{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,10,20]],"date-time":"2026-10-20T23:40:25Z","timestamp":1792539625822,"version":"4.5.0"},"reference-count":40,"publisher":"SAGE Publications","issue":"12","license":[{"start":{"date-parts":[[2026,6,15]],"date-time":"2026-06-15T00:00:00Z","timestamp":1781481600000},"content-version":"tdm","delay-in-days":0,"URL":"https:\/\/journals.sagepub.com\/page\/policies\/text-and-data-mining-license"}],"content-domain":{"domain":["journals.sagepub.com"],"crossmark-restriction":true},"short-container-title":["Journal of Laparoendoscopic &amp; Advanced Surgical Techniques"],"published-print":{"date-parts":[[2026,12,1]]},"abstract":"<jats:sec>\n                    <jats:title>Background:<\/jats:title>\n                    <jats:p>Holmium laser enucleation of the prostate (HoLEP) has emerged as an alternative for benign prostatic obstruction (BPO), with fewer perioperative and functional complications. However, its comparative performance relative to robot-assisted simple prostatectomy (RASP) remains debated, requiring updated evaluation.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Methods:<\/jats:title>\n                    <jats:p>A systematic review and meta-analysis of studies comparing HoLEP and RASP was performed using PubMed, Scopus, and Cochrane databases through August 2025. Outcomes were pooled using mean differences (MDs) and odds ratios (ORs) with random-effects models. Risk of bias assessment and trial sequential analysis were conducted to evaluate the robustness of evidence.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Results:<\/jats:title>\n                    <jats:p>Thirteen studies, including 1993 patients, were analyzed. HoLEP was associated with shorter operative time (MD = \u221232.05 minutes), lower transfusion rates (OR = 0.34), fewer Clavien\u2013Dindo grades III and IV complications (OR = 0.39), and earlier catheter removal (MD = \u22123.84 days). Postoperative International Prostate Symptom Score modestly favored RASP (MD = 0.96). No significant differences were observed in quality of life, maximum urinary flow rate, International Index of Erectile Function, prostate-specific antigen reduction, postvoid residual volume, estimated blood loss, specimen weight, hospital stay, minor complications, trifecta achievement, or postoperative urge and stress incontinence.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Conclusion:<\/jats:title>\n                    <jats:p>HoLEP provides improved perioperative safety with largely comparable functional outcomes compared with RASP. Further high-quality comparative studies are needed to confirm long-term effectiveness.<\/jats:p>\n                  <\/jats:sec>","DOI":"10.1177\/10926429261461101","type":"journal-article","created":{"date-parts":[[2026,6,16]],"date-time":"2026-06-16T01:46:00Z","timestamp":1781574360000},"page":"881-895","update-policy":"https:\/\/doi.org\/10.1177\/sage-journals-update-policy","source":"Crossref","is-referenced-by-count":0,"title":["Holmium Laser Enucleation of the Prostate Versus Robot-Assisted Simple Prostatectomy for Benign Prostatic Obstruction: A Systematic Review and Meta-Analysis with Trial Sequential Analysis"],"prefix":"10.1177","volume":"36","author":[{"given":"Giulia Luiza","family":"Garcia","sequence":"first","affiliation":[{"name":"University of S\u00e3o Caetano do Sul, S\u00e3o Paulo, Brazil."}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0009-0009-2960-3810","authenticated-orcid":false,"given":"Bernardo Fontel","family":"Pompeu","sequence":"additional","affiliation":[{"name":"University of S\u00e3o Caetano do Sul, S\u00e3o Paulo, Brazil."},{"name":"Department of Surgery, Heliopolis Hospital, S\u00e3o Paulo, Brazil."}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Gabriel Leal","family":"Barone","sequence":"additional","affiliation":[{"name":"University of S\u00e3o Caetano do Sul, S\u00e3o Paulo, Brazil."}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Giovanna Barbaroto","family":"Pilon","sequence":"additional","affiliation":[{"name":"University of S\u00e3o Caetano do Sul, S\u00e3o Paulo, Brazil."}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Camila Tur de Arruda","family":"Ribeiro","sequence":"additional","affiliation":[{"name":"Department of Urology, Hospital Militar de \u00c1rea de S\u00e3o Paulo, S\u00e3o Paulo, Brazil."}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Michel Azzem","family":"Goes","sequence":"additional","affiliation":[{"name":"Department of Urology, Hospital Militar de \u00c1rea de S\u00e3o Paulo, S\u00e3o Paulo, Brazil."}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Claudia","family":"Theis","sequence":"additional","affiliation":[{"name":"Department of Surgery, University of North Carolina, Chapel Hill, North Carolina, USA."}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0003-4009-7428","authenticated-orcid":false,"given":"Leonardo","family":"Borges","sequence":"additional","affiliation":[{"name":"Department of Urology, Albert Einstein Hospital, S\u00e3o Paulo, Brazil."}],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"179","published-online":{"date-parts":[[2026,6,15]]},"reference":[{"key":"e_1_3_3_2_1","doi-asserted-by":"publisher","DOI":"10.1186\/s12894-024-01615-4"},{"key":"e_1_3_3_3_1","doi-asserted-by":"publisher","DOI":"10.1007\/s00345-022-04176-z"},{"key":"e_1_3_3_4_1","doi-asserted-by":"publisher","DOI":"10.3390\/jcm9061798"},{"key":"e_1_3_3_5_1","doi-asserted-by":"publisher","DOI":"10.1016\/j.eururo.2014.12.038"},{"key":"e_1_3_3_6_1","doi-asserted-by":"publisher","DOI":"10.1089\/end.2000.14.529"},{"key":"e_1_3_3_7_1","doi-asserted-by":"publisher","DOI":"10.1016\/j.eururo.2009.03.070"},{"key":"e_1_3_3_8_1","doi-asserted-by":"publisher","DOI":"10.1016\/j.urology.2005.06.006"},{"key":"e_1_3_3_9_1","doi-asserted-by":"publisher","DOI":"10.1016\/j.juro.2016.08.114"},{"key":"e_1_3_3_10_1","doi-asserted-by":"publisher","DOI":"10.1097\/JU.0000000000004297"},{"key":"e_1_3_3_11_1","doi-asserted-by":"publisher","DOI":"10.1007\/s11701-025-02577-x"},{"key":"e_1_3_3_12_1","doi-asserted-by":"publisher","DOI":"10.1055\/a-2577-3748"},{"key":"e_1_3_3_13_1","doi-asserted-by":"publisher","DOI":"10.3390\/std14020017"},{"key":"e_1_3_3_14_1","doi-asserted-by":"publisher","DOI":"10.1136\/bmj.n71"},{"key":"e_1_3_3_15_1","first-page":"104280","article-title":"Comparative efficacy and safety of holmium laser enucleation of the prostate (HoLEP) and robotic-assisted simple prostatectomy (RASP): A systematic review and meta-analysis [Internet]","volume":"81","author":"Garcia G","year":"2025","unstructured":"14.Garcia G. Comparative efficacy and safety of holmium laser enucleation of the prostate (HoLEP) and robotic-assisted simple prostatectomy (RASP): A systematic review and meta-analysis [Internet]. 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