REVIEW   Free access

Minerva Urology and Nephrology 2023 April;75(2):144-53

DOI: 10.23736/S2724-6051.22.05160-6

Copyright © 2022 EDIZIONI MINERVA MEDICA

language: English

To drain or not to drain in uro-oncological robotic surgery? A systematic review and meta-analysis

Angelo TERRITO ¹ ✉, Michael BABOUDJIAN ^{1, 2, 3, 4}, Pietro DIANA ^{1, 5}, Andrea GALLIOLI ¹, Paolo VERRI ¹, Alessandro ULERI ¹, Giuseppe BASILE ¹, Alessandro TEDDE ¹, Josep M. GAYA ¹, Jordi HUGUET ¹, Oscar RODRIGUEZ-FABA ¹,
Francesco SANGUEDOLCE ^{1, 6}, Isabel SANZ GOMEZ ¹, Raul SANCHEZ MOLINA ¹, Joan PALOU ¹, Alberto BREDA ¹

¹ Unit of Uro-oncology and Kidney Transplant, Department of Urology, Puigvert Foundation, Universitat Autònoma de Barcelona (UAB), Barcelona, Spain; ² Department of Urology, North Academic Hospital, Marseille, France; ³ Department of Urology, La Conception Hospital, Marseille, France; ⁴ Department of Urology, La Croix du Sud Hospital, Quint Fonsegrives, France; ⁵ Department of Urology, IRCCS Humanitas Clinic, Rozzano, Milan, Italy; ⁶ Department of Medical, Surgical and Experimental Sciences, University of Sassari, Sassari, Italy

INTRODUCTION: The aim of this study was to compare the perioperative outcomes of routine drainage insertion vs. no drainage in patients undergoing robot-assisted radical prostatectomy (RARP), robot-assisted partial nephrectomy (RAPN), and robot-assisted radical cystectomy (RARC).
EVIDENCE ACQUISITION: A literature search was conducted through April 2022 using PubMed/Medline, Embase, and Web of Science databases. Preferred Reporting Items for Systematic Reviews and Meta-analysis (PRISMA) guidelines were followed to identify eligible studies.
EVIDENCE SYNTHESIS: Eleven studies comprising 8447 RARPs and 1890 RAPNs met our inclusion criteria. Our search strategy did not identify any studies within the RARC framework. In RARP, patients without postoperative drainage had lower rate of postoperative ileus (OR 0.53, 95% CI: 0.38 to 0.74; P<0.001) and similar low-grade (Clavien 1-2, P=0.41) and high-grade (Clavien ≥3; P=0.85) complications, urinary leakage (P=0.07), pelvic hematoma (P=0.35), symptomatic lymphocele (P=0.13), fever (P=0.25), incisional hernia (P=0.31), reintervention (P=0.57), length of hospital stay (P=0.22), and readmission (P=0.74) compared with routinely drained patients. In RAPN, patients without postoperative drainage had shorter length of hospital stay (mean difference: -0.84 days, 95% CI: -1.06 to -0.63; P<0.001) and similar low-grade (P=0.94) and high-grade (P=0.31) complications, urinary leakage (P=0.49), hemorrhage (P=0.39), reintervention (P=0.69), and readmission (P=0.20) compared with routinely drained patients.
CONCLUSIONS: In our study, patients without drainage had similar perioperative course to patients with prophylactic drain insertion after RARP and RAPN. Omission of drain insertion was associated with a lower rate of postoperative ileus for RARP and a shorter hospital stay for RAPN. In the era of robotic surgery, routine drain placement is no longer indicated in unselected patients.

KEY WORDS: Robotic surgical procedures; Drainage; Prostatectomy; Nephrectomy; Cystectomy