SIU-ICUD: Advances in Surgical Technique of Robotic Prostatectomy
Round 1
Reviewer 1 Report
Comments and Suggestions for AuthorsThis is an interesting literature review on the history of prostatectomy and the surgical innovations. However, the structure is a bit difficult to follow.
Here’s an example of a plan that seems less confusing to me:
- Introduction
- Different robotic techniques
- Intra/extra-peritoneal
- Multi/single port
- New surgical techniques
- To preserve erections and continence
- To preserve erections
- To preserve continence
- The future
Other points of concerns:
- It would also be helpful to introduce the structure at the end of the introduction for greater clarity.
- History of prostatectomy: Could some references be added?
- I don’t understand why “anatomical considerations” is a subsection of the introduction, and why the section on DVC is so detailed here.
- In terms of continence preservation, I don’t understand why the Hood technique RARP is so detailed in one paragraph. I think it would be better to expand on other techniques in a single paragraph that covers all techniques more comprehensively.
- Would it be possible to add more diagrams/images to illustrate the techniques mentioned?
Author Response
Comment 1: The structure is a bit difficult to follow. It would also be helpful to introduce the structure at the end of the introduction for greater clarity.
Response 1: The structure and headers have been clarified to provide better flow to the article. The introduction has been modified and now ends with an outline and objective of the review.
Comment 2: History of prostatectomy: Could some references be added?
Response 2: The appropriate references have now been added.
Comment 3: I don’t understand why “anatomical considerations” is a subsection of the introduction, and why the section on DVC is so detailed here.
Response 3: This section has now been removed for clarity.
Comment 4: In terms of continence preservation, I don’t understand why the Hood technique RARP is so detailed in one paragraph. I think it would be better to expand on other techniques in a single paragraph that covers all techniques more comprehensively.
Response 4: We believe this revised version covers all techniques more comprehensively.
Reviewer 2 Report
Comments and Suggestions for AuthorsDear Authors,
thank you for providing a comprehensive review of current state of the art of radical prostatectomy. However, I have some points to improve
1) methods: I would add a methods section, for a narrative review of radical prostatectomy, which include how you searched and selected the articles. A flow-chart would also be helpful
2) techniques: when reading extraperitoneal RALP, I recently read an article regarding the possibility of continuous spinal anesthesia eRALP. You can find it through this link. https://www.mdpi.com/1648-9144/60/12/1973 You can decide whether to add it or no, I'm just bringing it to your knowledge
Author Response
Comment 1: I would add a methods section, for a narrative review of radical prostatectomy, which include how you searched and selected the articles. A flow-chart would also be helpful.
Response 1: Thank you for your feedback. This review is adapted from a more comprehensive committee chapter published in the 3rd WUOF/SIU International Consultation on Urologic Diseases on Localized Prostate Cancer (2024). As such, it does not include a standalone methods section, given its nature as a narrative summary of that work. However, we are happy to include a brief description of the methodology used in developing the original chapter, should the reviewers feel this would enhance clarity or rigor.
Reviewer 3 Report
Comments and Suggestions for AuthorsI thank you very much for giving me the opportunity to review this article. The authors of this article have nicely comprehended the evolution of robotic prostatectomy technologies. The article also effectively covers the historical background, anatomical aspects, technical progress and new strategies. The authors have provided a fair evaluation of the topic, identifying the advantages of the new approaches and the uncertainties in the current research.
My recommendations are as follows:
1-The methodological sensitivity of the review could be increased by a more detailed description of the literature selection procedure.
2- The long-term oncological outcomes of these surgical approaches should consider from a broader perspective. The most selected articles contain information and data on short-term results.
3-Although the authors discuss issues such as higher rates of positive surgical margins with pelvic fascia-preserving RARP, a detailed comparison of the oncological outcomes based on the other techniques would have been useful.
4-The ‘Future Directions’ section is not as well developed as the detailed explanation of the present surgical methods. To enhance the content of this section, a more comprehensive discussion of artificial intelligence (AI) and novel robotic systems in prostatectomy techniques would improve the quality of this article.
5-Since the development of new platforms is quite costly, the issue of costs and resource utilization between the robotic strategies should also be discussed.
6- More tables or figures that compare the results across techniques would enhance the visual presentation of the data and this help for easier comparisons.
Therefore, the authors offer a fairly perception of the issue, which is based on both the strengths and the weaknesses of the available evidence.
Author Response
Comment 1: The methodological sensitivity of the review could be increased by a more detailed description of the literature selection procedure.
Response 1: Thank you very much for your feedback. This review is adapted from a more comprehensive committee chapter published in the 3rd WUOF/SIU International Consultation on Urologic Diseases on Localized Prostate Cancer (2024). As such, it does not include a standalone methods section, given its nature as a narrative summary of that work. However, we are happy to include a brief description of the methodology used in developing the original chapter, should the reviewers feel strongly this would enhance clarity or rigor.
Comment 2: The long-term oncological outcomes of these surgical approaches should consider from a broader perspective. The most selected articles contain information and data on short-term results.
Response 2: Long term oncologic outcomes for robotic prostatectomy have now been included. This change can be found on page 4, lines 95-105.
Comment 3: Although the authors discuss issues such as higher rates of positive surgical margins with pelvic fascia-preserving RARP, a detailed comparison of the oncological outcomes based on the other techniques would have been useful.
Response 3: Please refer to Response 2.
Comment 4: The ‘Future Directions’ section is not as well developed as the detailed explanation of the present surgical methods. To enhance the content of this section, a more comprehensive discussion of artificial intelligence (AI) and novel robotic systems in prostatectomy techniques would improve the quality of this article.
Response 4: We have added some more details regarding novel AI-based tools being used in RARP. This change can be found on page 9, line 303-308.
Comment 5: Since the development of new platforms is quite costly, the issue of costs and resource utilization between the robotic strategies should also be discussed.
Response 5: Thank you for this valuable suggestion. We agree that the topic of cost and resource utilization between robotic strategies is important; however, we believe it falls outside the intended scope of this narrative review, which focuses primarily on surgical techniques and outcomes. We appreciate the reviewer’s insight and recognize that a dedicated analysis of economic factors would be a meaningful contribution and could be included if deemed necessary.
Comment 6: More tables or figures that compare the results across techniques would enhance the visual presentation of the data and this help for easier comparisons.
Response 6: We have now added more figures to enhance the visual presentation of the data and to facilitate easier comparison across techniques. We hope these additions improve the clarity and overall utility of the review.
