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Ornaghi et al. Mini-invasive Surg 2021;5:42 https://dx.doi.org/10.20517/2574-1225.2021.50 Page 9 of 17

[17]
for RARC) were < 3 CCS complications. Whittum et al. recorded complication rates within 30 and 90
days after surgery in their study, which were 49% and 61%, respectively. Furthermore, when comparing
patients with gynecological organ invasion at RC histology with those without, there was no significant
difference between the two groups in the rate of postoperative complications (30-day: 47% vs. 51%, P = 0.79;
90-day: 59% vs. 62%, P = 0.78).

In the studies collected in our research, the readmission rate after RARC in women was 20.8% in the first 30
postoperative days and 28% in the first 90 days. Narayan et al. showed that these rates were overlapping
[18]
with ORC (ORC vs. RARC, 30-day: 22.67% vs. 29.09%, P = 0.67; 90-day: 28% vs. 32.61%, P = 0.68).

Postoperative pathological outcomes
The average detection rate of pT3 on histological examination of RARC was about 33%, with similar rates
compared to the open approach .
[18]

Surgical margins were negative in close to 100% of operations (with a mean of 97.5%). The robotic approach
was similar to the open approach (PSMs 4.44% vs. 5.26%, P = 1) . The association between PSMs and
[18]
[17]
gynecological organ invasion was significant (24% of cases vs. 4% of cases without invasion, P = 0.02) . In
the multivariable analysis performed by Whittum et al. , the number of pN+ (OR = 6.48, 95%CI: 1.64-
[17]
25.51, P = 0.008), the trigonal tumor location (OR = 5.72, 95%CI: 1.39-23.61, P = 0.02), and the presence of
variant histology other than pure urothelial (OR = 18.52, 95%CI: 3.32-103.4, P = 0.001) were confirmed as
predictors of gynecological organ invasion.

In the cohort of female patients undergoing RARC collected in our study, the mean pN+ rate was 12.72%.
The difference with the rate of pN+ found after ORC did not reach statistical significance (P = 0.89) .
[18]

The mean number of retrieved LN (LN yield) was 20.6 (range 11.3-35.5). The number of total LN removed
was significantly influenced by the robotic approach compared to the open one: in the study by
Narayan et al. , the median LN yield resulted 27 (IQR 19-41) for RARC and 20.5 (IQR 13-28) for ORC (P <
[18]
0.001). The difference between female and male cohorts was not statistically significant: mean LN removed
19 (range 12-34) vs. 18 (8-37) in the study by Pruthi et al. and 16 vs. 19 (P = 0.32) in the study by
[19]
[16]
Kang et al. .

Postoperative functional outcomes
Three of the collected studies reported data on recovery of urinary continence and sexual function after
RARC in iN female patients. One of these also administered a questionnaire to assess HRQoL .
[13]
[21]
The study by Canda et al. , collecting the initial experience of NS-RARC in their institute, described poor
functional outcomes in the only two female patients who underwent the procedure (NS-RARC and
intracorporeal Studer pouch): at the time of data collection, they both had severe (> 3 pads/die) daytime and
poor (wet, leakage, and urinary incontinence (UI) during sleep) nighttime UI. However, the postoperative
follow-up was very limited for these two patients (6 and 5 months).

The study by Tyritzis et al. , analyzing the effects of RARC on both male and female patients (all female
[22]
patients received a NS procedure by preserving the autonomic nerves identified on the anterior vaginal wall
at the 10 o’clock and 2 o’clock positions), showed the continence rate for daytime and nighttime at 12
months of follow-up was 74.2% for men, while two out of three evaluable female patients (66.7%) were
continent (≤ 1 pad/die) during both daytime and nighttime. No need for a pad was recorded in 27.5% of