title: Retropubic, laparoscopic, and robot-assisted radical prostatectomy: surgical, oncological, and functional outcomes: a systematic review.
abstract: OBJECTIVE
  Despite the wide diffusion of minimally invasive approaches, such as laparoscopic (LRP) and robot-assisted radical prostatectomy (RALP), few studies compare the results of these techniques with the retropubic radical prostatectomy (RRP) approach. The aim of this study is to compare the surgical, functional, and oncological outcomes and cost-effectiveness of RRP, LRP, and RALP.
  
  
  METHODS
  A systematic review of the literature was performed in the PubMed and Embase databases in December 2013. A 'free-text' protocol using the term 'radical prostatectomy' was applied. A total of 16,085 records were found. The authors reviewed the records to identify comparative studies to include in the review.
  
  
  RESULTS
  44 comparative studies were identified. With regard to the perioperative outcome, LRP and RALP were more time-consuming than RRP, but blood loss, transfusion rates, catheterisation time, hospitalisation duration, and complication rates were the most optimal in the laparoscopic approaches. With regard to the functional and oncological results, RALP was found to have the best outcomes.
  
  
  CONCLUSIONS
  Our study confirmed the well-known perioperative advantage of minimally invasive techniques; however, available data were not sufficient to prove the superiority of any surgical approach in terms of functional and oncologic outcomes. On the contrary, cost comparison clearly supports RRP.
authors.affiliation: Department of Experimental Medicine and Surgery, Tor Vergata University, Rome, Italy.
authors.forename: Francesco
authors.initials: F
authors.lastname: De Carlo
authors.forename: Francesco
authors.initials: F
authors.lastname: Celestino
authors.forename: Cristian
authors.initials: C
authors.lastname: Verri
authors.forename: Francesco
authors.initials: F
authors.lastname: Masedu
authors.forename: Emanuele
authors.initials: E
authors.lastname: Liberati
authors.forename: Savino Mauro
authors.initials: SM
authors.lastname: Di Stasi
mesh_terms: D003362:Cost-Benefit Analysis; D017048:Health Care Costs; D006801:Humans; D010535:Laparoscopy / Q000009:adverse effects / Q000191:economics / Q000379:methods* / Q000401:mortality; D008297:Male; D011183:Postoperative Complications; D011468:Prostatectomy / Q000009:adverse effects / Q000191:economics / Q000379:methods* / Q000401:mortality; D011471:Prostatic Neoplasms / Q000191:economics / Q000401:mortality / Q000473:pathology / Q000601:surgery*; D012307:Risk Factors; D065287:Robotic Surgical Procedures / Q000009:adverse effects / Q000191:economics / Q000379:methods* / Q000401:mortality; D016896:Treatment Outcome