NeuroSAFE-guided robot-assisted radical prostatectomy versus standard RARP: systematic review and meta-analysis of comparative studies

statistic, and publication bias was evaluated using Egger's test.Thirteen studies (2 randomized controlled trials and 11 observational cohorts) comprising 22,183 patients met the inclusion criteria. NeuroSAFE was associated with significantly improved postoperative erectile function (OR 2.00; 95% CI 1.46-2.74) and urinary continence recovery (OR 1.36; 95% CI 1.05-1.76). Positive surgical margins were significantly reduced in the NeuroSAFE group (OR 0.73; 95% CI 0.59-0.89). No differences in biochemical recurrence were observed (OR 0.81; 95% CI 0.43-1.56). Heterogeneity was substantial for some outcomes, and most nonrandomized studies carried a serious risk of bias, which limits causal inference.This systematic review and meta-analysis, including randomized evidence, demonstrates that NeuroSAFE is a safe and effective intraoperative strategy that is associated with improved erectile function, enhanced continence recovery, and negative surgical margins without compromising oncologic outcomes. These findings support integrating NeuroSAFE into surgical decision-making for patients undergoing RARP, particularly when nerve preservation can be achieved without compromising oncologic outcomes.In this study, we compared a surgical approach that uses real-time analysis during prostate cancer surgery with the standard technique. This method helps surgeons decide how much tissue to preserve while the operation is still ongoing. We found that this approach is safe and may improve recovery of urinary continence and sexual function, while also reducing the risk of leaving cancer behind, without compromising cancer control.