Robot-assisted Radical Prostatectomy with the Hugo RAS and da Vinci Surgical Robotic Systems: A Systematic Review and Meta-analysis of Comparative Studies

• Published in: European urology focus 2024-10
• Main Authors: Marino, Filippo, Moretto, Stefano, Rossi, Francesco, Bizzarri, Francesco Pio, Gandi, Carlo, Filomena, Giovanni Battista, Gavi, Filippo, Russo, Pierluigi, Campetella, Marco, Totaro, Angelo, Pierconti, Francesco, Lentini, Nicolò, Pastorino, Roberta, Sacco, Emilio
• Format: Article
• Language: English
• Subjects: Comparative studies; da Vinci surgical system; Hugo RAS system; Robot-assisted radical prostatectomy; Robotic surgery
• ISSN: 2405-4569; 2405-4569
• DOI: 10.1016/j.euf.2024.10.005

For robot-assisted radical prostatectomy, the Hugo RAS system shows comparable outcomes to the da Vinci system but has a longer docking time and a steeper learning curve, requiring better training. The Hugo RAS robot offers ergonomic benefits but presents challenges for certain advanced procedures and integration of technology. The introduction of the Hugo RAS system represents a recent innovation in robotic surgery. The potential benefits and limitations of this system and its integration into clinical practice in urology have yet to be fully delineated. Our objective was to assess surgical, early oncological, and functional outcomes in studies comparing robot-assisted radical prostatectomy (RARP) performed with the new Hugo RAS system and the well-established da Vinci surgical system. We conducted a systematic review and meta-analysis using PubMed, Web of Science, Scopus, and Embase databases. Eligible studies compared RARP outcomes in adult males between the Hugo RAS and da Vinci systems. The main endpoints were analyzed using a random-effects model, including perioperative outcomes (surgical times, estimated blood loss, length of hospital stay, Clavien-Dindo grade ≥2 complications), oncological outcomes (positive surgical margins and postoperative prostate-specific antigen), and functional outcomes (continence status and erectile function). Nine studies involving 1185 patients (478 Hugo RAS and 707 da Vinci) were included. Significant differences in pooled baseline characteristics included higher body mass index for the da Vinci cohort (p = 0.035) and a higher rate of palpable disease in the Hugo RAS cohort (p = 0.036). Docking time was significantly longer for the Hugo RAS, with a median difference of 6.1 min (95% confidence interval 3.9–8.2; I2 = 68.6%; p