Robot-Assisted Radical Prostatectomy With the Toumai Surgical System: Step-by-Step Description of the First Clinical Case From a Multiplatform User

We present the Toumai Surgical System's first clinical use for robot-assisted radical prostatectomy (RARP) at a high-volume multiplatform academic institution. As new robotic platforms arise, their integration into existing surgical workflows necessitates an accurate assessment of feasibility, safety, and efficiency. This prospective single-case evaluation involved a patient with clinically localized prostate cancer who underwent RARP with the Toumai system. The procedure was performed by a senior surgeon proficient across multiple robotic platforms, following a brief dry-lab simulation with the Toumai console. The Toumai system, characterized by 4 independent arm carts, immersive HD 3D vision, and wrist instruments akin to the Da Vinci system, facilitated a standardized operating room workflow. Procedural assessment used the validated Educational Working Group Metrics Initiative (ERUS/ORSI Academy), which standardizes RARP into 12 surgical steps and evaluates for critical and metric errors. The RARP was completed successfully without intraoperative complications. Interestingly, none of the 12 assessed steps showed any critical or metric errors. The estimated blood loss was less than 50 mL, the console time was 95 minutes, and the patient was discharged without complication on postoperative day 2. Setup and docking were straightforward, and instrument responsiveness was stable, with seamless transition from prior Da Vinci platform experience. This first clinical experience demonstrates the Toumai system's safety, reproducibility, and adequate reliability for RARP, showing its feasibility and effectiveness in the hands of an experienced robotic surgeon.