Comparative outcomes of Hugo RAS and Versius surgical systems versus da Vinci in four urological procedures: a systematic review

Robot-assisted surgery has transformed urological surgery, with the da Vinci Surgical System dominating for over two decades. Following the expiry of key Intuitive patents in 2019, two particular platforms - Medtronic’s Hugo™ RAS system and CMR Surgical’s Versius ® Surgical Robotic System - have gained regulatory approval and entered urological practice. Comparative evidence between these platforms and da Vinci ® across urological procedures remains limited. This systematic review follows PRISMA guidelines and a prospectively registered protocol (PROSPERO: CRD420261319741). MEDLINE, Embase, CENTRAL, Scopus, and Web of Science were searched from January 2016 to August 2026. Comparative studies of Hugo™ RAS or Versius ® versus da Vinci ® in patients undergoing robot-assisted radical prostatectomy (RARP), robot-assisted partial nephrectomy (RAPN), pyeloplasty, or radical cystectomy were eligible. Risk of bias was assessed using ROBINS-I. 19 studies (21 procedural comparisons) involving 2,482 patients were included. In RARP, blood loss and length of stay showed substantially overlapping ranges between platforms, with no consistent direction of effect, though setup and docking times were consistently longer with the newer platforms. Positive surgical margin rates and early continence recovery overlapped widely in RARP. In RAPN, warm ischaemia times differed by five minutes or less across reporting studies, and trifecta rates were within 5 percentage points. The single small pyeloplasty study reported identical median operative times, but provided minimal comparative information. Early comparative evidence has not demonstrated consistent differences in peri-operative, oncological or early functional outcomes between Hugo™ RAS or Versius ® and da Vinci ® in experienced, high-volume centres. However, the included studies were small, non-randomised and not powered to detect clinically meaningful differences or to demonstrate equivalence. These findings therefore represent an absence of evidence of a difference rather than evidence of comparable effectiveness. Prospective studies including robotic-naïve centres are needed to advance our understanding.