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Neurovascular structure-adjacent frozen-section examination (NeuroSAFE) during robot-assisted radical prostatectomy: a systematic review and meta-analysis of comparative studies

Prostate Cancer and Prostatic Diseases volume 28, pages 623–631 (2025)Cite this article

Subjects

Abstract

Background

To compare surgical, pathological, and functional outcomes of patients undergoing NeuroSAFE-guided RARP vs. RARP alone.

Methods

In February 2024, a literature search and assessment was conducted through PubMed®, Scopus®, and Web of Science™, to retrieve data of men with PCa (P) undergoing RARP with NeuroSAFE (I) versus RARP without NeuroSAFE (C) to evaluate surgical, pathological, oncological, and functional outcomes (O), across retrospective and/or prospective comparative studies (Studies). Surgical (operative time [OT], number of nerve-sparing [NS] RARP, number of secondary resections after NeuroSAFE), pathological (PSM), oncological (biochemical recurrence [BCR]), and functional (postoperative continence and sexual function recovery) outcomes were analyzed, using weighted mean difference (WMD) for continuous variables and odd ratio (OR) for dichotomous variables.

Results

Overall, seven studies met the inclusion criteria (one randomized clinical trial, one prospective non-randomized trial and five retrospective studies) and were eligible for SR and MA. A total of 4,207 patients were included in the MA, with 2247 patients (53%) undergoing RARP with the addition of NeuroSAFE, and 1 960 (47%) receiving RARP alone. The addition of NeuroSAFE enhanced the likelihood of receiving a nerve-sparing (NS) RARP (OR 5.49, 95% CI 2.48–12.12, I2 = 72%). In the NeuroSAFE cohort, a statistically significant reduction in the likelihood of PSM at final pathology (OR 0.55, 95% CI 0.39–0.79, I2 = 73%) was observed. Similarly, a reduced likelihood of BCR favoring the NeuroSAFE was obtained (OR 0.47, 95% CI 0.35–0.62, I2 = 0%). At 12-month postoperatively, NeuroSAFE led to a significantly higher likelihood of being pad-free (OR 2.01, 95% CI 1.25–3.25, I2 = 0%), and of erectile function recovery (OR 3.50, 95% CI 2.34–5.23, I2 = 0%).

Conclusion

Available evidence suggests that NeuroSAFE might represent a histologically based approach to NVB preservation, broadening the indications of NS RARP, reducing the likelihood of PSM and subsequent BCR. In addition, it might translate into better functional postoperative outcomes. However, the current body of evidence is mostly derived from non-randomized studies with a high risk of bias.

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Fig. 1: Literature search process.
Fig. 2: Pathological and oncological outcomes.
Fig. 3: Functional outcomes.
Fig. 4: Risk of bias assessment of included studies.

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Data availability

Sheets containing raw data (extracted variables, statistical analyses) are available upon reasonable request from the corresponding author.

References

  1. Dasgupta P, Patil K, Anderson C, Kirby R. Transition From Open To Robotic‐Assisted Radical Prostatectomy. BJU Int. 2008;101:667–8.

    Article  PubMed  Google Scholar 

  2. Cornford P, van den Bergh RCN, Briers E, Van den Broeck T, Brunckhorst O, Darraugh J, et al. EAU-EANM-ESTRO-ESUR-ISUP-SIOG Guidelines on Prostate Cancer—2024 Update. Part I: Screening, Diagnosis, and Local Treatment with Curative Intent. Eur Urol. 2024;86:148–63.

    Article  PubMed  Google Scholar 

  3. Ilic D, Evans SM, Allan CA, Jung JH, Murphy D, Frydenberg M. Laparoscopic and robotic-assisted versus open radical prostatectomy for the treatment of localised prostate cancer. Cochrane Database Syst Rev. 2017;9:CD009625.

    PubMed  Google Scholar 

  4. Tewari AK, Srivastava A, Huang MW, Robinson BD, Shevchuk MM, Durand M, et al. Anatomical grades of nerve sparing: a risk‐stratified approach to neural‐hammock sparing during robot‐assisted radical prostatectomy (RARP). BJU Int. 2011;108:984–92.

    Article  PubMed  Google Scholar 

  5. Moris L, Gandaglia G, Vilaseca A, Van den Broeck T, Briers E, De Santis M, et al. Evaluation of Oncological Outcomes and Data Quality in Studies Assessing Nerve-sparing Versus Non–Nerve-sparing Radical Prostatectomy in Nonmetastatic Prostate Cancer: A Systematic Review. Eur Urol Focus 2022;8:690–700.

    Article  PubMed  Google Scholar 

  6. Eissa A, Zoeir A, Sighinolfi MC, Puliatti S, Bevilacqua L, Del Prete C, et al. “Real-time” Assessment of Surgical Margins During Radical Prostatectomy: State-of-the-Art. Clin Genitourin Cancer. 2020;18:95–104.

    Article  PubMed  Google Scholar 

  7. Bianchi L, Chessa F, Angiolini A, Cercenelli L, Lodi S, Bortolani B, et al. The Use of Augmented Reality to Guide the Intraoperative Frozen Section During Robot-assisted Radical Prostatectomy. Eur Urol. 2021;80:480–8.

    Article  PubMed  Google Scholar 

  8. Oxley J, Bray A, Rowe E. Could a Mohs technique make Neuro <scp>SAFE</scp> a viable option? BJU Int. 2018;122:358–9.

    Article  PubMed  Google Scholar 

  9. Öbek C, Saglican Y, Ince U, Argun OB, Tuna MB, Doganca T, et al. Intra-surgical total and re-constructible pathological prostate examination for safer margins and nerve preservation (Istanbul preserve). Ann Diagn Pathol. 2018;33:35–9.

    Article  PubMed  Google Scholar 

  10. Fosså SD, Beyer B, Dahl AA, Aas K, Eri LM, Kvan E, et al. Improved patient-reported functional outcomes after nerve-sparing radical prostatectomy by using NeuroSAFE technique. Scand J Urol. 2019;53:385–91.

    Article  PubMed  Google Scholar 

  11. Preisser F, Theissen L, Wild P, Bartelt K, Kluth L, Köllermann J, et al. Implementation of Intraoperative Frozen Section During Radical Prostatectomy: Short-term Results from a German Tertiary-care Center. Eur Urol Focus 2021;7:95–101.

    Article  PubMed  Google Scholar 

  12. Beyer B, Schlomm T, Tennstedt P, Boehm K, Adam M, Schiffmann J, et al. A Feasible and Time-efficient Adaptation of NeuroSAFE for da Vinci Robot-assisted Radical Prostatectomy. Eur Urol. 2014;66:138–44.

    Article  PubMed  Google Scholar 

  13. Schlomm T, Tennstedt P, Huxhold C, Steuber T, Salomon G, Michl U, et al. Neurovascular Structure-adjacent Frozen-section Examination (NeuroSAFE) Increases Nerve-sparing Frequency and Reduces Positive Surgical Margins in Open and Robot-assisted Laparoscopic Radical Prostatectomy: Experience After 11 069 Consecutive Patients. Eur Urol. 2012;62:333–40.

    Article  PubMed  Google Scholar 

  14. Mirmilstein G, Rai BP, Gbolahan O, Srirangam V, Narula A, Agarwal S, et al. The neurovascular structure‐adjacent frozen‐section examination (Neuro <scp>SAFE</scp>) approach to nerve sparing in robot‐assisted laparoscopic radical prostatectomy in a British setting – a prospective observational comparative study. BJU Int. 2018;121:854–62.

    Article  PubMed  CAS  Google Scholar 

  15. Dinneen E, Haider A, Grierson J, Freeman A, Oxley J, Briggs T, et al. NeuroSAFE frozen section during robot‐assisted radical prostatectomy: peri‐operative and histopathological outcomes from the NeuroSAFE PROOF feasibility randomized controlled trial. BJU Int. 2021;127:676–86.

    Article  PubMed  Google Scholar 

  16. Dinneen EP, Van Der Slot M, Adasonla K, Tan J, Grierson J, Haider A, et al. Intraoperative Frozen Section for Margin Evaluation During Radical Prostatectomy: A Systematic Review. Eur Urol Focus. 2020;6:664–73.

    Article  PubMed  Google Scholar 

  17. Page MJ, McKenzie JE, Bossuyt PM, Boutron I, Hoffmann TC, Mulrow CD, et al. The PRISMA 2020 statement: an updated guideline for reporting systematic reviews. BMJ 2021;372:n71.

    Article  PubMed  PubMed Central  Google Scholar 

  18. Kumar A, Patel VR, Panaiyadiyan S, Seetharam Bhat KR, Moschovas MC, Nayak B. Nerve-sparing robot-assisted radical prostatectomy: Current perspectives. Asian J Urol. 2021;8:2–13.

    Article  PubMed  Google Scholar 

  19. Tal R, Alphs HH, Krebs P, Nelson CJ, Mulhall JP. Erectile Function Recovery Rate after Radical Prostatectomy: A Meta-Analysis. J Sex Med. 2009;6:2538–46.

    Article  PubMed  PubMed Central  Google Scholar 

  20. McGrath S, Zhao X, Steele R, Thombs BD, Benedetti A, Levis B, et al. Estimating the sample mean and standard deviation from commonly reported quantiles in meta-analysis. Stat Methods Med Res. 2020;29:2520–37.

    Article  PubMed  PubMed Central  Google Scholar 

  21. Hozo SP, Djulbegovic B, Hozo I. Estimating the mean and variance from the median, range, and the size of a sample. BMC Med Res Methodol. 2005;5:13.

    Article  PubMed  PubMed Central  Google Scholar 

  22. Ades AE, Lu G, Higgins JPT. The Interpretation of Random-Effects Meta-Analysis in Decision Models. Med Decis Mak. 2005;25:646–54.

    Article  CAS  Google Scholar 

  23. Sterne JAC, Savović J, Page MJ, Elbers RG, Blencowe NS, Boutron I, et al. RoB 2: a revised tool for assessing risk of bias in randomised trials. BMJ 2019;366:l4898.

    Article  PubMed  Google Scholar 

  24. Sterne JA, Hernán MA, Reeves BC, Savović J, Berkman ND, Viswanathan M, et al. ROBINS-I: a tool for assessing risk of bias in non-randomised studies of interventions. BMJ 2016;355:i4919.

    Article  PubMed  PubMed Central  Google Scholar 

  25. McGuinness LA, Higgins JPT. Risk‐of‐bias VISualization (robvis): An R package and Shiny web app for visualizing risk‐of‐bias assessments. Res Synth Methods. 2021;12:55–61.

    Article  PubMed  Google Scholar 

  26. Shea BJ, Reeves BC, Wells G, Thuku M, Hamel C, Moran J, et al. AMSTAR 2: a critical appraisal tool for systematic reviews that include randomised or non-randomised studies of healthcare interventions, or both. BMJ 2017;358:j4008.

    Article  PubMed  PubMed Central  Google Scholar 

  27. van der Slot MA, den Bakker MA, Tan TSC, Remmers S, Busstra MB, Gan M, et al. <scp>NeuroSAFE</scp> in radical prostatectomy increases the rate of nerve‐sparing surgery without affecting oncological outcome. BJU Int. 2022;130:628–36.

    Article  PubMed  PubMed Central  Google Scholar 

  28. Köseoğlu E, Kulaç İ, Armutlu A, Gürses B, Seymen H, Vural M, et al. Intraoperative Frozen Section via Neurosafe During Robotic Radical Prostatectomy in the Era of Preoperative Risk Stratifications and Primary Staging With mpMRI and PSMA-PET CT: Is There a Perfect Candidate? Clin Genitourin Cancer. 2023;21:602–11.

    Article  PubMed  Google Scholar 

  29. Leitsmann C, Uhlig A, Bremmer F, Mut TT, Ahyai S, Reichert M, et al. Impact of mpMRI targeted biopsy on intraoperative nerve‐sparing (NeuroSAFE) during robot‐assisted laparoscopic radical prostatectomy. Prostate 2022;82:493–501.

    Article  PubMed  Google Scholar 

  30. Sooriakumaran P, Dev HS, Skarecky D, Ahlering T. The importance of surgical margins in prostate cancer. J Surg Oncol. 2016;113:310–5.

    Article  PubMed  Google Scholar 

  31. Zhang L, Wu B, Zha Z, Zhao H, Jiang Y, Yuan J. Positive surgical margin is associated with biochemical recurrence risk following radical prostatectomy: a meta-analysis from high-quality retrospective cohort studies. World J Surg Oncol. 2018;16:124.

    Article  PubMed  PubMed Central  Google Scholar 

  32. Steineck G, Bjartell A, Hugosson J, Axén E, Carlsson S, Stranne J, et al. Degree of Preservation of the Neurovascular Bundles During Radical Prostatectomy and Urinary Continence 1 Year after Surgery. Eur Urol. 2015;67:559–68.

    Article  PubMed  Google Scholar 

  33. Sighinolfi MC, Eissa A, Spandri V, Puliatti S, Micali S, Reggiani Bonetti L, et al. Positive surgical margin during radical prostatectomy: overview of sampling methods for frozen sections and techniques for the secondary resection of the neurovascular bundles. BJU Int. 2020;125:656–63.

    Article  PubMed  Google Scholar 

  34. Vis AN, Nieuwenhuijzen JA, Veerman H, Roeleveld T, Wit E, van der Sluis TM, et al. NeuroSAFE remains an investigational, debatable, laborious (expensive) procedure. BJU Int. 2023;131:131–2.

    Article  PubMed  Google Scholar 

  35. van der Slot MA, den Bakker MA, Klaver S, Kliffen M, Busstra MB, Rietbergen JBW, et al. Intraoperative assessment and reporting of radical prostatectomy specimens to guide nerve‐sparing surgery in prostate cancer patients (NeuroSAFE). Histopathology 2020;77:539–47.

    Article  PubMed  PubMed Central  Google Scholar 

  36. Herlemann A, Meng MV. Editorial: Conversion to negative surgical margin after intraoperative frozen section – (un)necessary effort and relevance in 2019? BJU Int. 2019;123:744–6.

    Article  PubMed  Google Scholar 

  37. Walsh PC, Donker PJ. Impotence Following Radical Prostatectomy: Insight Into Etiology and Prevention. J Urol. 1982;128:492–7.

    Article  PubMed  CAS  Google Scholar 

  38. Schatloff O, Chauhan S, Sivaraman A, Kameh D, Palmer KJ, Patel VR. Anatomic Grading of Nerve Sparing During Robot-Assisted Radical Prostatectomy. Eur Urol. 2012;61:796–802.

    Article  PubMed  Google Scholar 

  39. Tewari A, Peabody JO, Fischer M, Sarle R, Vallancien G, Delmas V, et al. An Operative and Anatomic Study to Help in Nerve Sparing during Laparoscopic and Robotic Radical Prostatectomy. Eur Urol. 2003;43:444–54.

    Article  PubMed  Google Scholar 

  40. Moschovas MC, Patel V. Nerve-sparing robotic-assisted radical prostatectomy: how I do it after 15.000 cases. Int Braz J Urol. 2022;48:369–70.

    Article  PubMed  Google Scholar 

  41. Meeks JJ, Eastham JA. Radical prostatectomy: Positive surgical margins matter. Urologic Oncol: Semin Original Investig. 2013;31:974–9.

    Article  Google Scholar 

  42. Preston MA, Carrière M, Raju G, Morash C, Doucette S, Gerridzen RG, et al. The Prognostic Significance of Capsular Incision Into Tumor During Radical Prostatectomy. Eur Urol. 2011;59:613–8.

    Article  PubMed  Google Scholar 

  43. Preisser F, Heinze A, S. Abrams‐Pompe R, Budäus L, Chun FK‐H, Graefen M, et al. Impact of positive surgical margin length and Gleason grade at the margin on oncologic outcomes in patients with nonorgan‐confined prostate cancer. Prostate. 2022;82:949–56.

    Article  PubMed  Google Scholar 

  44. Kates M, Sopko NA, Han M, Partin AW, Epstein JI. Importance of Reporting the Gleason Score at the Positive Surgical Margin Site: Analysis of 4,082 Consecutive Radical Prostatectomy Cases. J Urol. 2016;195:337–42.

    Article  PubMed  Google Scholar 

  45. Shore ND, Moul JW, Pienta KJ, Czernin J, King MT, Freedland SJ. Biochemical recurrence in patients with prostate cancer after primary definitive therapy: treatment based on risk stratification. Prostate Cancer Prostatic Dis. 2024;27:192–201.

  46. Zaffuto E, Gandaglia G, Fossati N, Dell’Oglio P, Moschini M, Cucchiara V, et al. Early Postoperative Radiotherapy is Associated with Worse Functional Outcomes in Patients with Prostate Cancer. J Urol. 2017;197:669–75.

    Article  PubMed  Google Scholar 

  47. Menon M, Dalela D, Jamil M, Diaz M, Tallman C, Abdollah F, et al. Functional Recovery, Oncologic Outcomes and Postoperative Complications after Robot-Assisted Radical Prostatectomy: An Evidence-Based Analysis Comparing the Retzius Sparing and Standard Approaches. J Urol. 2018;199:1210–7.

    Article  PubMed  Google Scholar 

  48. Ficarra V, Rossanese M, Gilante M, Foti M, Macchione L, Mucciardi G, et al. Retzius-sparing vs. standard robot-assisted radical prostatectomy for clinically localised prostate cancer: a comparative study. Prostate Cancer Prostatic Dis. 2023;26:568–74.

    Article  PubMed  Google Scholar 

  49. Del Giudice F, Huang J, Li S, Sorensen S, Enemchukwu E, Maggi M, et al. Contemporary trends in the surgical management of urinary incontinence after radical prostatectomy in the United States. Prostate Cancer Prostatic Dis. 2023;26:367–73.

    Article  PubMed  Google Scholar 

  50. Seetharam Bhat KR, Moschovas MC, Sandri M, Reddy S, Onol FF, Noel J, et al. Stratification of Potency Outcomes Following Robot-Assisted Laparoscopic Radical Prostatectomy Based on Age, Preoperative Potency, and Nerve Sparing. J Endourol. 2021;35:1631–8.

    Article  PubMed  Google Scholar 

  51. Walz J, Epstein JI, Ganzer R, Graefen M, Guazzoni G, Kaouk J, et al. A Critical Analysis of the Current Knowledge of Surgical Anatomy of the Prostate Related to Optimisation of Cancer Control and Preservation of Continence and Erection in Candidates for Radical Prostatectomy: An Update. Eur Urol. 2016;70:301–11.

    Article  PubMed  Google Scholar 

  52. Kaye DR, Hyndman ME, Segal RL, Mettee LZ, Trock BJ, Feng Z, et al. Urinary Outcomes Are Significantly Affected by Nerve Sparing Quality During Radical Prostatectomy. Urology 2013;82:1348–54.

    Article  PubMed  Google Scholar 

  53. Boorjian SA, Eastham JA, Graefen M, Guillonneau B, Karnes RJ, Moul JW, et al. A Critical Analysis of the Long-Term Impact of Radical Prostatectomy on Cancer Control and Function Outcomes. Eur Urol. 2012;61:664–75.

    Article  PubMed  Google Scholar 

  54. Hatzichristodoulou G, Wagenpfeil S, Weirich G, Autenrieth M, Maurer T, Thalgott M, et al. Intraoperative frozen section monitoring during nerve-sparing radical prostatectomy: evaluation of partial secondary resection of neurovascular bundles and its effect on oncologic and functional outcome. World J Urol. 2016;34:229–36.

    Article  PubMed  Google Scholar 

  55. Morozov A, Barret E, Veneziano D, Grigoryan V, Salomon G, Fokin I, et al. A systematic review of nerve-sparing surgery for high-risk prostate cancer. Minerva Urol Nephrol. 2021;73:283–91.

    Article  PubMed  Google Scholar 

  56. Levinson AW, Pavlovich CP, Ward NT, Link RE, Mettee LZ, Su LM. Association of Surgeon Subjective Characterization of Nerve Sparing Quality With Potency Following Laparoscopic Radical Prostatectomy. J Urol. 2008;179:1510–4.

    Article  PubMed  Google Scholar 

  57. Sohayda C, Kupelian PA, Levin HS, Klein EA. Extent of extracapsular extension in localized prostate cancer. Urology 2000;55:382–6.

    Article  PubMed  CAS  Google Scholar 

  58. Patel VR, Sandri M, Grasso AAC, De Lorenzis E, Palmisano F, Albo G, et al. A novel tool for predicting extracapsular extension during graded partial nerve sparing in radical prostatectomy. BJU Int. 2018;121:373–82.

    Article  PubMed  Google Scholar 

  59. Zhang F, Liu CL, Chen Q, Shao SC, Chen SQ. Accuracy of multiparametric magnetic resonance imaging for detecting extracapsular extension in prostate cancer: a systematic review and meta-analysis. Br J Radio. 2019;92:20190480.

    Article  Google Scholar 

  60. Dinneen E, Grierson J, Almeida-Magana R, Clow R, Haider A, Allen C, et al. NeuroSAFE PROOF: study protocol for a single-blinded, IDEAL stage 3, multi-centre, randomised controlled trial of NeuroSAFE robotic-assisted radical prostatectomy versus standard robotic-assisted radical prostatectomy in men with localized prostate cancer. Trials 2022;23:584.

    Article  PubMed  PubMed Central  Google Scholar 

  61. Rocco B, Sarchi L, Assumma S, Cimadamore A, Montironi R, Reggiani Bonetti L, et al. Digital Frozen Sections with Fluorescence Confocal Microscopy During Robot-assisted Radical Prostatectomy: Surgical Technique. Eur Urol. 2021;80:724–9.

    Article  PubMed  CAS  Google Scholar 

  62. Lavery HJ, Xiao G, Nabizada‐Pace F, Mikulasovich M, Unger P, Samadi DB. ‘Mohs surgery of the prostate’: the utility of in situ frozen section analysis during robotic prostatectomy. BJU Int. 2011;107:975–9.

    Article  PubMed  Google Scholar 

  63. Petralia G, Musi G, Padhani AR, Summers P, Renne G, Alessi S, et al. Robot-assisted Radical Prostatectomy: Multiparametric MR Imaging–directed Intraoperative Frozen-Section Analysis to Reduce the Rate of Positive Surgical Margins. Radiology 2015;274:434–44.

    Article  PubMed  Google Scholar 

  64. Checcucci E, Pecoraro A, Amparore D, De Cillis S, Granato S, Volpi G, et al. The impact of 3D models on positive surgical margins after robot-assisted radical prostatectomy. World J Urol. 2022;40:2221–9.

    Article  PubMed  Google Scholar 

  65. Checcucci E, Piana A, Volpi G, Piazzolla P, Amparore D, De Cillis S, et al. Three-dimensional automatic artificial intelligence driven augmented-reality selective biopsy during nerve-sparing robot-assisted radical prostatectomy: A feasibility and accuracy study. Asian J Urol. 2023;10:407–15.

    Article  PubMed  PubMed Central  Google Scholar 

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Authors and Affiliations

  1. Department of Urology, Rush University Medical Center, Chicago, IL, USA

    Francesco Ditonno, Eugenio Bologna, Leslie Claire Licari, Antonio Franco & Riccardo Autorino

  2. Department of Urology, University of Verona, Azienda Ospedaliera Universitaria Integrata, Verona, Italy

    Francesco Ditonno, Alessandro Veccia, Riccardo Bertolo & Alessandro Antonelli

  3. Unit of Urology, Department of Maternal-Child and Urological Sciences, Policlinico Umberto I Hospital, ‘‘Sapienza’’ University, Rome, Italy

    Eugenio Bologna & Leslie Claire Licari

  4. Department of Urology, Sant’Andrea Hospital, Sapienza University, Rome, Italy

    Antonio Franco & Cosimo De Nunzio

  5. Department of Urology, University of Illinois at Chicago, Chicago, IL, USA

    Donato Cannoletta & Simone Crivellaro

  6. Department of Surgery, Candiolo Cancer Institute, FPO-IRCCS, Candiolo, Turin, Italy

    Enrico Checcucci

  7. Division of Urology, Department of Oncology, San Luigi Gonzaga Hospital, University of Turin, Turin, Italy

    Francesco Porpiglia

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Contributions

Conception and design: Autorino, Ditonno; Acquisition of data: Franco, Cannoletta, Licari; Statistical analysis: Ditonno, Bologna; Interpretation of the data: Veccia, Bertolo, Checcucci, Crivellaro, Porpiglia, De Nunzio, Antonelli; Drafting of the manuscript: Ditonno; Critical revision of the manuscript for important intellectual content: Bologna, Licari, Franco, Cannoletta, Checcucci, Veccia, Bertolo, Crivellaro, Porpiglia, De Nunzio, Antonelli, Autorino Supervision: Autorino; Final approval of the version to be published: Ditonno, Bologna, Licari, Franco, Cannoletta, Checcucci, Veccia, Bertolo, Crivellaro, Porpiglia, De Nunzio, Antonelli, Autorino; Agreement to be accountable for all aspects of the work in ensuring that questions related to the accuracy or integrity of any part of the work are appropriately investigated and resolved: Ditonno, Bologna, Licari, Franco, Cannoletta, Checcucci, Veccia, Bertolo, Crivellaro, Porpiglia, De Nunzio, Antonelli, Autorino; All authors read and approved the final version of the manuscript.

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Correspondence to Riccardo Autorino.

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Simone Crivellaro is a consultant for Intuitive. Cosimo De Nunzio is editor in chief of Prostate Cancer Prostatic Disease.

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Ditonno, F., Bologna, E., Licari, L.C. et al. Neurovascular structure-adjacent frozen-section examination (NeuroSAFE) during robot-assisted radical prostatectomy: a systematic review and meta-analysis of comparative studies. Prostate Cancer Prostatic Dis 28, 623–631 (2025). https://doi.org/10.1038/s41391-024-00891-3

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