Journal of Men's Health. 2026; 22(3): 36-41. doi: 10.22514/jomh.2026.025
Original Research

Risk factors for delayed discharge following early discharged robot-assisted laparoscopic radical prostatectomy

Jie Yuan1, Huan Wang1, Mingchao Wang1, Zhenghui Wang1, Gonghui Li1,*,

1Department of Urology, Sir Run Run Shaw Hospital, Zhejiang University School of Medicine, 310016 Hangzhou, Zhejiang, China

*Corresponding Author(s):3193119@zju.edu.cn (Gonghui Li)

History Submitted: 13 October 2025 | Accepted: 18 November 2025 | Published: 30 March 2026
Copyright:  ©2026 The Author(s). Published by MRE Press.
This is an open access article under the CC BY 4.0 license (https://creativecommons.org/licenses/by/4.0/).

Collapse table of contents

Abstract

Background: Prostate cancer is one of the most common malignancies among men worldwide, and its incidence in China has been increasing rapidly. Robot-assisted laparoscopic radical prostatectomy (RARP) has become the standard surgical approach for localized prostate cancer due to its high precision and minimally invasive advantages. With the growing implementation of enhanced recovery after surgery (ERAS) protocols, early discharged surgical models have been introduced in urology to shorten hospital stays and improve patient satisfaction. However, some patients experience delayed discharge, limiting the wider adoption of early discharged RARP. This study aimed to identify the factors associated with delayed discharge in patients undergoing early discharged RARP. Methods: A retrospective analysis was conducted on 57 patients with localized prostate cancer who underwent RARP performed by a single surgeon between January 2023 and October 2024. Patients were divided into two groups according to whether they were discharged as scheduled (early discharged group) or had delayed discharge. Perioperative and clinical data were analyzed to determine the factors associated with delayed discharge. Results: Of the 57 patients, 35 (61.4%) were discharged as scheduled, and 22 (38.6%) experienced delayed discharges. Extended postoperative fasting time, delayed drain removal, and surgeries ending after 20:00 were significant predictors of delayed discharge (p < 0.05). Other factors, such as operative time, intraoperative blood loss, surgical approach, postoperative pain score, postoperative inflammatory markers, and pathological findings showed no significant association (p > 0.05). Conclusions: Prolonged fasting, delayed drain removal, and late surgical completion are key factors associated with delayed discharge after early discharged RARP. Optimizing perioperative management—including early feeding, timely drain removal, and proper scheduling—can enhance recovery and promote the safe implementation of early discharged RARP.

Keywords:Prostate cancerRobot-assisted surgeryEarly discharged surgeryDelayed dischargeEnhanced recovery after surgery
PDF(1.65 MB)|EndNote (RIS)|BibTeX|RefMan|RefWorks

Cite this article

Jie Yuan, Huan Wang, Mingchao Wang, Zhenghui Wang, Gonghui Li. Risk factors for delayed discharge following early discharged robot-assisted laparoscopic radical prostatectomy. Journal of Men's Health. 2026; 22(3): 36-41. doi: 10.22514/jomh.2026.025

1. Introduction

Prostate cancer is one of the most prevalent malignancies among men worldwide, and its incidence in China has risen rapidly in recent years [1, 2]. Radical prostatectomy remains a cornerstone treatment for localized prostate cancer. Robot-assisted laparoscopic radical prostatectomy (RARP), characterized by superior visualization, precision, and functional preservation, has become the standard surgical technique globally [3, 4, 5]. In parallel, the concept of enhanced recovery after surgery (ERAS) has revolutionized perioperative management, and its integration into early discharged surgery has demonstrated benefits, such as reduced hospital stays, lower medical costs, and improved patient satisfaction [6, 7, 8, 9]. However, not all patients can be discharged as planned, and delayed discharge remains an obstacle to the widespread application of the early discharged model [10, 11, 12]. This study retrospectively analyzed the clinical data of patients undergoing early discharged RARP performed by a single surgeon to identify factors associated with delayed discharge and to provide evidence for optimizing perioperative management.

2. Materials and methods

2.1 Patient and general information

This retrospective study included 57 patients with clinically localized prostate cancer (T1–T2c) who underwent RARP performed by a single surgeon between January 2023 and October 2024. Patients were divided into two groups according to discharge status: early discharged group and delayed discharge group. In this study, an early discharged procedure was defined as discharge within 48 hours after surgery. Baseline parameters, such as age, body mass index (BMI), preoperative prostate-specific antigen (PSA), Gleason score, tumor node metastasis (TNM) stage, and prostate volume were compared, as shown in Table 1. Inclusion criteria were confirmed histological diagnosis of prostate cancer, complete clinical data, no prior radiotherapy, chemotherapy, or hormonal therapy. Exclusion criteria included neurogenic bladder, hepatic or renal dysfunction, coagulation disorders, and age below 18 years. Details of recruitment are given in Fig. 1. The study was approved by the institutional ethics committee in accordance with the Declaration of Helsinki.

Table 1.Baseline clinical characteristics of patients in the early discharged and delayed discharge groups.
VariableEarly discharged group
(n = 35)		Delayed discharge group
(n = 22)		t/χ2 valuep value
Age (yr)66.91 ± 8.0065.77 ± 7.840.530.60
BMI (kg/m2)24.12 ± 2.9023.87 ± 2.280.440.66
Prostate volume (mL)30.38 ± 16.8233.49 ± 12.690.750.46
PSA (µg/L)9.96 ± 5.7613.17 ± 12.381.320.19
Gleason score, n (%)
≤613 (37.14%)14 (63.64%)3.800.05
3 + 4 = 714 (40.00%)5 (22.72%)
4 + 3 = 78 (22.86%)3 (13.64%)
8–100 (0.00%)0 (0.00%)
Clinical TNM stage, n (%)
cT1N0M017 (48.57%)6 (27.27%)2.540.11
cT2N0M018 (51.43%)16 (72.73%)
BMI: Body Mass Index; PSA: Prostate-Specific Antigen; TNM: Tumor Node Metastasis.
Flow chart for study participant recruitment. RARP: Robot-assisted laparoscopic radical prostatectomy.

Fig. 1.Flow chart for study participant recruitment. RARP: Robot-assisted laparoscopic radical prostatectomy.

2.2 Interventions

All patients underwent standardized preoperative evaluation, including laboratory tests, imaging, and anesthetic assessment. RARP was performed using the da Vinci Xi robotic system via either transperitoneal or extraperitoneal approaches. ERAS protocol components include preoperative nutrition, avoidance of preoperative fasting and carbohydrate loading, no or selective bowel preparation, and early mobilization. Intraoperative management includes hypothermia prevention (warm irrigation fluid, forced-air warming), restrictive fluid management, and multimodal analgesia. Postoperative management followed ERAS principles, emphasizing early ambulation, controlled analgesia, early oral intake, and prompt removal of drains when appropriate. Discharge criteria: (1) The patient’s vital signs are stable, with the ability to ambulate independently; (2) No significant discomfort is reported after consuming a semi-liquid diet; (3) The urinary catheter drainage is unobstructed, with no gross hematuria observed; (4) Postoperative pain is effectively controlled, with no signs of incision infection, fever, nausea, vomiting, or other postoperative complications; (5) Discharge is arranged with a family member to provide post-discharge care.

2.3 Statistical analysis methods

Data were analyzed using SPSS 25.0 (IBM Corporation, Armonk, NY, USA). Continuous variables were expressed as mean ± standard deviation or median (range) and compared using t-tests or Mann-Whitney U tests as appropriate. Categorical variables were expressed as numbers and percentages, with comparisons made by chi-square or Fisher’s exact tests. Statistical significance was defined as p < 0.05.

3. Results

3.1 Surgical outcomes

All 57 patients successfully underwent robot-assisted laparoscopic radical prostatectomy (RARP) without conversion to open surgery, intraoperative blood transfusion, or any severe intraoperative or postoperative complications. Among them, 35 patients (61.4%) were discharged according to the early discharged protocol, while 22 patients (38.6%) experienced delayed discharge.

3.2 Comparison of perioperative parameters

There were no statistically significant differences between the early discharged group and the delayed discharge group regarding operative time, intraoperative blood loss, postoperative pain score (using the Numerical Rating Scale at 6 hours after surgery), postoperative white blood cell count (WBC), postoperative C-reactive protein (CRP) levels, or surgical approach (transperitoneal vs. extraperitoneal) (all p > 0.05), as shown in Table 2.

Table 2.Comparison of perioperative parameters between the early discharged and delayed discharge groups.
VariableEarly discharged group
(n = 35)		Delayed discharge group
(n = 22)		t/χ2 valuep value
Operative time (min)139.90 ± 30.26150.40 ± 39.941.130.26
Intraoperative blood loss (mL)68.86 ± 41.5758.18 ± 44.150.920.36
Surgical approach, n (%)
Extraperitoneal single-port26 (74.29%)11 (50.00%)2.920.09
Transperitoneal multi-port9 (25.71%)11 (50.00%)
Postoperative WBC (×109/L)8.76 ± 1.819.56 ± 2.691.340.19
Postoperative pain score1.07 ± 0.280.95 ± 0.211.860.07
Postoperative CRP (mg/L)20.28 ± 17.0023.98 ± 23.660.660.51
Postoperative fasting time (h)11.49 ± 8.2826.05 ± 23.843.330.0016
Time to drain removal (d)1.83 ± 1.273.32 ± 2.423.050.0036
End of operation time, n (%)
Before 20:0030 (85.71%)13 (59.09%)5.170.023
After 20:005 (14.29%)9 (40.91%)
WBC: white blood cell count; CRP: C-reactive protein.

However, several perioperative parameters showed significant differences between the two groups. The mean postoperative fasting time was markedly shorter in the early discharged group (11.49 ± 8.28 h) compared with the delayed discharge group (26.05 ± 23.84 h) (t = 3.3323, p < 0.05). Similarly, the mean time to drain removal was significantly earlier in the early discharged group (1.83 ± 1.27 days) than in the delayed discharge group (3.32 ± 2.42 days) (t = 3.046, p < 0.05), as shown in Table 2.

3.3 Timing of surgery

The timing of surgery completion also had a notable impact on discharge outcomes. In the early discharged group, 30 patients (85.7%) completed surgery before 20:00, while only 5 (14.3%) finished after 20:00. In contrast, in the delayed discharge group, 13 patients (59.1%) completed surgery before 20:00 and 9 (40.9%) after 20:00. This difference was statistically significant (t = 5.168, p < 0.05), as shown in Table 2.

3.4 Pathological outcomes

No significant differences were observed between the two groups regarding positive surgical margin rates, postoperative Gleason scores, or pathological TNM stages (all p > 0.05), as shown in Table 3. These findings indicate that both groups achieved comparable oncological outcomes, suggesting that delayed discharge was not related to tumor characteristics or surgical radicality.

Table 3.Pathological characteristics between the early discharged and delayed discharge groups.
VariableEarly discharged
(n = 35)		Delayed discharge group
(n = 22)		t/χ2 valuep value
Positive surgical margin, n (%)15 (42.86%)7 (31.82%)0.690.40
Gleason score, n (%)
≤63 (8.57%)5 (22.73%)2.240.13
3 + 4 = 716 (45.71%)13 (59.09%)
4 + 3 = 711 (31.43%)2 (9.09%)
8–105 (14.29%)2 (9.09%)
Pathological TNM stage, n (%)
pT1N0M01 (2.86%)4 (18.18%)0.340.56
pT2N0M031 (88.57%)17 (77.27%)
pT3N0M03 (8.57%)1 (4.55%)
TNM: Tumor Node Metastasis.

4. Discussion

With the continuous integration of minimally invasive surgery and the ERAS concept, the application of the early discharged model in RARP has become an important trend in prostate cancer surgery [13, 14]. This study retrospectively analyzed factors associated with delayed discharge in early discharged RARP to identify potential barriers to successful implementation. Among the 57 patients undergoing RARP under an early discharged protocol, 22 (38.6%) experienced delayed discharge. This proportion underscores the importance of identifying and addressing related factors. Clancy et al. [15] reported a 29% delayed discharge rate in 28 RARPs patients, consistent with our findings, reflecting similar perioperative care patterns in Western cohorts. George et al. [16] documented a lower rate (6.2%) in a cohort (n = 180) with full ERAS implementation. This finding is likely reflective of our restrictive discharge criteria, further emphasizing the clinical value of a protocol-driven management approach.

The findings demonstrated that prolonged postoperative fasting, delayed drain removal, and late completion of surgery (after 20:00) were significant factors associated with delayed discharge. In contrast, variables such as operative time, intraoperative blood loss, surgical approach, postoperative inflammatory markers, and pathological features were not significantly related to discharge timing. These observations suggest that the success of early discharged RARP relies more on perioperative management and workflow optimization than on surgical complexity itself.

Prolonged postoperative fasting emerged as one of the most influential contributors to delayed discharge. Within the ERAS framework, early postoperative oral intake is crucial for reducing surgical stress, promoting bowel function recovery, and shortening hospitalization [17, 18, 19]. In this study, patients in the delayed discharge group had significantly longer fasting durations, often reflecting delayed gastrointestinal recovery, such as postoperative nausea, vomiting, or ileus. Therefore, optimizing perioperative anesthesia management (for example, minimizing opioid use and employing prophylactic antiemetic strategies) and strengthening postoperative nursing care to safely encourage early oral intake may be key to improving the success rate of early discharged RARP. We recommend that clear liquid intake may be initiated 6 hours after surgery if the patient has no nausea, no vomiting, and positive bowel sounds; progression to a semi-liquid diet should be completed within 12 hours postoperatively.

Similarly, delayed drain removal was another factor significantly associated with prolonged hospitalization. Retained drainage tubes restrict early ambulation, increase discomfort and infection risk, and are often perceived as a sign that patients have not yet met discharge criteria [20, 21, 22]. In this study, patients in the delayed discharge group had later drain removal times than those in the early discharged group. This finding calls for a reevaluation of existing drain management strategies. When drainage is minimal and the fluid is clear, early drain removal (within 24 hours) could be considered, provided the surgeon is confident in achieving meticulous hemostasis and watertight anastomosis. A standardized, quantifiable protocol for drain management would also help reduce inter-operator variability and ensure consistent clinical decision-making.

Furthermore, the timing of surgery completion significantly affected discharge outcomes. Patients whose surgeries ended after 20:00 were at a much higher risk of delayed discharge. Late surgeries limit the time available for postoperative observation, early ambulation, and dietary progression, which may postpone crucial discharge assessments, such as pain control and complication screening, to the next day. Therefore, efficient operating room scheduling and prioritization of early discharged patients during daytime hours are vital to ensuring the smooth operation of the early discharged model.

Notably, no significant differences were observed in operative duration, blood loss, inflammatory markers, or oncological outcomes between the two groups. These findings indicate that, under the care of an experienced surgeon, RARP can reach a high degree of technical maturity and consistency. Consequently, delays in discharge appear to stem mainly from modifiable management factors rather than surgical complexity itself. This reinforces the notion that successful early discharged surgery depends primarily on perioperative planning and multidisciplinary coordination.

China has a large patient population coupled with limited healthcare resources. Against this backdrop, facilitating the early and appropriate discharge of patients has emerged as a pivotal strategy to curtail unnecessary healthcare expenditures and optimize the utilization of limited healthcare resources, particularly by reducing the opportunity cost of bed occupancy and minimizing avoidable inpatient service consumption.

Nevertheless, this study has certain limitations. It was a single-center retrospective analysis with a relatively small sample size and operation done by a single surgeon, which limits generalizability. Though we enrolled consecutive cases, 27 eligible patients were excluded, which may introduce bias. Moreover, unmeasured factors, such as psychological readiness for early discharge and family support, may also influence discharge decisions. Intraoperative intra-abdominal pressure (IAP) is also a critical physiological parameter during robotic surgery, as it exerts significant impacts on hemodynamics, renal perfusion, postoperative pain, and bowel recovery [23, 24]. Compared with high-pressure surgery, low-pressure surgery offers notable clinical advantages, including a reduced incidence of postoperative complications and a shortened hospital stay [25, 26]. Shao et al. [27] reported that low IAP during RARP could decrease the incidence of postoperative ileus, without significant differences in hematoma, positive margin rate, urinary retention, operative time, or intraoperative blood loss. However, in the present study, a consistent IAP of 15 mmHg was routinely maintained intraoperatively, while specific IAP-related data, including mean pneumoperitoneum pressure, duration of elevated IAP, and IAP variability, were not collected. These factors will be incorporated into our subsequent research to address this gap. More, this retrospective study only demonstrates associations between the identified factors and delayed discharge; causal relationships cannot be established. For instance, prolonged fasting may not be a cause of delayed discharge, but rather a consequence of extended hospital stays due to other clinical factors. And, we do not collect patient preference scores or family support metrics, limiting analysis of their independent impact on discharge timing. Post-discharge outcomes and cost are also uncollected, limiting assess of long-term effects and cost analysis. Future large-scale, multicenter prospective studies are warranted to validate these findings and to establish risk-stratified protocols that can further optimize early discharged RARP management.

5. Conclusions

Delayed discharge after early discharged RARP is primarily associated with prolonged postoperative fasting, delayed drain removal, and late surgery completion. Enhanced perioperative management focusing on early feeding, timely drain removal, and efficient surgical scheduling can improve the success rate of early discharged RARP and promote its broader clinical adoption.

Availability of data and materials

The authors declare that all data supporting the findings of this study are available within the paper and any raw data can be obtained from the corresponding author upon request.

Author contributions

JY and GHL—designed this study and put it into practice. HW, JY and MCW—supervised the data collection, analyzed and interpreted the data. ZHW, JY and GHL—prepared the manuscript for publication and reviewed the draft. All authors have read and approved the manuscript.

Ethics approval and consent to participate

This study has obtained ethical approval from the Medical Ethics Committee of Sir Run Run Shaw Hospital (approval no. 20251261), and informed consent has been obtained from all patients.

Acknowledgment

The authors would like to thank the medical and nursing teams involved in the perioperative care of the patients for their dedication and support.

Funding

This work was supported by the Natural Science Foundation of Zhejiang Province (No. LTGD23H050001 to Jie Yuan).

Conflict of interest

The authors declare no conflict of interest.

References

Sung H, Ferlay J, Siegel RL, Laversanne M, Soerjomataram I, Jemal A, et al. Global cancer statistics 2020: GLOBOCAN estimates of incidence and mortality worldwide for 36 cancers in 185 countries. CA: A Cancer Journal for Clinicians. 2021; 71: 209–249.

[Google Scholar]

Chen W, Zheng R, Baade PD, Zhang S, Zeng H, Bray F, et al. Cancer statistics in China, 2015. CA: A Cancer Journal for Clinicians. 2016; 66: 115–132.

[Google Scholar]

Mottet N, van den Bergh RCN, Briers E, Van den Broeck T, Cumberbatch MG, De Santis M, et al. EAU-EANM-ESTRO-ESUR-SIOG Guidelines on Prostate Cancer-2020 Update. Part 1: screening, diagnosis, and local treatment with curative intent. European Urology. 2021; 79: 243–262.

[Google Scholar]

Ficarra V, Novara G, Rosen RC, Artibani W, Carroll PR, Costello A, et al. Systematic review and meta-analysis of studies reporting urinary continence recovery after robot-assisted radical prostatectomy. European Urology. 2012; 62: 405–417.

[Google Scholar]

Clayman RV. A prospective comparison of radical retropubic and robot-assisted prostatectomy: experience in one institution. The Journal of Urology. 2004; 172: 2106–2107.

[Google Scholar]

Ljungqvist O, Scott M, Fearon KC. Enhanced recovery after surgery: a review. JAMA Surgery. 2017; 152: 292–298.

[Google Scholar]

Wu C, Jiang X, Shi Y, Lv Z. A review of enhanced recovery after surgery concept in perioperative radical prostatectomy for prostate cancer. Journal of Robotic Surgery. 2024; 19: 9.

[Google Scholar]

Vangheluwe L, Legeay M, Surlemont L, Dupuis H, Defortescu G, Cornu JN, et al. Clinical impact of an enhanced recovery protocol implementation for nephrectomy and radical prostatectomy. The French Journal of Urology. 2024; 34: 102674.

[Google Scholar]

Xu H, Xu Y, Shi G, Lu J, Zhu L, He G, et al. Cognition and experience of surgical incisions in patients undergoing laparoscopic surgery with enhanced recovery after surgery protocol: a qualitative study. Laparoscopic, Endoscopic and Robotic Surgery. 2025; 8: 96–101.

[Google Scholar]

Ploussard G, Grabia A, Barret E, Beauval JB, Brureau L, Créhange G, et al. Same-day-discharge robot-assisted radical prostatectomy: an annual countrywide analysis. European Urology Open Science. 2022; 36: 23–25.

[Google Scholar]

Reddy SS, Noël J, Covas Moschovas M, Bhat S, Perera R, Rogers T, et al. Same-day discharge protocol for robot-assisted radical prostatectomy: experience of a high-volume referral center. Journal of Endourology. 2022; 36: 934–940.

[Google Scholar]

Uy M, Alrumaih A, Fuda M, Cassim R, Millan B, Shayegan B. Predictors of failed same-day discharge in patients undergoing robot-assisted radical prostatectomy in a Canadian universal healthcare system. Canadian Urological Association Journal. 2024; 18: 316.

[Google Scholar]

Rodrigues Pessoa R, Urkmez A, Kukreja N, Baack Kukreja J. Enhanced recovery after surgery review and urology applications in 2020. BJUI Compass. 2020; 1: 5–14.

[Google Scholar]

Peerbocus M, Wang ZJ. Enhanced recovery after surgery and radical cystectomy: a systematic review and meta-analysis. Research and Reports in Urology. 2021; 13: 535–547.

[Google Scholar]

Mulholland C, Soliman C, Furrer MA, Sathianathen N, Corcoran NM, Schramm B, et al. Same day discharge for robot-assisted radical prostatectomy: a prospective cohort study documenting an Australian approach. ANZ Journal of Surgery. 2023; 93: 669–674.

[Google Scholar]

Hill GT, Jeyanthi M, Coomer W, Bryant RJ, Colmsee MT, Tozer J, et al. Same-day discharge robot-assisted laparoscopic prostatectomy: feasibility, safety and patient experience. BJU International. 2023; 132: 92–99.

[Google Scholar]

Xu Y, Liu A, Chen L, Huang H, Gao Y, Zhang C, et al. Enhanced recovery after surgery (ERAS) pathway optimizes outcomes and costs for minimally invasive radical prostatectomy. Journal of International Medical Research. 2020; 48: 0300060520920072.

[Google Scholar]

Cao J, Gu J, Wang Y, Guo X, Gao X, Lu X. Clinical efficacy of an enhanced recovery after surgery protocol in patients undergoing robotic-assisted laparoscopic prostatectomy. Journal of International Medical Research. 2021; 49: 03000605211033173.

[Google Scholar]

Lin C, Wan F, Lu Y, Li G, Yu L, Wang M. Enhanced recovery after surgery protocol for prostate cancer patients undergoing laparoscopic radical prostatectomy. Journal of International Medical Research. 2019; 47: 114–121.

[Google Scholar]

Pfail J, Drobner J, Kaldany A, Chua K, Lichtbroun B, Passarelli R, et al. Omission of intraoperative drain placement during robotic partial nephrectomy and robotic radical prostatectomy is safe: an analysis of 18,000 patients. World Journal of Urology. 2024; 42: 601.

[Google Scholar]

Territo A, Baboudjian M, Diana P, Gallioli A, Verri P, Uleri A, et al. To drain or not to drain in uro-oncological robotic surgery? A systematic review and meta-analysis. Minerva Urology and Nephrology. 2023; 75: 144–153.

[Google Scholar]

Yanagisawa T, Kawada T, Mostafaei H, Sari Motlagh R, Quhal F, Laukhtina E, et al. Role of pelvic drain and timing of urethral catheter removal following RARP: a systematic review and meta‐analysis. BJU International. 2023; 132: 132–145.

[Google Scholar]

Reijnders-Boerboom G, Albers KI, Jacobs LMC, Helden EV, Rosman C, Díaz-Cambronero O, et al. Low intra-abdominal pressure in laparoscopic surgery: a systematic review and meta-analysis. International Journal of Surgery. 2023; 109: 1400–1411.

[Google Scholar]

Hamid M, Mostafa OES, Mohamedahmed AYY, Zaman S, Kumar P, Waterland P, et al. Comparison of low versus high (standard) intraabdominal pressure during laparoscopic colorectal surgery: systematic review and meta-analysis. International Journal of Colorectal Disease. 2024; 39: 104.

[Google Scholar]

Celarier S, Monziols S, Célérier B, Assenat V, Carles P, Napolitano G, et al. Low-pressure versus standard pressure laparoscopic colorectal surgery (PAROS trial): a phase III randomized controlled trial. British Journal of Surgery. 2021; 108: 998–1005.

[Google Scholar]

Hua J, Gong J, Yao L, Zhou B, Song Z. Low-pressure versus standard-pressure pneumoperitoneum for laparoscopic cholecystectomy: a systematic review and meta-analysis. The American Journal of Surgery. 2014; 208: 143–150.

[Google Scholar]

Yang Y, Duan Y, Wan X, Wan L, Wang G, Shao J. The impact of intra-abdominal pressure on perioperative outcomes in robotic-assisted radical prostatectomy: a systematic review and network meta-analysis of randomized controlled trials. Journal of Oncology. 2022; 2022: 4974027.

[Google Scholar]