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Outcomes of robot-assisted radical prostatectomy with novel robotic platforms vs da Vinci multiport systems: a systematic review and network meta-analysis

Prostate Cancer and Prostatic Diseases (2025)Cite this article

Subjects

Abstract

Introduction

The introduction of novel robotic platforms has expanded surgical options for robot-assisted radical prostatectomy (RARP). However, comparative outcomes with da Vinci multiport (MP) system remain unclear. This systematic review and network meta-analysis aimed to compare perioperative, early oncological, and functional outcomes of RARP performed with novel robotic platforms versus the da Vinci MP system.

Methods

A systematic literature search was conducted in PubMed, Scopus, and Embase (updated December 22, 2024) following PRISMA guidelines. Eligible studies compared RARP performed with alternative robotic platforms versus da Vinci MP, reporting perioperative, oncological, or functional outcomes. A network meta-analysis was conducted using a random-effects model. Outcomes were expressed as mean differences for continuous variables and odds ratios (OR) for dichotomous variables, with 95% confidence intervals (CI).

Results

Thirty-three studies for a total of 5987 patients were included. Compared to da Vinci MP, da Vinci SP had lower odds of lymph node dissection (OR 0.39, 95% CI 0.26–0.61) and nerve-sparing (OR 0.11, 95% CI 0.02–0.61) but was associated with shorter catheterization (−1.18 days, 95% CI −2.05 to -0.31) and hospital stay (−0.68 days, 95% CI −1.05 to −0.31). Versius, KangDuo, and SHURUI SP had significantly longer operative times (MD 74.00, 95% CI 42.49–105.51; MD 53.96, 95% CI 18.26–89.67; MD 103.88, 95% CI 69.99–137.78, respectively). Hugo RAS had higher intraoperative malfunction rates (OR 6.53, 95% CI 2.17–19.63). Positive surgical margin rates were lower for da Vinci SP (OR 0.70, 95% CI 0.53–0.92) but higher with the perineal approach (OR 6.30, 95% CI 1.53–25.94). PSA persistence, biochemical recurrence, continence and erectile function rates were comparable across platforms.

Conclusion

This is the first network meta-analysis comparing robotic platforms for RARP. While perioperative differences exist, oncological and functional outcomes appear comparable. Future studies should address learning curve effects, cost-effectiveness, and long-term functional outcomes to optimize robotic platform selection.

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Funding

Francesco Chierigo certifies that all conflicts of interest, including specific financial interests and relationships and affiliations relevant to the subject matter or materials discussed in the manuscript (eg, employment/affiliation, grants or funding, consultancies, honoraria, stock ownership or options, expert testimony, royalties, or patents filed, received, or pending), are the following: None.

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Author notes

  1. These authors contributed equally: Bernardo Rocco, Matteo Ferro.

Authors and Affiliations

  1. Department of Urology, Department of Health Science, University of Milan, ASST Santi Paolo e Carlo, Milan, Italy

    Francesco Chierigo, Giuseppe Fallara, Massimiliano Depalma, Marco Tozzi, Alberto Quistini, Roberto Bianchi, Martina Maggi & Matteo Ferro

  2. Department of Surgical and Diagnostic Integrated Sciences (DISC), University of Genoa; IRCCS Ospedale Policlinico San Martino, Genoa, Italy

    Guglielmo Mantica

  3. Department of Urology, Sant’Andrea Hospital, Sapienza University, Rome, Italy

    Cosimo De Nunzio

  4. Department of Urology, Magna Graecia University, Catanzaro, Italy

    Rocco Damiano

  5. Department of Urology, Azienda Ospedaliera Universitaria Integrata Verona, Verona, Italy

    Alessandro Veccia & Alessandro Antonelli

  6. Department of Oncology, Division of Urology, San Luigi Gonzaga Hospital, Turin, Italy

    Francesco Porpiglia

  7. Cancer Prognostics and Health Outcomes Unit, Division of Urology, University of Montreal Health Center, Montreal, QC, Canada

    Pierre Karakiewicz

  8. Department of Urology, Rush University Medical Center, Chicago, IL, USA

    Riccardo Autorino

  9. Department of Urology, IRCCS A. Gemelli University Polyclinic Foundation, Sacred Heart Catholic University, Rome, Italy

    Bernardo Rocco

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Contributions

Francesco Chierigo had full access to all the data in the study and takes responsibility for the integrity of the data and the accuracy of the data analysis. Francesco Chierigo: Study concept and design, Acquisition of data, Analysis and interpretation of data, Drafting of the manuscript, Statistical analysis. Giuseppe Fallara: Study concept and design, Analysis and interpretation of data, Drafting of the manuscript. Massimiliano Depalma: Acquisition of data, Drafting of the manuscript. Marco Tozzi: Study concept and design, Acquisition of data. Alberto Quistini: Acquisition of data. Roberto Bianchi: Critical revision of the manuscript for important intellectual content, Supervision. Martina Maggi: Critical revision of the manuscript for important intellectual content, Supervision. Guglielmo Mantica: Supervision. Cosimo De Nunzio: Supervision. Rocco Damiano: Supervision. Alessandro Veccia: Supervision. Alessandro Antonelli: Supervision. Francesco Porpiglia: Supervision. Pierre Karakiewicz: Critical revision of the manuscript for important intellectual content, Supervision. Riccardo Autorino: Critical revision of the manuscript for important intellectual content, Supervision. Bernardo Rocco: Supervision. Matteo Ferro: Study concept and design, Critical revision of the manuscript for important intellectual content, Supervision.

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Chierigo, F., Fallara, G., Depalma, M. et al. Outcomes of robot-assisted radical prostatectomy with novel robotic platforms vs da Vinci multiport systems: a systematic review and network meta-analysis. Prostate Cancer Prostatic Dis (2025). https://doi.org/10.1038/s41391-025-01023-1

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