Intraoperative Performance of DaVinci Versus Hugo RAS During Radical Prostatectomy: Focus on Timing, Malfunctioning, Complications, and User Satisfaction in 100 Consecutive Cases (the COMPAR-P Trial)

The present prospective study compared 50 versus 50 unselected patients who underwent robotic prostatectomy performed with the DaVinci versus Hugo RAS system. Although more malfunctioning/troubleshooting events were recorded during Hugo RAS cases, the surgery outcomes, including the occurrence of in...

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Published in:	European urology open science (Online) Vol. 63; pp. 104 - 112
Main Authors:	Antonelli, Alessandro, Veccia, Alessandro, Malandra, Sarah, Rizzetto, Riccardo, De Marco, Vincenzo, Baielli, Alberto, Franceschini, Andrea, Fumanelli, Francesca, Montanaro, Francesca, Palumbo, Iolanda, Pettenuzzo, Greta, Roggero, Luca, Angela Cerruto, Maria, Bertolo, Riccardo, Aloe, Michele, Artoni, Francesco, Bianchi, Paolo, Brancelli, Claudio, Costantino, Sonia, Pongmoni, Peres Fokana, Fracasso, Piero, Patuzzo, Giulia Marafioti, Raiti, Antonio, Toska, Endri, Vetro, Vincenzo
Format:	Journal Article
Language:	English
Published:	Netherlands Elsevier B.V 01-05-2024 Elsevier
Subjects:	DaVinci Hugo RAS Prostate Cancer Radical prostatectomy Robotic surgery Surgical outcomes Robotic surgery Surgical outcomes Radical prostatectomy Performance Hugo RAS DaVinci
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Summary:	The present prospective study compared 50 versus 50 unselected patients who underwent robotic prostatectomy performed with the DaVinci versus Hugo RAS system. Although more malfunctioning/troubleshooting events were recorded during Hugo RAS cases, the surgery outcomes, including the occurrence of intraoperative complications, were not statistically different. Longer operative time was recorded for Hugo RAS cases, likely explained by the meticulous care applied in the surgery due to the use of the novel platform. Still, the prospect of improvement within a relatively low number of procedures was evident. All these findings can contribute to the adoption of this new platform. The Hugo RAS and DaVinci Xi systems are used for performing robot-assisted radical prostatectomy (RARP). This study aims to compare these two platforms providing granular and comprehensive data on their intraoperative performance. The Comparison of Outcomes of Multiple Platforms for Assisted Robotic surgery—Prostate (COMPAR-P) trial is a prospective post-market study (clinicaltrials.org NCT05766163). Enrollment began in March 2023, allocating patients to DaVinci or Hugo RAS for RARP, without selection criteria, for up to 50 consecutive cases. Two experienced console surgeons performed the procedures, following the same technique. Evaluation focused on timing, learning curves, malfunctioning events, complications, and users’ satisfaction, using standard statistical methods, including the cumulative summation analysis (CUSUM) for the learning curve assessment. Fifty patients each were enrolled for DaVinci (DV-RARP) and Hugo RAS (H-RARP) RARP. Baseline features were balanced. DV-RARP showed significantly shorter “setup” and “console” phase durations than H-RARP (37 vs 55 min and 97 vs 126 min, respectively, p < 0.001). A longitudinal timing analysis revealed DV-RARP’s flat line, while H-RARP showed a modest decline with breakpoints at 22 and 17 procedures by CUSUM for the setup and console phases. The numbers of malfunctioning events were 4 (DV-RARP) and 20 (H-RARP). DV-RARP had high user satisfaction, while the user satisfaction of H-RARP varied. The comparison was between the first 50 H-RARP and the last 50 DV-RARP cases performed at our institution. This likely accounts for the observed differences in setup and console times between the cohorts. The specialized expertise of the surgeons involved could limit the generalizability of our findings. This prospective study compared unselected patients who underwent DV-RARP and H-RARP. More malfunctioning events occurred in case of Hugo RAS, but surgical outcomes were similar. Longer operative times for Hugo RAS were attributed to meticulous care with the novel platform. Improvement potential was evident within a few procedures, providing valuable insights for adopting this new platform. This study compared two advanced robotic systems, DaVinci and Hugo RAS, used to remove the prostate in patients diagnosed with prostate cancer. While both systems showed similar surgical outcomes, the newer Hugo RAS system required more meticulous movements, leading to slightly longer operation times. The findings suggest that, with further experience, both systems can provide effective treatment options for patients undergoing prostate surgery.
Bibliography:	ObjectType-Article-1 SourceType-Scholarly Journals-1 ObjectType-Feature-2 content type line 23 The list of collaborators is provided in the Acknowledgments section.
ISSN:	2666-1683 2666-1691 2666-1683
DOI:	10.1016/j.euros.2024.03.013