Introduction

Renal cell carcinoma represents 2-3% of all malignant tumors identified in adults and has the highest death rate among urological malignancies1. The incidence of this condition is increasing, attributable to the extensive use of ultrasound and other cross-sectional imaging technologies, leading to earlier diagnosis and a higher total incidence2. Partial nephrectomy (PN) has emerged as a viable treatment option for masses diagnosed at an earlier stage and confined to the kidney to prevent organ loss3. In the present medical environment, the primary therapy for localized tumors at the in T1a clinical stage is PN, even in individuals with a healthy contralateral kidney4. The management of renal malignancies has transitioned from open radical nephrectomy to open partial nephrectomy, followed by laparoscopic (LPN) and robot-assisted laparoscopic partial nephrectomy (RAPN)5. This transition occurs over time. Minimally invasive techniques offer advantages such as improved cosmetic outcomes, reduced postoperative pain, and shorter hospital stays than open surgery6. RAPN has evolved since its inception in 2002 by Gettman et al., becoming a safe technique capable of treating T1 and T2 tumors and complex masses7.

Robot-assisted surgery offers various benefits over open and laparoscopic surgery, such as precise operation handling, three-dimensional visualization, minimally invasiveness, and fewer postoperative complications8,9,10. This is beneficial for both surgeons and patients. It has become an alternative to the other two surgical routes. The da Vinci surgical system (Intuitive Surgical, Inc., Sunnyvale, California) has been the undisputed market leader in robotic-assisted surgery for the last two decades. Other surgical robot platforms have proven their effectiveness and safety in the field of robot assisted nephrectomy11, recent studies such as Hugo-RAS12,13,14,15, Versius16, Senhance17, Micro Hand S18, and Avatera and Hinotori systems19. A is a new robot platform in China called the KangDuo Surgical Robot 2000 (KD-SR-2000), was developed by Harbin Sizherui Intelligent Medical Equipment Co. Ltd. (Harbin, Heilongjiang, China). There are no previously reported initial applications of the KD-SR-2000 system for RAPN, and follow-up is required to evaluate its efficacy. The KangDuo robotic products SR1000, SR1500, and SR2000 have carried out more than 30 clinical studies that have also been published in well-known academic journals in China and abroad, including the results of randomized controlled studies with imported surgical robots. The KangDuo robotic products (SR1000, SR1500, and SR2000) are the three types of registrations certified by the National Medical Products Administration (NMPA) in June 2022. This shows that KangDuo and imported surgical robots are equivalent in terms of clinical effectiveness and safety. The EDGE MP1000 (MP 1000) Surgical Robot System (Shenzhen Jingfeng Medical Technology Co., Ltd., China) is an innovative surgical robotic system that can be applied to minimally invasive surgeries across various departments. The MP1000 is a multi-port surgical robot developed by Shenzhen Edge Medical Co., Ltd. (Shenzhen, China), which was registered by the NMPA and entered the market in December 2022. This KD-SR-2000 and MP1000 are new Chinese domestic surgical robots compared with the da Vinci Xi (DV) robotic system in RAPN. In this study, we investigated all the patients who underwent RAPN. We believe that this is the first study to compare the safety, feasibility, effectiveness, and comparable of the Chinese robots KD-SR-2000, MP1000, and DV-RAP.

In this study, we compared the two Chinese robotic surgical systems with the DV system in patients who underwent RAPN. To the best of our knowledge, this is the first study to evaluated the safety, feasibility, efficacy, and comparability of a new a novel robotic surgical platform for Chinese robots KD-SR-2000 and MP1000 versus DV-RAPN.

Patients and methods

Study design

This prospective cross-sectional analytical study was conducted from February 2023 to June 2024. A total of 170 patients underwent RAPN using either the Chinese robotic systems (KD-SR-2000 or MP1000) and the da Vinci Xi Surgical System (Intuitive Surgical, Sunnyvale, CA, USA). All surgical procedures were performed by three urologists, each with expertise in over 100 robotic-assisted surgeries using the da Vinci Xi system. Each participant’s data were captured in chronological order and analyzed at a single point in time, without longitudinal follow-up. While the data collection was forward-looking, no repeated measures or time-to-event analyses were performed. Cases were assigned consecutively without exclusion based on tumor anatomy. The research protocol was approved by the Ethics Review Committee of Harbin Medical University Cancer Hospital (IRB No. RCR03-0631). Informed consent was obtained from all patients.

Patient selection

The inclusion criteria were patients who were ≤ 80 years old with T1a, T1b, and T2a (early stage) renal tumors (including hilar location), RENAL scores ≤ 9, and deemed suitable for nephrectomy. Exclusion criteria included a history of previous multiple abdominal surgeries, serious cardiovascular or pulmonary diseases, uncontrolled diseases, or urinary tract infections. Patients with a solitary kidney, impaired kidney function, coagulation dysfunction, or inability or reluctance to cooperate during follow-up were excluded. We prospectively collected patient demographic characteristics, renal tumor information, preoperative and intraoperative parameters, pathological data, postoperative data, and follow-up outcomes for a comprehensive analysis. All patients underwent preoperative diagnostic imaging (CT or MRI) without routine biopsy.

Each robot systems

The KD-SR-2000 System is a seven-degree-of-freedom master-slave robotic system that simulates human hand dexterity. It has a vision system, robotic cart, and surgical console (Fig. 1). The console’s 3D high-definition display and two master manipulators allow for accurate, strain-free operation. High accuracy and flexibility are made possible by its 540-degree instrument rotation and 12 degrees of freedom per arm, whereas its hand-eye coordination algorithm guarantees real-time synchronization.

The MP1000 Surgical Robot System (Shenzhen Jingfeng Medical Technology Co., Ltd., China) is a versatile platform for minimally invasive surgery. It includes a surgeon’s console, a patient platform, and a 3D imaging system. With four robotic arms (12 degrees of freedom each, Fig. 1) and advanced imaging (latency < 40 ms), it supports complex procedures with high accuracy.

The da Vinci Robotic System (Intuitive Surgical, Inc., USA), has been widely used in urology and other fields since 2002. It consists of a surgeon console, patient-side cart, and vision cart (Fig. 1), which enhance precision and safety in minimally invasive surgeries.

Fig. 1
figure 1

The Robotic system. (A) The Robot system KD- SR-2000 and surgical procedure of RAPN was carried whereas (A1) open the surgeon console, (A2) the patient side cart with four robotic arms and (A3) the vision cart. (B) The Robot system EDGE MP1000 show: (B1) the surgeon console, (B2) the patient side cart with four arms and (B3) the vision cart. (C) The DV Xi Robot system show: (C1) the surgeon console with flexion of the neck, (C2) the patient side cart with four robotic arms and (C3) the vision cart.

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Surgical procedures

All surgeries were performed under general anesthesia using the retroperitoneal (Fig. 2A) or transperitoneal (Fig. 2B) approaches. The technique was chosen based on the tumor location, patient factors, and surgeon preference. The retroperitoneum was used for posterior, lateral, and some anterior tumors, while the transperitoneum was preferred for tumors near the renal hilum, especially medial or anterior tumors.

Operational teams received platform-specific training prior to case initiation. The nursing and technical staff had substantially more experience with the da Vinci Xi system (median 3 years) compared to the Chinese platforms (median 3 months training period). This difference in team experience should be considered when interpreting docking time differences.

Fig. 2
figure 2

The surgical approach for RAPN. (A) The using of the retroperitoneal approach was performed with patients positioned in a 90° lateral flank posture. Robotic port placement was templated, utilizing robotic arms 1, 2, and 3. Robotic arm 1 was equipped with monopolar scissors, robotic arm 2 was used for the camera, and robotic arm 3 was fitted with bipolar cautery. Additionally, a 12 mm 1 assistant port was placed on the ventral side. (B) The surgical procedures for RAPN using the Transperitoneal approach were performed with patients in a contralateral decubitus position. On this Template of port placement, Robotic arm 1 and 3 are used for instruments and Robotic arm 2 for camera is inserted. The two-assistant port (Assistant 1 port and assistant 2 port) were inserted on the midline, 5 cm above and below the umbilicus, respectively.

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Retroperitoneal surgery procedure

The patients were placed in the 90° lateral flank position. A 3 cm oblique incision was made below the 12th rib and the retroperitoneal space was expanded using a balloon dilator. A 10 mm robotic camera trocar was inserted 2 cm below the costal border at the mid-axillary line. A 30-degree 3D laparoscope was introduced to establish a 14 mm Hg pneumoperitoneum. Two 10 mm robotic trocars were placed at the costal ridge angle, and the other at the anterior axillary line along with a 12 mm assistant trocar on the ventral side (Fig. 2A). The robotic arms were docked parallel to the spine, above the patient’s head. Retroperitoneal fat was cleared to access Gerota’s fascia, which was incised above the psoas muscle to expose renal arteries. The partial nephrectomy (PN) steps are illustrated in Fig. 3, and Supplementary comparison videos is in SI 1–3. The tumor was excised, placed in a specimen bag, and a drainage tube was inserted. Finally, all incisions were sutured.

Transperitoneal surgical procedure

The patient assumed a contralateral decubitus position (Fig. 2B). The midclavicular line on the affected side was cut 1 cm below the costal edge. A Veress needle was then introduced for the injection of CO2 gas until the pneumoperitoneum pressure reached 14 mmHg. At the outside border of the rectus abdominis, a 10-mm robotic camera port for the 30-degree 3D video laparoscope was positioned supraumbilical. Two 10-mm robotic arms were placed for the robotic instruments at the anterior axillary line under the umbilicus and at the initial puncture site. A 12 mm auxiliary ports were placed 5 cm above and below the umbilicus. Docking was subsequently performed, and the colon was mobilized and retracted. Next, an incision was made in Gerota’s fascia to reveal the perinephric fat. The renal artery was exposed and the kidney was freed to expose the tumor. Once the bulldog clamped the renal artery, the renal parenchyma was excised 0.5 cm from the tumor margin, and the tumor was removed. The resected portion of the kidney was sutured, using process similar to the retroperitoneal approach. After releasing the bulldog clamps, a specimen bag was used to retrieve the tumor (Fig. 3, SI 1–3) and a drainage tube was placed.

Fig. 3
figure 3

Surgical steps of different robots used in this study. (A) KD-SR-2000-RAPN, (B) EDGE MP1000-RAPN and (C) DV-RAPN surgical steps. (A1, B1, & C1) Dissection of fat and Gerta’s fascia to reveal the perinephric fat. (A2, B2, & C2) The Free kidney and exposed a small renal tumor. (A3, B3, & C3) Dissection and exposed the renal artery. (A4, B4, & C4) The renal artery clamping with bulldog. (A5, B5, & C5) Resection of the renal tumor, maintaining a margin of 0.5 cm from the tumor edge. (A6, B6, & C6) Reconstruction of the renal parenchyma.

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Statistical analysis

All data were analyzed using SPSS 26.0 for statistical analysis of data. Numerical parameters are expressed as statistics, such as median (range), mean, and standard deviation values, compared using Student’s t-test and one sample proportional. Data are expressed as percentages, and two categorical groups were compared using the chi-square test or Fisher’s exact test. One-way ANOVA was used to compare the participation between the Chinese robotic systems KD-SR-2000, MP1000, and Da Vinci. Additionally, binary logistic multiple regression analysis was performed to identify significant variables. Results were considered statistically significant when the p-value was < 0.05. Recognizing baseline differences in patient characteristics between groups, we performed additional sensitivity analyses adjusting for gender, tumor stage, and pathological subtype. These covariates were selected a priori based on their potential to influence surgical outcomes.

Results

The baseline demographic and clinical characteristics of patients, comparing the Chinese robotic systems (KD-SR-2000 and MP1000) with the da Vinci Robotic system, are shown in Table 1. There were no statistically significant differences between the Chinese robots and the da Vinci system in terms of average age (p = 0.746), body mass index (p = 0.211), surgical history (p = 0.070), diabetes mellitus (p = 0.399), hypertension (p = 0.729), drug allergies (p = 0.889), renal score (p = 0.536), preoperative ASA scores (grades 1 and 2, p = 0.234 and p = 0.235), tumor side (p = 0.590), preoperative hemoglobin level(p = 0.428), platelet count (p = 0.289), total blood count (p = 0.564), and eGFR (p = 0.036). However, the p-values showed statistically significant in gender (p < 0.001), BMI categories (≥ 28 and < 28, p = 0.030) tumor node metastasis staging (T1aN0M0, T1bN0M0, T2aN0M0, p < 0.003), and pathological type (p = 0.010).

The analytical values of the studies during the intraoperative and postoperative follow-up periods are presented in Table 2. All surgeries were completed without open or laparoscopic conversion. The warm ischemia time was under ≤ 30 min, and no positive surgical margins occurred in either group. In our study, the p-value was statistically significant between the Chinese robot group and the da Vinci group in terms of operative time (p < 0.001), intraoperative blood loss (p = 0.049). The median docking time was longer for both Chinese systems (KD-SR-2000: 4.13 ± 1.36 min; MP1000: 4.28 ± 1.35 min) compared to da Vinci (2.69 ± 0.50 min, p < 0.001). This likely reflects both the technical learning curve for new platforms and inherent system design differences. we could not find statistically significant differences and the study did not have power to prove that variable such as hospital stay (p = 0.329), postoperative eGFR 2 days (p = 0.731) and 4 weeks (p = 0.136), post hemoglobin (p = 0.272), post platelet (p = 0.568), and post total blood count (p = 0.137). But, the postoperative complications according to the Clavien-Dindo classification (CDC) class I and II (p = < 0.001). Out of the 170 patients, none had serious postoperative complications (Clavien-Dindo score ≥ 3). No technical failures were reported for either robotic system. Specifically, there were no occurrences of error alarms, instrument malfunctions during tissue clamping, unintended tissue damage, disconnections between the console and the robotic arms, or reconnection failures. Univariate binary multiple logistic regression analysis was performed for further evaluation of the significance. The operative time, intraoperative blood loss and docking time were statistically significant in terms of safety and effectiveness between both robotic systems, as shown in Table 3.

Table 1 Demographic and clinical characteristic of the patients show comparison Date analysis between Chinese with Da Vinic robotic system.
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Table 2 Intraoperative and postoperative follow up analytical values of the studies sample.
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Table 3 Binary logistic regression analysis comparing outcomes between the Chinese robotic system and the Da Vinci robotic system, identifying statistically significant factors.
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Discussion

Kidney cancer is one of the deadliest tumors in the world today and nephrectomy still remains the main treatment for cancer. However, in accordance with the criteria for renal cell carcinomas (RCCs), PN has been suggested as a treatment for T1 renal tumors20. Minimally invasive surgery has entered the era of robotics, with surgical robots emerging as an evolving development direction of minimally invasive surgery. Numerous studies have documented that the da Vinci Surgical Robotic System (Intuitive Surgical) enables more delicate surgery with three-dimensional magnified vision, seven degrees of freedom, and flexible endowrists that enhance access to the operative field since it was authorized for use in clinical practice. Despite its high purchase and maintenance costs, the da Vinci surgical robotic system has dominated the surgical robotics industry over the past two decades21. The KangDuo Robot system, was developed by Harbin Sizherui Intelligent Medical Equipment Co. Ltd. (Harbin, Heilongjiang China). The KD-SR-01 system successfully performed PN in animal experiments in 2019. The KD-SR-01 robotic PN and traditional 3D laparoscopic PN were randomly allocated to 12 pig models. A single surgeon performed surgeries. Compared to typical 3D laparoscopic surgery, there was no significant change in intraoperative factors such as operation time. However, the KD-SR-01 system provided notable benefits in terms of both physical and mental strain. The KD-SR-2000 is a new robotic system that may be the first study of PN with DV. Compared to the da Vinci surgical robotic systems, the new innovative robotic KD-SR-2000 has benefits. The open console, the KD-SR-2000 system, allows surgeons to maintain and alter their natural neck posture during the operation, thereby reducing discomfort. Neck stiffness is a common complaint described by surgeons during robotic surgery using a DV system. Qualitative observations suggested potential ergonomic differences between systems: (1) The open console design of KD-SR-2000 allowed greater neck mobility, (2) MP1000’s manufacturer-reported latency of < 40ms appeared subjectively comparable to da Vinci in clinical use. These experiential observations require formal ergonomic studies and technical benchmarking for validation. This is the lowest latency currently known for a laparoscopic surgical robot, surpassing that of a DV robot. Low master-slave control latency allows the surgeon to operate smoothly and with good hand-eye coordination. When an unforeseen circumstance occurs, the EDGE MP1000 provides real-time feedback regarding the surgeon’s actions.

There are more comparative studies done between the new surgical robot and the DV surgical system, including partial nephrectomy, radical nephrectomy22, adrenalectomy23, and radical prostatectomy24. In the new era of robotic surgery, the RAPN is a widely used approach for evaluating new robotic systems. In this study, early stage of renal tumors and R.E.N.A.L. nephrometry score ≤ 9 for RAPN is the first report of a new two Chinese surgical robot together KD-SR-2000, MP1000 with da Vinci. In our study, the main intraoperative endpoints showed statistically significance between both robots, the Chinese robotic group and the da Vinci group. These findings suggest Chinese robotic systems may achieve comparable performance to the da Vinci platform for selected intraoperative metrics, though more formal comparability testing would be required to confirm this. The study found no major adverse events (Clavien-Dindo grade III) or significant differences in complications between the two groups, indicating that the Chinese robotic system was comparable to the da Vinci system in terms of safety, feasibility, and efficacy.

In this study, we compared the perioperative, intraoperative, post operative follows-up outcomes of the new surgical two-Chinese robotic system with the da Vinci Xi Surgical System in RAPN. We found p-value were achieved statistically significant variable were gender (p = < 0.001), BMI categories (≥ 28 and < 28, p = 0.030), tumor node metastasis staging (p = < 0.003), and pathological types (p = 0.010). The intraoperative and follow up results showed that the p-value was statistically significant at the operation time, intraoperative blood loss, and docking time among both groups (p < 0.05). For intermediate incidence, no positive surgical margin, and follow at up 2days, 4 weeks eGFR, the results were similar between the both groups. Operative time and intraoperative blood loss showed statistically significant between groups, though absolute differences were modest (median operative time: 120–165 min; blood loss: 50 ml all groups). This could be because the surgical team had already completed a large number of procedures using the da Vinci Surgical System before attempting RAPN with the Chinese Robotic System. The surgical team had prior expertise in working with the robotic procedures. The surgical team was able to perform the surgery easily using Chinese robots. The Chinese robots were fitted with a laser-targeting device that could alter the robotic arms for placement. This device can help surgeons perform incisions and dockings more efficiently, lowering the overall surgical time. The docking time was longer in the two Chinese groups (4.21 ± 1.35) (4.28 ± 1.35) than in the da Vinci group (2.69 ± 0.50). This might be related to the learning curve of the nurses and assistants required to master the new equipment. However, the p-value difference was statistically significant (p < 0.001).

The prolonged docking times observed with Chinese platforms (approximately 1.5 min longer than da Vinci) should be interpreted in context of the team’s asymmetric experience. While the surgeons had comparable case volumes across platforms, the supporting teams had significantly less experience with the Chinese systems. This operational learning curve may account for some of the observed time difference, though system-specific factors like port placement requirements or docking mechanisms may also contribute. Future studies with standardized team training would help isolate platform-specific performance characteristics.

This indicates that the Chinese robotic system was comparable to the da Vinci system in terms of safety, feasibility and effectiveness. Our study is consistent with the findings of Li et al., who reported results in a study of 99 patients newly developed by the KD-SR system, demonstrated safety and effectiveness, and achieved comparable outcomes compared with the da Vinci surgical system for RAPN. His study showed that docking, suturing time, and Clavien-Dindo grades I and II were similar to those of da Vinci25. In a further trial including 26 patients, Li et al. found that the median operating time for the robotic arm and the median docking time were significant. This proves the effectiveness and safety of the KD-SR surgical method for partial nephrectomy26. Based on our results, the Chinese robot operative time and intraoperative blood loss were comparable to those of da Vinci (p < 0.05), and Fan et al. and his colleagues reported their first experience with KD-SR-01 robotic pyeloplasty in 16 instances, proving its safety and viability27. Weifang Xu et al. conducted a study of 17 patients using KD-SR-01 for RAPN. This study focused on the clinical evaluation of the KD-SR-01 robotic surgical system for PN procedures. KD-RAPN has been proven feasible and safe28. A comparative analysis of 28 patients in the KD group and 30 patients in the DV group was conducted for colon cancer. The surgical success rate was 100% without laparoscopic or open coverage. In both KD and DV, the intraoperative operating sensation score and equipment docking workload evaluation were comparable. Indicators of the internal environment and postoperative pathological outcomes produced similar results29.

Our Chinese robot has comparable results to those of the Guo et al. Study, which reported that 62 patients underwent RAPN using the newly developed MP1000 Chinese robot system. which results in a comparable level of safety and effectiveness to the Da Vinci system30. The 42 patients who were randomly allocated to undergo robot-assisted radical prostatectomy (RARP) were compared to the DV Si and the MP1000 groups. Patients underwent RARP using the assigned robotic system and were followed-up at three-month intervals. The results were similar, safe, and effectiveness31.

In recent years, the deployment of DV surgical robots in China has steadily increased. However, socioeconomic disparities persist compared with more affluent regions, affecting the availability and distribution of medical resources. The dominance of the American Intuitive Company made DV expensive, hindering its adoption in developing countries. Emerging Chinese surgical robots provide a more cost-effective option, potentially expanding the access to modern medical care. With robust national policies emphasizing innovation, China aims to rapidly localize and develop cost-effective robotic surgical systems using independent technology.

It is advantageous to perform remote laparoscopic surgery to fully utilize the top-notch medical resources, particularly in the context of COVID-19. Using a high-speed terrestrial optical fiber network, the ZEUS robotic system conducted its first telecholecystectomy in 200132. The KD-SR system was used to conduct the first long-distance animal surgery using 5G technology in December 201833. This technology should be further improved for clinical applications. With the use of 5G technology, the two new Chinese robots KD-SR-2000, MP1000 has the Telesurgery from Beijing surgeon console to city Harbin Robotic Arms around 2000 miles far from each other in November 2023. On November 29, an advanced surgical technique was performed at the Hainan Provincial Hospital of Traditional Chinese Medicine using a robotic arm system. The procedure was managed remotely by three domestic robotic surgeon consoles in Beijing, Changsha, and Haikou, China. The Beijing and Changsha teams provided real-time instructions as the remote operation continued smoothly. The 3D HD video stream was clear and the response of robotic arm was consistent. The surgery was performed successfully after two hours, representing a significant milestone in China’s urological robotic remote surgery. In November 2023, Doctor Wanhai Xu and Vipul Patel used KD-SR 2 technology to successfully execute PN telesurgery on animal models between Harbin and Beijing. One notable advantage of the Chinese robotic system is its superior endoscopic vision quality, which can enhance the precision and effectiveness of surgical procedures. Additionally, the vision cart of the Chinese robotic system is designed to be compatible with other surgical instruments, providing greater flexibility during surgery. In contrast, the da Vinci system has limitations in terms of compatibility with other instruments, which could restrict the range of surgical tools that can be used in conjunction. Furthermore, the introduction of new competing devices will lower the cost of robotic surgery, given the current high cost of da Vinci robotic surgery systems. The advent of surgical robotics has marked a significant milestone in the surgery field. The Chinese company behind this new robotic platform is poised to deepen collaboration with medical institutions, enhance technical capabilities, and drive innovation. By advancing the technology and creating robotic systems tailored to local needs, they aim to provide significant benefits to healthcare providers, doctors, and patients. This initiative reflects a broader trend of innovation in surgical robotics and promises to contribute to the future of minimally invasive surgeries.

Our study has several limitations that should be acknowledged. First, the non-randomized design introduces potential selection bias, and while statistical adjustments were made, baseline differences in patient and tumor characteristics between groups may still confound outcome interpretation. Second, the limited sample size and lack of direct comparability with the da Vinci robotic system within our center restrict the generalizability of our findings. Third, the analysis lacked critical surgical performance metrics, such as grip strength and reaction speed, which are essential for comprehensive robotic system evaluation.

Fourth, differences in team experience across platforms may have influenced operational metrics, such as docking times. The shorter docking times observed with the da Vinci system likely reflect institutional familiarity rather than inherent system superiority. Fifth, the study predominantly included patients with small tumors and low to moderate R.E.N.A.L. nephrometry scores (≤ 9), with hilar tumors categorized as moderate-complexity. While our findings demonstrate comparable performance across platforms for these anatomies, the safety and effectiveness of the new Chinese robotic systems should be further investigated in more complex partial nephrectomy (PN) scenarios and other surgical procedures. Sixth, the 4-week follow-up period precludes assessment of long-term oncologic outcomes, renal function preservation, and quality of life metrics. Although early eGFR measurements showed comparable results, studies with ≥ 12-month follow-up are necessary to evaluate cancer control, chronic kidney disease progression, and patient-reported outcomes. The absence of long-term oncological data (e.g., recurrence rates, survival) is a notable limitation for a cancer study, though this is common in initial reports on new technologies.

Finally, this study was not designed as a non-inferiority trial, and the observed outcomes should be interpreted as exploratory comparisons rather than definitive equivalence assessments. Future multicenter studies with larger cohorts, longer follow-up, and cost-effectiveness analyses comparing Chinese and da Vinci robotic systems are needed to validate these findings.

Conclusions

RAPN using Chinese robotic systems demonstrated comparable safety and efficacy to the da Vinci platform for early-stage renal tumors, including moderate-complexity and hilar lesions. While our findings are encouraging, the predominance of moderate-complexity tumors in our cohort suggests these results may be most applicable to this patient population.