Effectiveness of modified surgical position on patients undergoing robot-assisted laparoscopic radical prostatectomy: a systematic review and meta-analysis.

Abstract

To systematically evaluate the comparative efficacy of modified versus conventional positioning in robot-assisted laparoscopic radical prostatectomy (RALP) for prostate cancer.  We systematically searched PubMed, Web of Science (WOS), China National Knowledge Internet (CNKI), VIP Database, and Wanfang Databases up to August 2025 for randomized controlled trials (RCTs). Two investigators independently screened studies, extracted data, and assessed methodological quality using the Cochrane Risk of Bias tool. Meta-analysis was performed using RevMan 5.3, calculating mean differences (MD) for continuous outcomes and odds ratios (OR) for dichotomous outcomes, with 95% confidence intervals (CIs). Seven RCTs involving 719 patients (380 modified vs. 339 conventional) were included. Modified positioning significantly reduced operative time (MD: - 11.92 min, 95% CI: - 21.04 to - 2.80, P = 0.01) and positioning time (MD: - 3.79 min, 95% CI: - 4.73 to - 2.85, P < 0.001). It lowered risks of adverse events ( OR:0.24, 95% CI:0.11 to 0.51, P = 0.0002), robotic arm collisions (OR: 0.10, 95% CI: 0.02 to 0.47, P = 0.003), and second docking requirements (OR: 0.08, 95% CI: 0.01 to 0.42, P = 0.003). No significant intergroup difference was observed in blood loss (MD: - 1.55 mL, 95% CI: - 5.25 to 2.15, P = 0.41). Modified positioning enhances both safety and efficiency in RALP by reducing operative duration, minimizing robotic technical challenges, and decreasing perioperative complications. These findings strongly advocate for its adoption in standard clinical practice to optimize surgical workflows and improve patient outcomes.Registration: Registration number (PROSPERO): CRD 42024616927, registered on 2/12/2024.