Editorial Comment: Comparing Robot-Assisted Surgery Outcomes in Urology With Those From Open and Laparoscopic Techniques: A Systematic Review
Notice bibliographique
Résumé
In this interesting systematic review, McGill et al1 aim to support surgeons, commissioners, and other health service leaders to understand how robot-assisted surgery compares with open and laparoscopic techniques with respect to clinical outcomes when performing radical prostatectomy, radical cystectomy, and nephrectomy. In total, 17 studies were used for robotic-assisted radical prostatectomy, 13 for radical cystectomy, and 15 for nephrectomies (10 for partial and 5 for radical). It is very important to mention that in experienced hands, the oncological outcomes are comparable with the 3 approaches (robotic, open, and laparoscopic) when performing these types of surgeries. The authors confirm that a robotic-assisted radical prostatectomy offers the patient less blood loss and transfusion rates when compared with the open or laparoscopic approaches. Regarding complications, it will really depend on surgeon experience, patient comorbidities, and patient selection in the series of cases analyzed in this systematic review. Having said this, the robotic approach in this systematic review shows a tendency for less complication-related events as well as less length of stay than the open and laparoscopic techniques. With respect to cost effectiveness as indicated by quality-adjusted life years, the robotic approach had a tendency to be superior then the open and laparoscopic techniques. For this reason, the authors support the use of the robotic approach for prostate cancer and recommend that surgical centers have a default position of prioritizing the use of robotic devices for this purpose. We clearly agree on this, however, if there is no access to a robotic system, patients should select the surgeon with the most experience in either open or laparoscopic techniques that can give them results comparable with the robotic approach. For cystectomies, the authors report less transfusions and blood loss for the robotic approach compared with open approach. There was no difference when compared with the laparoscopic approach. With respect to complications, although there is no definitive difference between approaches, it is difficult to really compare an open approach to a combination of studies involving intracorporeal and extracorporeal urinary diversion reconstruction using the robotic approach. This could also influence on finding no difference in hospital stay for the robotic approach in comparison with open and laparoscopic techniques. Having said this, there is no mention on “ERAS” protocol usage for all of the approaches evaluated. With respect to nephrectomy, there is clearly less hospital stay with the robotic approach compared with the open, but similar when compared with the laparoscopic technique. However, in this systematic review, it is difficult to differentiate partial nephrectomies and radical nephrectomies. They did not specify also if retroperitoneal lymphadenectomy was performed for radical nephrectomies. Finally, we can say that radical cystectomies and nephrectomies are performed more and more robotically. Surgeons feel comfortable with the robotic approach. There is a need to proof its cost effectiveness, but it clearly depends on surgeon experience and appropriate patient selection.
Récupéré en direct depuis OpenAlex et désinversé. Les résumés ne sont pas conservés dans cette base de données : les index inversés représentent 8,6 Go des 9,3 Go de texte de la base, et le serveur dispose de 13 Go libres.
Comment cette classification a été obtenuedéplier
Prédiction machine sur la base complète
Imitation des enseignantsNi prévalence calibrée, ni vérité terrain. Validation humaine à venir. Le volet Gemma est une étiquette directe du modèle pour chaque travail de la base, lue sur la notice réduite au titre. Le volet Codex est un classifieur appris des 10 348 étiquettes directes de Codex et calibré sur les taux pondérés de l'échantillon; les champs sans appui suffisant ne portent aucun appel Codex. Le mode candidate est l'union des deux volets; le consensus est leur intersection. Ces sorties portent le statut machine_predicted_unvalidated et ne sont pas des étiquettes humaines.
Scores du classifieur distillé par catégorie (deux têtes)
| Catégorie | Codex | Gemma |
|---|---|---|
| Métarecherche | 0,024 | 0,127 |
| Méta-épidémiologie (sens strict) | 0,002 | 0,001 |
| Méta-épidémiologie (sens large) | 0,005 | 0,005 |
| Bibliométrie | 0,004 | 0,003 |
| Études des sciences et des technologies | 0,002 | 0,003 |
| Communication savante | 0,005 | 0,006 |
| Science ouverte | 0,006 | 0,002 |
| Intégrité de la recherche | 0,019 | 0,012 |
| Charge utile insuffisante (le modèle a refusé de juger) | 0,013 | 0,005 |
Scores machine (provisoires)
Les deux têtes enseignantes du modèle étudiant, lues sur ce travail. Un score ordonne la base pour la relecture; il n'affirme jamais une catégorie, et le statut de validation accompagne chaque rangée tel quel.
Scores de référence d'un modèle non mature (critères de maturité non atteints, 7 itérations). Un score ordonne; il n'affirme jamais une catégorie.
score_only:v0-immature-baseline · tel quel depuis la passe de notation : score_only signifie que le nombre peut ordonner les travaux, et qu'aucune étiquette de catégorie n'en découleClassification
machine, non validéePrédiction automatique; un appel candidat d’une seule source (Gemma direct ou Codex distillé), pas un consensus.
Le détail, modèle par modèle et score par score, se trouve en fin de page sous « Comment cette classification a été obtenue ».