Da Vinci® X™, Versius®, and Hugo™ RAS in minimally invasive robotic-assisted hysterectomy: the COMPAR-HYST prospective study

Objective(s) To compare the da Vinci® X™ (Intuitive Surgical), Versius® (CMR Surgical), and Hugo™ RAS (Medtronic) robotic platforms for the procedure of hysterectomy. Design Prospective single-center non-randomized study. Setting Referral center for gynecologic surgery. Population All consecutive adult women scheduled for elective laparoscopic hysterectomy between January and December 2024 were eligible. Methods Enrolled patients were assigned to one of the three robotic platforms (1:1:1) based on the availability on the day of surgery, with a maximum of 50 procedures per platform. Main outcome measures Optimal hysterectomy (composite outcome for performance), perioperative outcomes, and costs. Results The overall performance did not differ, with an optimal hysterectomy achieved in 29, 32, and 24% of cases with da Vinci X, Hugo, and Versius, respectively ( p = 0.735). Intraoperative blood loss was associated with uterine weight and robotic platform (Hugo reported lower blood loss than da Vinci X (− 72 mL; 95%CI − 114, − 29; p = 0.001); both Hugo (− 1.1; 95%CI − 2.1, − 0.17; p = 0.012) and Versius (− 1.4; 95%CI − 2.4, − 0.43; p < 0.01) provided lower pain on postoperative day three than da Vinci X. Other perioperative outcomes (i.e., operative times and malfunctions) did not differ. Platform-related indirect costs averaged €1550.43 for da Vinci X, €1748.18 for Hugo, and €1847.47 for Versius; when consumables were added, the cost per procedure was €5048.46, €3334.18, and €2921.07, respectively ( p < 0.001). Conclusions The three robotic platforms exhibited similar performance and safety, with minor differences. The expenses related to the robotic system remain the most relevant for the procedure, with differences between robotic consumables and platform-related costs.