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

Background and objective: 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.

Methods: 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).

Key findings and limitations: 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 < 0.001; three studies). Overall, there were no significant differences in perioperative, oncological, and functional outcomes between the two systems.

Conclusions and clinical implications: Despite the preliminary nature of the evidence, this systematic review and meta-analysis show comparable surgical and clinical outcomes for RARP performed with the Hugo RAS system and the da Vinci robotic platform.

Patient summary: We reviewed studies comparing the use of two different surgical robots for removal of the prostate. The results suggest that surgical and clinical outcomes with the new Hugo RAS robot are comparable to those with the established da Vinci robot for this procedure.