Comparative effectiveness of robotic and laparoscopic radical prostatectomy: a GRADE-assessed systematic review and meta-analysis of randomized controlled trials featuring geographic subgroup analyses.

This systematic review and meta-analysis pooled data from four randomized controlled trials (1,095 men) directly comparing robot-assisted radical prostatectomy (RARP) with conventional laparoscopic radical prostatectomy (LRP) for localized or locally advanced prostate cancer.

Key findings at 12 months:

• Urinary continence: LRP was statistically superior to RARP (moderate-certainty evidence), translating to about 66 more continent patients per 1,000 treated with LRP.
• Erectile function: LRP also showed significantly better recovery of erectile function (moderate-certainty evidence), with about 91 more potent patients per 1,000 compared with RARP.
• Oncologic control: Positive surgical margin rates were similar between approaches (low-certainty evidence), indicating comparable oncological safety.
• Perioperative outcomes: Operative time, blood loss, and overall complication rates did not differ meaningfully between RARP and LRP.

Geographic subgroup analyses hinted at possible regional variation, but no statistically significant interaction was found.

Overall, the evidence indicates that, in randomized trials, conventional LRP yielded better 12‑month functional outcomes (continence and potency) than RARP without compromising cancer control or perioperative safety. The authors emphasize that surgeon and institutional experience likely play a major role in outcomes, independent of the surgical platform.