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Lower vs standard pressure pneumoperitoneum in robotic-assisted radical prostatectomy: a systematic review and meta-analysis

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Abstract

Robotic-assisted laparoscopic radical prostatectomy (RARP) has been traditionally performed at a pneumoperitoneum insufflation pressure of 12–15 mmHg. This meta-analysis and systematic review aims to assess the current evidence comparing lower to standard pressure pneumoperitoneum in RARP. Systematic searches of MEDLINE, COCHRANE, SCOPUS and EMBASE were performed to identify articles published up until November 2021 comparing lower pressure with standard pressure pneumoperitoneum in RARP. Standard pressure was defined as > 12 mmHg and lower pressure ≤ 12 mmHg. Estimated blood loss, length of operation, length of hospital stay, post-operative ileus, 30-day readmissions, Clavien–Dindo complications and rate of positive surgical margins were extracted as endpoints of interest. Our searches identified 165 abstracts of which 4 articles with 1319 patients were eligible. Cumulative analysis demonstrated reduced length of stay when a lower pressure was used: WMD − 0.23 (− 0.45 to − 0.02) days (p = 0.03) as well as a reduced rate of post-operative ileus: OR 0.41 (0.22 to 0.77) (p = 0.006). There was no significant increase in length of operation WMD − 1.79 (− 15.96 to 12.38) (p = 0.8), estimated blood loss WMD − 2.89 (− 29.41 to 23.62) (p = 0.83), 30-day readmissions or positive surgical margins OR 1.04 (0.78 to 1.38) (p = 0.81) and RD − 0.01 (− 0.04 to 0.01) (p = 0.3) when using a lower pressure. We have demonstrated reduced length of stay and rates of post-operative ileus, when performing RARP at a lower pressure without a significant increase in length of operation, estimated blood loss, positive surgical margins or complications. The recommendation to use lower pressure pneumoperitoneum is moderate to weak and more randomised control trials are required to validate these results.

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Authors and Affiliations

  1. Department of Urology, Royal Liverpool and Broadgreen University Hospitals, Prescot St, Liverpool, L7 8XP, UK

    Omar El-Taji, Samih Taktak & Vishwanath Hanchanale

  2. School of Health and Life Sciences, University of Liverpool, Liverpool, UK

    Omar El-Taji, Jack Howell-Etienne & Vishwanath Hanchanale

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  1. Omar El-Taji
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  2. Jack Howell-Etienne
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  3. Samih Taktak
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  4. Vishwanath Hanchanale
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Contributions

All the authors contributed to the study conception and design. Material preparation, data collection and analysis were performed by OE-T, JH-E, ST and VH. The first draft of the manuscript was written by OE-T and all the authors commented on previous versions of the manuscript. All the authors read and approved the final manuscript.

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Correspondence to Omar El-Taji.

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Omar El-Taji, Jack Howell-Etienne, Samih Taktak and Vishwanath Hanchanale declare that they have no conflict of interest and declare that no funds, grants, or other support were received during the preparation of this manuscript.

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El-Taji, O., Howell-Etienne, J., Taktak, S. et al. Lower vs standard pressure pneumoperitoneum in robotic-assisted radical prostatectomy: a systematic review and meta-analysis. J Robotic Surg 17, 303–312 (2023). https://doi.org/10.1007/s11701-022-01445-2

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  • DOI: https://doi.org/10.1007/s11701-022-01445-2

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