing surgical treatment for localized prostate cancer: a short-term evaluation of five approaches from a single institution. J Endourol. Oct 2006;20(10):723-31. doi:10.1089/end.2006.20.723
56. Barbosa HoN, Siqueira TM, Barreto F, Menezes LG, Luna MJ, Calado AA. 4-Ports endoscopic extraperitoneal radical prostatectomy: preliminary and learning curve results. Int Braz J Urol. 2016 May-Jun 2016;42(3):438-48.
57. Barnoiu OS, Baron Lopez F, Garcia Galisteo E, et al. Comprehensive prediction model of urinary incontinence one year following robot-assisted radical prostatectomy. Urol Int. 2013;90(1):31-5. doi:10.1159/000343735
58. Barnoiu OS, Garcia Galisteo E, Baron Lopez F, et al. Prospective urodynamic model for prediction of urinary incontinence after robot-assisted radical prostatectomy. Urol Int. 2014;92(3):306-9. doi:10.1159/000354352
59. Barocas DA, Salem S, Kordan Y, et al. Robotic assisted laparoscopic prostatectomy versus radical retropubic prostatectomy for clinically localized prostate cancer: comparison of short-term biochemical recurrence-free survival. J Urol. Mar 2010;183(3):990-6. doi:10.1016/j.juro.2009.11.017
60. Barré C. Open radical retropubic prostatectomy. Eur Urol. Jul 2007;52(1):71-80. doi:10.1016/j.eururo.2006.11.057
61. Barry MJ, Gallagher PM, Skinner JS, Fowler FJ. Adverse effects of robotic-assisted laparoscopic versus open retropubic radical prostatectomy among a nationwide random sample of medicare-age men. J Clin Oncol. Feb 2012;30(5):513-8. doi:10.1200/JCO.2011.36.8621
62. Baumert H, Fromont G, Adorno Rosa J, Cahill D, Cathelineau X, Vallancien G. Impact of learning curve in laparoscopic radical prostatectomy on margin status: prospective study of first 100 procedures performed by one surgeon. J Endourol. Mar 2004;18(2):173-6. doi:10.1089/089277904322959824
63. Begg CB, Riedel ER, Bach PB, et al. Variations in morbidity after radical prostatectomy. N Engl J Med. Apr 2002;346(15):1138-44. doi:10.1056/NEJMsa011788
64. Bentas W, Wolfram M, Jones J, Bräutigam R, Kramer W, Binder J. Robotic technology and the translation of open radical prostatectomy to laparoscopy: the early Frankfurt experience with robotic radical prostatectomy and one year follow-up. Eur Urol. Aug 2003;44(2):175-81. doi:10.1016/s0302-2838(03)00256-2
65. Berge V, Berg RE, Hoff JR, et al. A prospective study of transition from laparoscopic to robot-assisted radical prostatectomy: quality of life outcomes after 36-month follow-up. Urology. Apr 2013;81(4):781-6. doi:10.1016/j.urology.2013.01.017
66. Bhandari A, McIntire L, Kaul SA, Hemal AK, Peabody JO, Menon M. Perioperative complications of robotic radical prostatectomy after the learning curve. J Urol. Sep 2005;174(3):915-8. doi:10.1097/01.ju.0000169458.96014.f8
67. Bhayani SB, Pavlovich CP, Hsu TS, Sullivan W, Su L. Prospective comparison of short-term convalescence: laparoscopic radical prostatectomy versus open radical retropubic prostatectomy. Urology. Mar 2003;61(3):612-6.
68. Bianco FJ, Grignon DJ, Sakr WA, et al. Radical prostatectomy with bladder neck preservation: impact of a positive margin. Eur Urol. May 2003;43(5):461-6. doi:10.1016/s0302-2838(03)00103-9
69. Bianco FJ, Scardino PT, Eastham JA. Radical prostatectomy: long-term cancer control and recovery of sexual and urinary function ("trifecta"). Urology. Nov 2005;66(5 Suppl):83-94. doi:10.1016/j.urology.2005.06.116
70. Bickert D, Frickel D. Laparoscopic radical prostatectomy. AORN J. Apr 2002;75(4):762-6, 768-74, 777-80 passim; quiz 785-90.
71. Biki B, Mascha E, Moriarty DC, Fitzpatrick JM, Sessler DI, Buggy DJ. Anesthetic technique for radical prostatectomy surgery affects cancer recurrence: a retrospective analysis. Anesthesiology. Aug 2008;109(2):180-7. doi:10.1097/ALN.0b013e31817f5b73
72. Billia M, Elhage O, Challacombe B, et al. Oncological outcomes of robotic-assisted radical prostatectomy after more than 5 years. World J Urol. Apr 2014;32(2):413-8. doi:10.1007/s00345-013-1120-5
73. Binder J, Kramer W. Robotically-assisted laparoscopic radical prostatectomy. BJU Int. Mar 2001;87(4):408-10. doi:10.1046/j.1464-410x.2001.00115.x
74. Bivalacqua TJ, Pierorazio PM, Gorin MA, Allaf ME, Carter HB, Walsh PC. Anatomic extent of pelvic lymph node dissection: impact on long-term cancer-specific outcomes in men with positive lymph nodes at time of radical prostatectomy. Urology. Sep 2013;82(3):653-8. doi:10.1016/j.urology.2013.03.086
75. Bivalacqua TJ, Schaeffer EM, Alphs H, et al. Intraperitoneal effects of extraperitoneal laparoscopic radical prostatectomy. Urology. Aug 2008;72(2):273-7. doi:10.1016/j.urology.2007.12.040
76. Blana A, Straub M, Wild PJ, et al. Approach to endoscopic extraperitoneal radical prostatectomy (EERPE): the impact of previous laparoscopic experience on the learning curve. BMC Urol. Jul 2007;7:11. doi:10.1186/1471-2490-7-11
77. Boczko J, Erturk E, Golijanin D, Madeb R, Patel H, Joseph JV. Impact of prostate size in robot-assisted radical prostatectomy. J Endourol. Feb 2007;21(2):184-8. doi:10.1089/end.2006.0163
78. Boczko J, Erturk E, Joseph JV. Is there a proper pelvic size for an extraperitoneal robot-assisted radical prostatectomy? J Endourol. Nov 2007;21(11):1353-6. doi:10.1089/end.2007.9898
79. Bolenz C, Gupta A, Hotze T, et al. Cost comparison of robotic, laparoscopic, and open radical prostatectomy for prostate cancer. Eur Urol. Mar 2010;57(3):453-8. doi:10.1016/j.eururo.2009.11.008
80. Bolenz C, Gupta A, Roehrborn CG, Lotan Y. Predictors of costs for robotic-assisted laparoscopic radical prostatectomy. Urol Oncol. 2011 May-Jun 2011;29(3):325-9. doi:10.1016/j.urolonc.2011.01.016
81. Bollens R, Vanden Bossche M, Roumeguere T, et al. Extraperitoneal laparoscopic radical prostatectomy. Results after 50 cases. Eur Urol. Jul 2001;40(1):65-9. doi:49750
82. Boorjian SA, Crispen PL, Carlson RE, et al. Impact of obesity on clinicopathologic outcomes after robot-assisted laparoscopic prostatectomy. J Endourol. Jul 2008;22(7):1471-6. doi:10.1089/end.2008.0056
83. Boorjian SA, Karnes RJ, Crispen PL, et al. The impact of positive surgical margins on mortality following radical prostatectomy during the prostate specific antigen era. J Urol. Mar 2010;183(3):1003-9. doi:10.1016/j.juro.2009.11.039
84. Borin JF, Skarecky DW, Narula N, Ahlering TE. Impact of urethral stump length on continence and positive surgical margins in robot-assisted laparoscopic prostatectomy. Urology. Jul 2007;70(1):173-7. doi:10.1016/j.urology.2007.03.050
85. Boris RS, Kaul SA, Sarle RC, Stricker HJ. Radical prostatectomy: a single surgeon comparison of retropubic, perineal, and robotic approaches. Can J Urol. Jun 2007;14(3):3566-70.
86. Bove P, Iacovelli V, Celestino F, De Carlo F, Vespasiani G, Finazzi Agrò E. 3D vs 2D laparoscopic radical prostatectomy in organ-confined prostate cancer: comparison of operative data and pentafecta rates: a single cohort study. BMC Urol. Feb 2015;15:12. doi:10.1186/s12894-015-0006-9
87. Braslis KG, Bowsher WG, Joyce G, Peters J, Costello AJ. Evolving experience with radical prostatectomy. Br J Urol. Sep 1993;72(3):341-8. doi:10.1111/j.1464-410x.1993.tb00730.x
88. Breyer BN, Davis CB, Cowan JE, Kane CJ, Carroll PR. Incidence of bladder neck contracture after robot-assisted laparoscopic and open radical prostatectomy. BJU Int. Dec 2010;106(11):1734-8. doi:10.1111/j.1464-410X.2010.09333.x
89. Brien JC, Barone B, Fabrizio M, Given R. Posterior reconstruction before vesicourethral anastomosis in patients undergoing robot-assisted laparoscopic prostatectomy leads to earlier return to baseline continence. J Endourol. Mar 2011;25(3):441-5. doi:10.1089/end.2010.0251
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