To investigate the current evidence in post-operative outcomes to support the use of Robotic-Assisted Laparoscopic (radical) Prostatectomy (RALP) over Laparoscopic Radical Prostatectomy (LRP) in cases of organ-confined prostate cancer

Objective: To investigate the current evidence in post-operative outcomes to support the use of Robotic-Assisted Laparoscopic (radical) Prostatectomy (RALP) over Laparoscopic Radical Prostatectomy (LRP) in cases of organ-confined prostate cancer. Methods: A systematic review was performed according to PRISMA/MOOSE guidelines. Dichotomous variables were pooled as odds ratios (OR). Continuous variables were pooled as weighted mean differences (WMD). Quality assessment was performed using the Newcastle-Ottawa score (NOS). Results: Four suitable randomised controlled studies were identified from the literature. 1026 male patients with prostate cancer (LRP n=342, 33.33%; RALP n= 684, 66.67%) were identified as eligible for inclusion. These patients were randomised for definitive operative management to RALP or LRP. There was no statistically significant difference identified in operative time (MD -2.81, 95% CI -12.92 – 7.31, I ² = 77%, P = 0.59). There was no statistically significant difference identified in operative blood-loss (MD -9.34, 95% CI -55.81 +37.12, I ² = 77%, P = 0.69). There was no statistically significant difference identified in biochemical recurrence free rates at 12 months. Statistically significant differences were identified in meta-analysis of post-operative urinary continence, and post-operative potency. These favoured RALP over LRP. No statistically significant difference was identified in operative time, operative blood-loss, or biochemical recurrence free rates at 12 months. Conclusion: There is an statistically significant improved post-operative profile of patients having undergone RALP v LRP, in particular with respect to return of sexual function and urinary continence. There was no statistical difference identified in intra-operative blood-loss, perioperative complications, or operative time.