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Ficarra V, Rossanese M, Giannarini G, Longo N, Viganò S, Russo D, Sorce G, Simonato A, Bartoletti R, Crestani A, Di Trapani E. Evaluation of Clinical Research on Novel Multiport Robotic Platforms for Urological Surgery According to the IDEAL Framework: A Systematic Review of the Literature. EUR UROL SUPPL 2024; 67:7-25. [PMID: 39100226 PMCID: PMC11293526 DOI: 10.1016/j.euros.2024.06.014] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 06/24/2024] [Indexed: 08/06/2024] Open
Abstract
Background and objective Several novel multiport robotic systems have been developed and introduced in clinical practice after regulatory approval. The objective of this systematic review was to assess the evolution status of novel robotic platforms approved for clinical use in urological surgery according to the IDEAL framework. Methods A systematic review was conducted using the Medline and Scopus databases according to the updated Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) guidelines (CRD42024503227). Comparative or noncomparative studies reporting on any urological procedures performed with novel robotic platforms (Hugo RAS; Versius, KangDuo, Senhance, REVO-I, Avatera, Hinotori, Dexter, or Toumai) were selected and included in the analysis. Key findings and limitations Seventy-four eligible studies were included, of which 67 (90.5%) were noncomparative surgical series representing developmental or explorative studies according to the IDEAL criteria. Only one randomised controlled trial (comparing KangDuo vs da Vinci robot-assisted partial nephrectomy) was included. The trial showed comparable perioperative outcomes between the two robotic systems. Four studies assessed clinical outcomes for patients undergoing urological procedures using a REVO-I (1 study), Senhance (2 studies), or Hinotori (1 study) system in comparison to the same procedures performed using a da Vinci system. All studies revealed outcomes comparable to those with the da Vinci system. Limitations include the small sample size in all studies, and assessment of first-generation novel platforms versus the fourth-generation multiarm da Vinci system in most of the comparative studies. Conclusions and clinical implications A few poor-quality studies have compared the use of novel robotic platforms to da Vinci systems in urological surgery and demonstrated comparable results. Most studies can be classified as developmental or explorative, representing the initial steps of clinical research. Large multicentre series are needed to understand whether these novel robots could offer advantages beyond cost reductions over the da Vinci systems. Patient summary We reviewed research on new robotic systems for surgery in urology. Several studies have shown the feasibility and safety of these new robots during the most common procedures. Very few studies have assessed clinical outcomes with the new robots in comparison to the reference standard, which is a fourth-generation da Vinci robot. Large multicentre studies are needed to understand whether the new robots could offer advantages other than cost savings over the da Vinci robot.
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Affiliation(s)
- Vincenzo Ficarra
- Department of Clinical and Experimental Medicine, Urologic Section, University of Messina, Messina, Italy
- Department of Oncology, Urologic Section, AOU G. Martino, Messina, Italy
| | - Marta Rossanese
- Gaetano Barresi Department of Human and Paediatric Pathology, Urology Section, University of Messina, Messina, Italy
| | - Gianluca Giannarini
- Urology Unit, Santa Maria della Misericordia University Hospital, Udine, Italy
| | - Nicola Longo
- Department of Neurosciences, Sciences of Reproduction and Odontostomatology, Federico II University of Naples, Naples, Italy
| | - Silvia Viganò
- Gaetano Barresi Department of Human and Paediatric Pathology, Urology Section, University of Messina, Messina, Italy
| | - Domenico Russo
- Gaetano Barresi Department of Human and Paediatric Pathology, Urology Section, University of Messina, Messina, Italy
| | - Gabriele Sorce
- Department of Oncology, Urologic Section, AOU G. Martino, Messina, Italy
| | - Alchiede Simonato
- Department of Precision Medicine in Medical, Surgical and Critical Care, Urology Unit, University of Palermo, Palermo, Italy
| | - Riccardo Bartoletti
- Department of Translational Research and New Technologies in Medicine and Surgery, Urology Unit, University of Pisa, Pisa, Italy
| | - Alessandro Crestani
- Urology Unit, Santa Maria della Misericordia University Hospital, Udine, Italy
| | - Ettore Di Trapani
- Gaetano Barresi Department of Human and Paediatric Pathology, Urology Section, University of Messina, Messina, Italy
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Gandi C, Marino F, Totaro A, Scarciglia E, Bellavia F, Bientinesi R, Gavi F, Russo P, Ragonese M, Palermo G, Racioppi M, Lentini N, Pastorino R, Sacco E. Perioperative Outcomes of Robotic Radical Prostatectomy with Hugo™ RAS versus daVinci Surgical Platform: Propensity Score-Matched Comparative Analysis. J Clin Med 2024; 13:3157. [PMID: 38892868 PMCID: PMC11173080 DOI: 10.3390/jcm13113157] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/29/2024] [Revised: 05/05/2024] [Accepted: 05/23/2024] [Indexed: 06/21/2024] Open
Abstract
Background/Objectives: There is an urgent need for comparative analyses of the intraoperative, oncological, and functional outcomes of different surgical robotic platforms. We aimed to compare the outcomes of RARP performed at a tertiary referral robotic centre with the novel HugoTM RAS system with those performed with a daVinci surgical system, which is considered the reference standard. Methods: We analysed the data of 400 patients undergoing RARP ± pelvic lymph node dissection between 2021 and 2023, using propensity score (PS) matching to correct for treatment selection bias. All procedures were performed by three surgeons with HugoTM RAS or daVinci. Results: The PS-matched cohort included 198 patients with 99 matched pairs, balanced for all covariates. Positive surgical margins (PSMs) were found in 22.2% and 25.3% (p = 0.616) of patients, respectively, in the HugoTM RAS and daVinci groups. No significant differences were found for other important perioperative outcomes, including median (1st-3rd q) operative time (170 (147.5-195.5) vs. 166 (154-202.5) min; p = 0.540), median (1st-3rd q) estimated blood loss (EBL) (100 (100-150) vs. 100 (100-150) ml; p = 0.834), Clavien-Dindo (CD) ≥ 2 complications (3% vs. 4%; p = 0.498), and social continence at 3 months (73.7% vs. 74.7%; p = 0.353). In multiple analyses, no associations were found between surgical outcomes (PSM, length of PSM, operative time, EBL, length of catheterization, length of hospital stay, social continence at three months after surgery, and CD ≥ 2 complications) and the robotic platform. Conclusions: Our findings demonstrate that HugoTM RAS enables surgeons to safely and effectively transfer the level of proficiency they reached during their previous experience with the daVinci systems.
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Affiliation(s)
- Carlo Gandi
- Department of Urology, Fondazione Policlinico Universitario Agostino Gemelli IRCCS, 00168 Rome, Italy; (C.G.); (A.T.); (E.S.); (F.B.); (R.B.); (F.G.); (P.R.); (M.R.); (G.P.); (M.R.)
- Department of Medicine and Translational Surgery, Università Cattolica Del Sacro Cuore, 00168 Rome, Italy;
| | - Filippo Marino
- Department of Urology, Fondazione Policlinico Universitario Agostino Gemelli IRCCS, 00168 Rome, Italy; (C.G.); (A.T.); (E.S.); (F.B.); (R.B.); (F.G.); (P.R.); (M.R.); (G.P.); (M.R.)
- Department of Medicine and Translational Surgery, Università Cattolica Del Sacro Cuore, 00168 Rome, Italy;
- Department of Urology, Addenbrooke’s Hospital, Cambridge University Hospitals NHS Foundation Trust, Cambridge CB2 0QQ, UK
| | - Angelo Totaro
- Department of Urology, Fondazione Policlinico Universitario Agostino Gemelli IRCCS, 00168 Rome, Italy; (C.G.); (A.T.); (E.S.); (F.B.); (R.B.); (F.G.); (P.R.); (M.R.); (G.P.); (M.R.)
- Department of Medicine and Translational Surgery, Università Cattolica Del Sacro Cuore, 00168 Rome, Italy;
| | - Eros Scarciglia
- Department of Urology, Fondazione Policlinico Universitario Agostino Gemelli IRCCS, 00168 Rome, Italy; (C.G.); (A.T.); (E.S.); (F.B.); (R.B.); (F.G.); (P.R.); (M.R.); (G.P.); (M.R.)
- Department of Medicine and Translational Surgery, Università Cattolica Del Sacro Cuore, 00168 Rome, Italy;
| | - Fabrizio Bellavia
- Department of Urology, Fondazione Policlinico Universitario Agostino Gemelli IRCCS, 00168 Rome, Italy; (C.G.); (A.T.); (E.S.); (F.B.); (R.B.); (F.G.); (P.R.); (M.R.); (G.P.); (M.R.)
- Department of Medicine and Translational Surgery, Università Cattolica Del Sacro Cuore, 00168 Rome, Italy;
| | - Riccardo Bientinesi
- Department of Urology, Fondazione Policlinico Universitario Agostino Gemelli IRCCS, 00168 Rome, Italy; (C.G.); (A.T.); (E.S.); (F.B.); (R.B.); (F.G.); (P.R.); (M.R.); (G.P.); (M.R.)
- Department of Medicine and Translational Surgery, Università Cattolica Del Sacro Cuore, 00168 Rome, Italy;
| | - Filippo Gavi
- Department of Urology, Fondazione Policlinico Universitario Agostino Gemelli IRCCS, 00168 Rome, Italy; (C.G.); (A.T.); (E.S.); (F.B.); (R.B.); (F.G.); (P.R.); (M.R.); (G.P.); (M.R.)
- Department of Medicine and Translational Surgery, Università Cattolica Del Sacro Cuore, 00168 Rome, Italy;
| | - Pierluigi Russo
- Department of Urology, Fondazione Policlinico Universitario Agostino Gemelli IRCCS, 00168 Rome, Italy; (C.G.); (A.T.); (E.S.); (F.B.); (R.B.); (F.G.); (P.R.); (M.R.); (G.P.); (M.R.)
- Department of Medicine and Translational Surgery, Università Cattolica Del Sacro Cuore, 00168 Rome, Italy;
| | - Mauro Ragonese
- Department of Urology, Fondazione Policlinico Universitario Agostino Gemelli IRCCS, 00168 Rome, Italy; (C.G.); (A.T.); (E.S.); (F.B.); (R.B.); (F.G.); (P.R.); (M.R.); (G.P.); (M.R.)
- Department of Medicine and Translational Surgery, Università Cattolica Del Sacro Cuore, 00168 Rome, Italy;
| | - Giuseppe Palermo
- Department of Urology, Fondazione Policlinico Universitario Agostino Gemelli IRCCS, 00168 Rome, Italy; (C.G.); (A.T.); (E.S.); (F.B.); (R.B.); (F.G.); (P.R.); (M.R.); (G.P.); (M.R.)
- Department of Medicine and Translational Surgery, Università Cattolica Del Sacro Cuore, 00168 Rome, Italy;
| | - Marco Racioppi
- Department of Urology, Fondazione Policlinico Universitario Agostino Gemelli IRCCS, 00168 Rome, Italy; (C.G.); (A.T.); (E.S.); (F.B.); (R.B.); (F.G.); (P.R.); (M.R.); (G.P.); (M.R.)
- Department of Medicine and Translational Surgery, Università Cattolica Del Sacro Cuore, 00168 Rome, Italy;
| | - Nicolò Lentini
- Department of Life Sciences and Public Health, Section of Hygiene, Università Cattolica del Sacro Cuore, 00168 Rome, Italy; (N.L.); (R.P.)
| | - Roberta Pastorino
- Department of Life Sciences and Public Health, Section of Hygiene, Università Cattolica del Sacro Cuore, 00168 Rome, Italy; (N.L.); (R.P.)
- Department of Woman and Child Health and Public Health—Public Health Area, Fondazione Policlinico Universitario Agostino Gemelli IRCCS, 00168 Rome, Italy
| | - Emilio Sacco
- Department of Medicine and Translational Surgery, Università Cattolica Del Sacro Cuore, 00168 Rome, Italy;
- Department of Urology, Ospedale Isola Tiberina—Gemelli Isola, 00168 Rome, Italy
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Paciotti M, Bravi CA, Piramide F, Mottaran A, Sarchi L, Dell'oglio P, Turri F, DI Maida F, Liakos N, Andras I, Covas Moschovas M, Wenzel M, Sorce G, Wurnschimmel C, Lambert E, DE Groote R, Larcher A. Urological surgery with the Hugo RAS™ System: insights into system adaptability. Minerva Urol Nephrol 2024; 76:267-270. [PMID: 38742562 DOI: 10.23736/s2724-6051.24.05879-8] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 05/16/2024]
Affiliation(s)
- Marco Paciotti
- Department of Urology, IRCCS Humanitas Research Hospital, Rozzano, Milan, Italy -
| | - Carlo A Bravi
- Department of Urology, Northampton General Hospital, Northampton, UK
| | - Federico Piramide
- Division of Urology, Department of Oncology, San Luigi Gonzaga Hospital, University of Turin, Orbassano, Turin, Italy
| | - Angelo Mottaran
- Division of Urology, IRCCS University Hospital of Bologna, Bologna, Italy
| | - Luca Sarchi
- Department of Urology, ASST Santi Paolo e Carlo, University of Milan, Milan, Italy
| | | | - Filippo Turri
- Department of Urology, ASST Santi Paolo e Carlo, University of Milan, Milan, Italy
| | - Fabrizio DI Maida
- Unit of Oncologic Minimally Invasive Urology and Andrology, Department of Experimental and Clinical Medicine, Careggi Hospital, University of Florence, Florence, Italy
| | | | - Iulia Andras
- Department of Urology, Iuliu Hatieganu University of Medicine and Pharmacy, Cluj-Napoca, Romania
| | | | - Mike Wenzel
- Department of Urology, University Hospital Frankfurt, Goethe University Frankfurt, Frankfurt am Main, Germany
| | - Gabriele Sorce
- Division of Experimental Oncology, Department of Urology, Urological Research Institute (URI), IRCCS San Raffaele Scientific Institute, Milan, Italy
| | | | - Edward Lambert
- Department of Urology, OLV Hospital, Aalst, Belgium
- ORSI Academy, Melle, Belgium
| | - Ruben DE Groote
- Department of Urology, OLV Hospital, Aalst, Belgium
- ORSI Academy, Melle, Belgium
| | - Alessandro Larcher
- Division of Experimental Oncology, Department of Urology, Urological Research Institute (URI), IRCCS San Raffaele Scientific Institute, Milan, Italy
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Bertolo R, Veccia A, Antonelli A. Democratizing robotic prostatectomy: navigating from novel platforms, telesurgery, and telementoring. Prostate Cancer Prostatic Dis 2024:10.1038/s41391-024-00812-4. [PMID: 38388777 DOI: 10.1038/s41391-024-00812-4] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/29/2024] [Revised: 02/09/2024] [Accepted: 02/14/2024] [Indexed: 02/24/2024]
Affiliation(s)
- Riccardo Bertolo
- Department of Surgery, Dentistry, Pediatrics and Gynecology, Urology Unit, University of Verona, Verona, Italy.
| | - Alessandro Veccia
- Department of Surgery, Dentistry, Pediatrics and Gynecology, Urology Unit, University of Verona, Verona, Italy
| | - Alessandro Antonelli
- Department of Surgery, Dentistry, Pediatrics and Gynecology, Urology Unit, University of Verona, Verona, Italy
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De Nunzio C, Lombardo R. Best of 2023 in Prostate Cancer and Prostatic Diseases. Prostate Cancer Prostatic Dis 2024:10.1038/s41391-024-00790-7. [PMID: 38263282 DOI: 10.1038/s41391-024-00790-7] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/01/2024] [Revised: 01/05/2024] [Accepted: 01/10/2024] [Indexed: 01/25/2024]
Affiliation(s)
- Cosimo De Nunzio
- Department of Urology, Sapienza University of Rome, Rome, Italy.
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