Abstract
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We have found that there is a possibility of data duplication in two studies before we included the literatures. The two studies (Lenfant/Kaouk) that were from the same institution were included in this analysis. 1,2 However, we believe it would not affect our results. First, whether patients are shared between studies is not only inferred based on time. Second, among all the outcomes, there were only three primary outcomes included in both studies (operative time, readmission, and positive surgical margins).
The two studies have similar operation time about the single-port (SP) −195 (31.85) minutes and 198 (36.5) minutes. We think those SP groups were performed by one surgeon, whereas two surgeons dedicated to multiport (MP) groups led to this result. Furthermore, there is statistical significance in the operation time on MP groups between the two studies. It also proved that most of the patients in the two studies were inconsistent. At last, after we eliminated the Lenfant (a) or Lenfant (b), the statistical significance did not change in terms of operative time and positive surgical margins. Therefore, the results were robust.
The perineal approach could represent an effective radical alternative treatment for highly selected patients declared unsuitable for abdominal surgery or radiotherapy. Unfortunately, mini-invasive perineal approaches (MP or laparoscopic) have not really prevailed as an effective alternative to conventional radical prostatectomy (open). But the SP robotic platform could resolve some of the problems encountered with the conventional MP robotic platform.
There are recent reports on the safety and feasibility of the perineal approach using the SP console for highly selected patients declared unfit for abdominal surgery or radiotherapy. 3,4 In contrast, to avoid the huge heterogeneity and bias, the operative time and blood loss during perineal radical prostatectomy were excluded in the analysis. We also performed a subgroup analysis based on the different surgical approach of SP platform. Furthermore, the inclusion of this study seems to remind the clinicians that SP platform could be a better optional mini-invasive for patients declared unsuitable for abdominal surgery or radiotherapy.
To avoid the heterogeneity and bias, we performed a subgroup analysis based on the different surgical approaches for SP. We included five patients undergone extraperitoneal into the transperitoneal group in the outcome of operative time. 5 We did not think it could affect the outcomes. First, the five patients only accounted for about 2.6% in the transperitoneal group. Second, after we performed the leave-one-out test, the statistical significance did not change in terms of operative time.