Impact of Prior Da Vinci Experience on Hugo RAS Radical Prostatectomy Outcomes

Overview

This prospective study compared perioperative and oncological outcomes of radical prostatectomy using the Hugo RAS system between surgeons experienced with the Da Vinci robot and those without such experience. Results showed no significant difference in positive surgical margin rates or complication rates between groups, although Da Vinci-experienced surgeons had shorter operative times and performed more bilateral nerve-sparing procedures.

Background

Robot-assisted surgical systems have revolutionized urological procedures over the past two decades, with the Da Vinci system being the most widely adopted. The Hugo RAS system, introduced in 2022, offers a novel platform with potential technological and cost advantages. While feasibility studies have shown comparable outcomes between Hugo RAS and Da Vinci systems, the impact of prior robotic surgery experience on outcomes with Hugo RAS remains unclear, especially in robotic-naïve settings.

Data Highlights

Key Findings

• No significant difference in positive surgical margin rates between Da Vinci-experienced and non-experienced surgeons (17% vs. 21%; p=0.40).
• Complication rates classified by Clavien-Dindo were low and similar across both groups (p=0.63).
• Da Vinci-experienced surgeons had significantly shorter operative times (179 vs. 206 minutes; p=0.0004).
• Estimated blood loss was higher in the non-Da Vinci experienced group (161 mL vs. 127 mL; p=0.008).
• Bilateral nerve-sparing procedures were more frequent among Da Vinci-experienced surgeons (32% vs. 21%; p=0.004).
• One-year biochemical recurrence rates were equivalent between groups (11% each; p=0.86).

Clinical Implications

The findings suggest that prior experience with the Da Vinci robotic system may facilitate shorter operative times and more frequent nerve-sparing approaches when adopting the Hugo RAS platform, without compromising oncological safety or increasing complications. Surgeons new to robotic prostatectomy can achieve comparable safety and oncological outcomes with appropriate training on the Hugo system. This supports the feasibility of introducing Hugo RAS in centers without prior robotic surgery experience.

Conclusion

Prior Da Vinci robotic surgery experience influences operative efficiency and nerve-sparing rates but does not affect positive margin or complication rates in Hugo RAS radical prostatectomy. Hugo RAS is a safe and effective platform for radical prostatectomy regardless of previous robotic experience.

References

1. Medtronic Hugo RAS CE Approval 2022 -- Introduction of Hugo RAS for Urological Procedures
2. Recent Meta-Analyses -- Feasibility and Outcomes of Hugo RARP vs Da Vinci
3. Clavien-Dindo Classification 2004 -- Surgical Complication Grading
4. Briganti 2018 Nomogram -- Lymph Node Invasion Risk Assessment
5. Montsouris Technique -- Standardized Approach for Radical Prostatectomy