Table 2.
RASP versus open simple prostatectomy (OSP) and minimally invasive simple prostatectomy comparative studies.
| Reference | Versus | Study Design | Number of Cases | Baseline Characteristics | Main Findings |
|---|---|---|---|---|---|
| Pavan et al. [39] | LSP | Multileft retrospective | 319 (LSP = 189; RASP = 130) |
Median prostate volume larger for RASP (118.5 versus 109 mL; p = 0.02) | -No significant difference for blood loss, catheter time, hospital stay, major complication rate -On MVA technique not influencing ‘trifecta’ outcome |
| Martin Garzon et al. [38] | LSP | Single left retrospective | 315 (LSP = 82; IF-RASP = 75) |
No differences | -Similar surgical outcomes and functional outcomes at 1 year |
| Umari et al. [40] | HoLEP | Single left retrospective | 126 (HoLEP = 45; RASP = 81) |
RASP patients younger (median age 69 versus 74, p = 0.032), less healthy (Charlson index >2 in 62% versus 29%, p < 0.001), with higher preoperative IPSS (25 versus 21, p = 0.049) | -Similar improvement for Qmax, PVR, IPSS -Similar operative time -Catheter time (3 versus 2, p = 0.005) and hospital stay (4 versus 2 days, p = 0.0001) longer for RASP -Complication rates similar |
| Zhang et al. [40] | HoLEP | Bileft retrospective | 632 (HoLEP = 600; RASP = 32) |
No differences | -Mean operative time shorter for HoLEP (103 versus 274 min, p < 0.001 -HoLEP with lower transfusion rate (1.8 versus 9.4%, p = 0.03), shorter catheter time (0.7 versus 8 days, p < 0.001), and shorter hospital stay (1.3 versus 2.3 days, p < 0.001) -Complication rates similar |
| Sorokin et al. [42] | OSP | Single left retrospective propensity score matched | 188 (OSP = 59; RASP = 59) |
No differences | -RASP with shorter mean hospital stay (1.5 versus 2.6 days, p < 0.001), but longer operative time (161 versus 93 min, p < 0.001) -Lower blood loss (339 versus 587 mL, p < 0.001) and hemoglobin drop (12.3% versus 19.5%, p = 0.001) for RASP -No differences in transfusion rates, functional outcomes, complication rate |
| Mourmouris et al. [43] | OSP | Bileft prospective | 41 (OSP = 15; RASP = 26) |
RASP patients younger (median age 66.73 versus 70.46 p = 0.032), | -RASP achieves similar functional outcomes and provides significant advantages, such as decreased blood loss, faster catheter removal (because of the uneventful postoperative course), a shorter LOS and a lower complication rate, at the cost of a longer operating time |
| Nestler et al. [44] | OSP, ThuVEP | Multileft, Matched Pair Analysis |
105 (OSP = 35; RASP = 35; ThuVEP = 35) |
No differences | -Blood loss in OSP was significantly higher compared to the minimal invasive approaches. ThuVEP showed a median operation time of 83 min and was therefore significantly faster than OSP with 130 min (p = 0.004) and RASP needing 182 min. Significant advantages for the minimal invasive approaches compared to open surgery concerning blood loss, transfusion rates and early continence |
| Autorino et al. [37] | LSP | Multileft, Retrospective |
1330 (RASP = 487; LSP = 843) |
Median Charlson Index for LSP patients: 4 and for RASP patients: 2 Median prostate volume is larger in RASP patients (110 versus 99 mL) |
Trifecta outcome, arbitrarily defined as a combination of the following postoperative events: International Prostate Symptom Score <8, maximum flow rate >15 mL/s, and no perioperative complications. Trifecta outcome was not significantly influenced by the type of procedure (robotic versus laparoscopic; p = 0.136; odds ratio: 1.6; 95% confidence interval, 0.8–2.9), whereas operative time (p = 0.01; OR: 0.9; 95% CI, 0.9–1.0) and estimated blood loss (p = 0.03; OR: 0.9; 95% CI, 0.9–1.0) were the only two significant factors. |
| Hoy et al. [36] | OSP | Single left Retrospective |
32 (RASP = 4; OSP = 28) |
No differences RASP patients younger (median age 69.3 versus 75.18, p = 0.17), Prostate volume on TRUS (mL); RASP = 239 ± 49.8 OSP = 180 ± 54.7 0.09 |
-There was a significant difference in the mean length of operation, with RASP exceeding OSP (161 versus 79 min; p = 0.008). -The mean intraoperative blood loss was significantly higher in the open group (835.7 versus 218.8 mL; p = 0.0001). -Mean LOS was shorter in the RASP group (2.3 versus 5.5 days; p = 0.0001). -No significant differences were noted in the 90-day transfusion rate (p = 0.13), or overall complication rate at 0% with RASP versus 57.1% with OSP (p = 0.10). |
HoLEP, Holmium laser enucleation of the prostate, ThuVEP: Thulium laser VapoEnucleation, IF-RASP, intrafascial robotic assisted simple prostatectomy, LSP, laparoscopic simple prostatectomy, MVA, multivariable analysis, OSP, open simple prostatectomy, PVR, postvoid residual.