Robot-Assisted Radical Prostatectomy by the Hugo Robotic-Assisted Surgery (RAS) System and the da Vinci System: A Comparison between the Two Platforms

Abstract

Objective: In a previous study, we proved that an experienced urologist is more likely to adapt to the Hugo RAS system. Based on this, we further examine various parameters in this study. Parameters included in this study consisted of console time, functional outcomes, and oncological outcomes. Materials and Methods: A total of 60 patients who underwent robot-assisted radical prostatectomy (RARP) performed by a single surgeon using the da Vinci (DV) system (n = 30) or the Hugo RAS system (n = 30) between March 2023 and August 2023 were included in the analysis. The intraoperative operative time was categorized into vesicourethral anastomosis time and overall console time. Functional and oncological outcomes were documented at the 1st and 3rd postoperative months. Parametric and non-parametric methods were adopted after checking skewness and kurtosis, and an α value of 5% was used to determine the significance. Results: The vesicourethral anastomosis time was significantly lengthened (Hedge’s g: 0.87; 95% confidence interval (CI): 0.34–1.39; J factor = 0.987). However, the overall console time was not affected. The functional (postoperative 3rd month: p = 0.130) and oncological outcomes (postoperative 3rd month: p = 0.103) were not significantly different. We also found that the adverse effect on surgical specimens and positive surgical margins was not affected (p = 0.552). Conclusion: During the process of adaptation, although intricate motions (such as the vesicourethral anastomosis time) would be lengthened, the overall console time would not change remarkably. In this process, the functional and oncological outcomes would not be compromised. This encourages urologists to adopt the Hugo RAS system in RARP if they have previous experiences of using the DV system, since their trifecta advantage would not be compromised.

Robot-Assisted Radical Prostatectomy Performed with the Novel Hugo™ RAS System: A Systematic Review and Pooled Analysis of Surgical, Oncological, and Functional Outcomes

“…We assessed 37 documents, and 12 papers met our inclusion criteria, including 579 patients. Four studies were conference abstracts [18][19][20][21], and eight were reported in full-text [3,[22][23][24][25][26][27][28]. Five citations [29][30][31][32][33] were duplicated studies by the same group of authors and were retained exclusively because they provided additional data compared to the most recent included report [22,23,26,28].…”

“…Four studies were conference abstracts [18][19][20][21], and eight were reported in full-text [3,[22][23][24][25][26][27][28]. Five citations [29][30][31][32][33] were duplicated studies by the same group of authors and were retained exclusively because they provided additional data compared to the most recent included report [22,23,26,28]. Specifically, Bravi et al [29] provide additional data on postoperative PSA and console time, while Totaro et al [30], Ragavan et al [31], Ou et al [32], and Veccia/Antonelli et al [33] provide additional information on docking parameters.…”

“…The included studies were published between February 2023 and April 2024. Six studies used a comparative design [18,[23][24][25][26]28], one of which was a randomized study [18]. For our analysis, only data from the arm of patients undergoing RARP with the Hugo™ RAS system were extracted from these studies.…”

“…For our analysis, only data from the arm of patients undergoing RARP with the Hugo™ RAS system were extracted from these studies. Eight studies were retrospective [3,[19][20][21]23,24,26,27], and only four [18,22,25,28] used a prospective design. Supplementary Table S2 provides a complete description of the reasons for exclusion after a full-text review.…”

“…We summarized RoB assessments in Figure 2. Six studies were judged to be at low RoB [3,22,[24][25][26]28] and six at high RoB [18][19][20][21]23,27]. The most frequent biases were incomplete outcome data and inadequate explanations for missing data (five studies) [18][19][20][21]23] and the absence of a priori protocol (three studies) [19][20][21].…”