Comparing robotic, laparoscopic and open cystectomy: a systematic review and meta-analysis

Area of Science:

• Urology
• Surgical Oncology
• Minimally Invasive Surgery

Background:

• Radical cystectomy is a standard treatment for muscle-invasive bladder cancer.
• Open, laparoscopic, and robot-assisted approaches exist, each with potential benefits and drawbacks.

Purpose of the Study:

• To systematically review and meta-analyze surgical and oncological outcomes of Open Radical Cystectomy (ORC), Laparoscopic Radical Cystectomy (LRC), and Robot-assisted Radical Cystectomy (RARC).
• To compare RARC vs. LRC, RARC vs. ORC, and LRC vs. ORC.

Main Methods:

• Systematic literature review and meta-analysis.
• Inclusion of studies comparing RARC, LRC, and ORC.
• Extraction and analysis of surgical and oncological outcome data.

Main Results:

• RARC demonstrated longer operative times than LRC but similar length of stay and estimated blood loss.
• RARC showed shorter length of stay, reduced blood loss, and fewer complications than ORC, with longer operative times.
• No significant differences in lymph node yield or positive surgical margins were observed between RARC and LRC, or RARC and ORC.
• LRC had reduced blood loss and shorter length of stay compared to ORC, with increased operative time.

Conclusions:

• Robot-assisted radical cystectomy (RARC) is comparable to laparoscopic radical cystectomy (LRC) and offers better surgical outcomes than open radical cystectomy (ORC).
• Laparoscopic radical cystectomy (LRC) also provides better surgical outcomes than open radical cystectomy (ORC).
• The technological advantages of robotic systems and intra-corporeal reconstruction suggest RARC may become the preferred surgical approach.