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Page 8 of 17 Ornaghi et al. Mini-invasive Surg 2021;5:42 https://dx.doi.org/10.20517/2574-1225.2021.50

The female patients underwent different types of UD: most of them underwent ileal conduit (136 cases),
while 34 underwent neobladder; in 13 cases, it was defined as ONB and in 21 cases it was defined as
intracorporeal neobladder (iN). One patient underwent Indiana pouch, while in 58 cases the type of urinary
reconstruction was not specified.

Preoperative characteristics
The mean age of the female patients was 61.12 years (range 48.25-71.25 years). The mean body mass index
(BMI) recorded was 24.7 kg/m (range 19.8-34 kg/m ). Three of the studies also reported the preoperative
2
2
[18]
ASA (American Society of Anesthesiologists) score [13,17,18] . In the study by Narayan et al. , comparing
RARC and ORC, the rate of patients with ASA ≥ 3 was high and similar in RARC vs. ORC (93.48% vs.
92.11%, P = 1). In contrast, the study by Tuderti et al. , which focused on sex-sparing (SS)-RARC, enrolled
[13]
patients with a low ASA score (< 3) in more than 90% of cases. Whittum et al. found that a higher
[17]
percentage of patients with an ASA score ≥ 3 was associated with gynecological organ invasion at RARC
histology, although this did not reach statistical significance (76% vs. 57%, P = 0.14).
Peri- and post-operative surgical outcomes
The median OT of RARC in female patients was 418 min (range 311-562 min). The median EBL was 380
mL (range 100-1160 mL). Pruthi et al. , when comparing female and male patients, reported that women
[19]
had shorter OT (mean 276 min vs. 354 min, P < 0.001) and less EBL (mean 215 mL vs. 330 mL, P = 0.012).
This difference was only significant, however, comparing female patients with a cohort of 20 male patients
operated at the beginning of the learning curve, whereas no parameters were different between the female
and the concurrent male patients. Kang et al. also compared perioperative outcomes between females and
[16]
males. They obtained non-significant differences in OT (median 567 min vs. 550 min, P = 0.64) and EBL
(median 591 mL vs. 515 mL, P = 0.32).

In the study by Narayan et al. , OT was longer for RARC compared with ORC [median 513 (IQR 365-810)
[18]
min vs. 392 (IQR 208-875) min, respectively, P < 0.001], and the median EBL in RARC was significantly
lower than in ORC [275 (IQR 150-700) mL vs. 762 (IQR 100-7000) mL, P < 0.01]. Furthermore, women who
underwent ORC were significantly more likely to require an IT. OR for the transfusion of ≥ 1 unit during
ORC was 9.97 (95%CI: 3.39-29.31, P < 0.001) on multivariable analysis: nearly 68% of women who
underwent ORC received an IT, compared with only 24% of those that underwent RARC. EBL was also
significantly greater in the ORC group: median of 762 mL (IQR 600 mL) compared to 275 mL (IQR 350
mL) in the RARC group (P < 0.01). Postoperative transfusion (PT) did not differ between the two groups
(36% ORC vs. 26% RARC, P = 0.32). Considering IT and PT together, women who underwent ORC were
significantly more likely to have undergone the transfusion of ≥ 4 units compared to RARC with a OR 21.06
(95%CI: 6.51-68.44, P < 0.001) on multivariable analysis.

The median LOS was 9.8 days (range 6.5-21 days) with a median time to flatus (TTF) of 3.5 days.
Postoperative LOS did not seem to be significantly influenced by the type of surgical approach [ORC vs.
RARC: median 6 (IQR 5-8) days vs. 5 (IQR 4-7) days, P = 0.13] . No differences were found when
[18]
comparing female to male RARC patients in the studies by both Pruthi et al. (mean 4.9 days vs. 4.4 days, P
[19]
> 0.05) and Kang et al. (median 20 days vs. 17.7 days, P = 0.19).
[16]
All included studies reported the complication rate. The mean incidence of early postoperative
complications (30-day complications) was 32.9%, with a percentage of high-grade complications (CCS ≥ 3)
that tended to be low, averaging around 12%. Narayan et al. found no difference in rates of overall
[18]
complications between ORC and RARC groups (76.3% vs. 73.9%, respectively, P = 0.83). Although the
complication rate was higher in this study compared to the others, most of them (89.5% for ORC and 82.3%