| Robotics Compared to Retropubic: Prostate Cancer | ||||||
|---|---|---|---|---|---|---|
| Outcomes | Illustrative comparative risks* (95% CI) |
Relative effect (95% CI) | No of Participants (studies) | Quality of the evidence (GRADE) | Comments** | |
| Assumed risk | Corresponding risk | |||||
| Retropubic | Robotic | |||||
| Erectile Dysfunction | Study population | OR 0.44 (0.25 to 0.79) |
1039 (4 studies) | □□⊖⊖ low1,2 |
RB > RP | |
| 452 per 1000 | 266 per 1000 (171 to 395) | |||||
| Medium risk population | ||||||
| 506 per 1000 | 311 per 1000 (204 to 447) | |||||
| Positive Surgical Margins | Study population | OR 0.60 (0.44 to 0.82) |
1308 (9 studies) | □□⊖⊖ low3 |
RB > RP | |
| 183 per 1000 | 118 per 1000 (90 to 155) | |||||
| Medium risk population | ||||||
| 104 per 1000 | 65 per 1000 (49 to 87) | |||||
| Urinary Incontinence | Study population | OR 0.42 (0.1 to 1.85) |
1224 (3 studies) | □⊖⊖⊖ low4,5,6 |
n/a | |
| 86 per 1000 | 38 per 1000 (9 to 148) | |||||
| Medium risk population | ||||||
| 120 per 1000 | 54 per 1000 (13 to 201) | |||||
| Length of Hospitalization | The mean length of hospitalization in the intervention groups was 0.23 lower (0.44 to 0.02 lower) | 802 (3 studies) | □□⊖⊖ low |
RB > RP | ||
| Blood Loss | The mean blood loss in the intervention groups was 652.86 lower (819.13 to 486.6 lower) | 802 (3 studies) | □□⊖⊖ low |
RB > RP | ||
| Transfusions | Study population | OR 0.14 (0.05 to 0.36) |
2852 (7 studies) | □□⊖⊖ low2 |
RB > RP | |
| 223 per 1000 | 39 per 1000 (14 to 94) | |||||
| Medium risk population | ||||||
| 167 per 1000 | 27 per 1000 (10 to 67) | |||||
| Operation Time | The mean operation time in the intervention groups was 0.72 higher (0.01 to 1.44 higher) | 842 (4 studies) | □□⊖⊖ low2 |
RB < RP | ||
| Complications | Study population | OR 0.46 (0.15 to 1.42) | 2212 (4 studies) | □⊖⊖⊖ very low2,7 |
n/a | |
| 382 per 1000 | 221 per 1000 (85 to 467) | |||||
| Medium risk population | ||||||
| 260 per 1000 | 139 per 1000 (50 to 333) | |||||
| Post-Operative Pain | The mean post-operative pain in the intervention groups was 8.55 lower (15.62 to 1.47 lower) | 1055 (3 studies) | □□⊖⊖ low |
RB > RP | ||
| Catheterization Duration | The mean catheterization duration in the intervention groups was 1.5 lower (2.77 to 0.23 lower) | 60 (1 study) | □□⊖⊖ low |
RB > RP | ||
| Anastomotic Stricture | Study population | OR 0.25 (0.05 to 1.23) |
2794 (3 studies) | □□⊖⊖ low |
n/a | |
| 40 per 1000 | 10 per 1000 (2 to 49) | |||||
| Medium risk population | ||||||
| 45 per 1000 | 12 per 1000 (2 to 55) | |||||
The basis for the assumed risk (e.g. the median control group risk across studies) is provided in footnotes. The corresponding risk (and its 95% confidence interval) is based on the assumed risk in the comparison group and the relative effect of the intervention (and its 95% CI).
RB > RP indicates that robotics had a more favourable profile for the specific outcome; RB < RP indicates robotics had a less favourable profile for the specific outcome.
CI: Confidence interval; OR: Odds ratio; RB: Robotics; RP: Retropubic.
GRADE Working Group grades of evidence
High quality: Further research is very unlikely to change our confidence in the estimate of effect.
Moderate quality: Further research is likely to have an important impact on our confidence in the estimate of effect and may change the estimate.
Low quality: Further research is very likely to have an important impact on our confidence in the estimate of effect and is likely to change the estimate.
Very low quality: We are very uncertain about the estimate.
Measurement of erectile dysfunction was not consistent across studies.
Level of surgeon skill differed across studies.
Differences in pathology review across studies, some of which are unknown.
Measurement of urinary continence was measured and characterized inconsistently.
Experienced surgeons had a more favourable profile for robotic surgery.
Stage difference in one study, with more advanced tumours in the retropubic surgery group.
Differences in the reporting of complications may have contributed to the inconsistency.