Concomitant Introduction of New Robotic Systems (Hugo RAS and Versius) at a Single Center: Analysis of First Clinical Cases of Radical Prostatectomy by a Single Surgeon

Introduction: Radical prostatectomy is a standard option for clinically localized prostate cancer. The first robot-assisted radical prostatectomy (RARP) was performed in 2001 with the DaVinci surgical system (Intuitive Surgical Inc., Sunnyvale, CA); after 2 decades from the first procedure and the expiry of the patents, new systems are entering the market to improve the existing technology and increase the whole accessibility to robotic surgery. Currently, a face-to-face comparison of systems is still unavailable. The aim of the study was to report the first case of concomitant introduction of new systems—Hugo robot-assisted surgery (RAS) and Versius surgical system—at a single center already equipped with a Da Vinci. Methods: This is a prospective study that analyzes the first cases performed with the Hugo RAS and Cambridge Medical Robotics Versius for RARP at a single center. Three patients with clinical organ-confined prostate cancer were selected to receive a Hugo RAS, a CMR Versius, or a DaVinci—as standard reference—radical prostatectomy. All procedures were recorded, and videos were reviewed by internal and external reviewers. RARP was evaluated according to the definition of metric errors and critical errors (Mottrie et al, BJU 2020) (See Supplemental Data, http://links.lww.com/JU9/A20). The primary end point is to evaluate the safety of novel systems; outcome measure is the absence of critical errors or intraoperative adverse events. Results: Surgical procedures were fully completed with all robotic systems. No intraoperative adverse events occurred, nor surgical errors classified as “critical” according to the European Association of Urology Robotic Urology Section metric system. None of the metric error nor technological issues were clinically significant to invoke a change in surgical strategy. Conclusions: This is the first analysis of concomitant introduction of new robotic systems at a single institution. Even if the shift from one model to another is expected to pose some challenges for surgeons, RARP is feasible with HugoRAS and Versius systems by an already experienced surgeon with the Da Vinci. A proper structured training is mandatory; the impact of prior console expertise is unknown and still unmeasured, but is expected to have significance. The current clinical experience supports the feasibility of the implementation of a new surgical system into surgical practice; however, further studies are required to evaluate outcomes in an unselected cohort.