Development and application of Reverse Systematic Review on laparoscopic radical prostatectomy

Area of Science:

• Surgical innovation and evidence-based medicine
• Systematic review methodology and meta-analysis
• Health informatics and bibliometrics

Background:

• Traditional systematic reviews (SRs) face limitations in assessing surgical technique maturity due to outcome specificity and potential bias.
• Evaluating the full lifecycle and developmental trajectory of surgical procedures requires novel analytical approaches beyond standard SRs.
• Understanding the evolution of surgical techniques is crucial for evidence-based practice and future advancements.

Purpose of the Study:

• To introduce and validate a Reverse Systematic Review (RSR) methodology incorporating temporal population analysis.
• To apply the RSR methodology to the well-established surgical technique of laparoscopic radical prostatectomy (LRP).
• To delineate the development, trends, and scientific maturity of LRP from 2000 to 2017.

Main Methods:

• A systematized search was conducted to gather primary studies for a comprehensive database, including clinical-surgical and bibliometric variables.
• Quantitative, qualitative, and temporal correlations were performed on study variables to identify trends in outcomes, geographic distribution, and bibliometrics.
• The RSR methodology was utilized to analyze the evolution of LRP, focusing on its development trajectory and scientific influences.

Main Results:

• Analysis of 40 SRs (from 353) and 238 primary studies revealed a concentration of research in Europe and the USA until 2011.
• A significant shift in publication focus from LRP to robotic-assisted surgery was observed post-2011, indicating a change in research trends.
• While operative time, blood loss, and conversion rates trended downwards, only biochemical recurrence showed a positive correlation with publication year, stabilizing over time.

Conclusions:

• The Reverse Systematic Review (RSR) is a feasible and effective method for demonstrating a surgical technique's evolution and
• The RSR methodology successfully identified scientific influencers and potential biases within the literature, providing insights into the development of evidence.
• This approach allows for tracing the developmental curve of a surgical technique to its scientific maturity, aiding in comparative analyses of different procedures.