Versius robotic surgical system: case series of 18 robot-assisted radical prostatectomies

Outcomes and efficacy of robotic-assisted radical prostatectomy using the CMR Versius platform: a prospective study on 118 patients with 1-year follow-up

OBJECTIVE

To evaluate the outcomes and efficacy of robot-assisted radical prostatectomy (RARP) using the Versius robotic surgical system, aiming to provide comprehensive data on perioperative outcomes, postoperative recovery, and complications.

PATIENT AND METHODS

All cases of RARP using the CMR Versius platform performed at Cairo University Hospital over a two-year period were enrolled in this study. All patients had pathologically confirmed prostate cancer in both localized and locally advanced stages. Data were prospectively collected including preoperative parameters as patients' demographics, serum PSA, and Gleason score after trans-rectal ultrasound guided biopsy. Intraoperative parameters and complications were assessed. Postoperatively, we monitored the oncological and functional outcomes such as continence and sexual functions for at least 12 months. Follow up of PSA was done at 6 weeks, 3 and 6 months, postoperatively.

RESULTS

One-hundred-and-eighteen patients continued the follow-up till 12 months. The median patient age was 64.26 ± 7.13 years. The median PSA value at diagnosis was 9 (4.16-64) ng/ml and the median prostate size was 50 (20-167) grams. The mean docking time, console time, and the total operative time were 13.17 ± 1.157, 194.75 ± 24.3 and 225.76 ± 25 min, respectively and the median blood loss was 307.46 ± 61.44 ml. The mean hospital stay and the mean catheter time were 2.16 ± 0.867 and 7.26 ± 1.441 days, respectively. Forty-nine patients underwent nerve-sparing RARP (bilateral in 41 patients and unilateral in 8 patients). Post-operative continence and potency showed progressive improvement over time during follow-up. Twelve months postoperatively, 90.7% of patients were totally continent and 49% of those patients who underwent nerve-sparing RARP (24/49) were potent.

CONCLUSION

With a positive safety profile and a successful oncological outcome, the use of the CMR system for robot-assisted radical prostatectomy presents a safe and promising method in the surgical management of prostate cancer.

Robot-Assisted Radical Prostatectomy Using the KangDuo Surgical Robot-1500: A Prospective, Multicenter, Single-Arm Clinical Study

Introduction: The KangDuo Surgical Robot-1500 (KD-SR-1500) is a newly developed surgical robot. We aim to evaluate the feasibility and efficiency of the KD-SR-1500 system for robot-assisted radical prostatectomy (RARP). Materials and Methods: This prospective, multicenter, single-arm clinical study was conducted among 18-75-year-old patients with suspected T1-2N0M0 prostate cancer scheduled for RARP. The perioperative and follow-up data were prospectively recorded. Early oncologic outcomes were assessed according to surgical margin status and prostate-specific antigen (PSA) at 6 weeks after surgery. Continence was defined as no more than one pad daily. Ergonomics were assessed with the National Aeronautics and Space Administration task load index (NASA-TLX). Perioperative complications were recorded according to the Clavien-Dindo classification. Results: A total of 31 patients were involved in the trial. One patient with severe abdominal adhesion withdrew from the trial. All surgeries were performed successfully without any conversion or secondary surgery due to surgical complications. The median docking time and console time were 3.8 (3.3-5.2) and 104.6 (80.0-145.6) minutes, with a median estimated blood loss of 50 (20-100) mL. Positive surgical margin was observed in 6 (20%) patients. One (3.4%) patient experienced PSA persistence at 6 weeks after surgery. The urinary continence rate was 75.9% (22/29) at 4 weeks after catheter removal. There were no major complications (grade ≥ III) or equipment-related adverse events. The mean NASA-TLX score was 23.9 ± 11.7. Conclusions: The KD-SR-1500 is feasible and effective for the management of T1-T2 prostate cancer.

Evaluation of Clinical Research on Novel Multiport Robotic Platforms for Urological Surgery According to the IDEAL Framework: A Systematic Review of the Literature

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.

Partial nephrectomy series using Versius robotic surgical system: technique and outcomes of an initial experience

Partial nephrectomy (PN) represents a procedure where the use of a robot has further enabled successful completion of this complex surgery. The results of this procedure using Versius Robotic Surgical System (VRSS) still need to be evaluated. Our working group described the technique and reported the initial results of a series of PN using VRSS. We presented our setting, surgical technique and outcomes for PN, using VRSS. Between 2022 and 2023, 15 patients underwent PN performed by two surgeons in two different centers. Fifteen patients underwent PN. The median lesion size identified on preoperative imaging was 4 (IQR 2.3-5) cm. Median PADUA score was 8 (IQR 7-9). Two procedures were converted to radical nephrectomy for enhanced oncological disease control. Of the 13 nephrectomies that were completed as partial, 7 were performed clampless and 6 with warm ischemia clamping. Median clamping time was 10 (IQR 9-11) minutes. No procedure was converted to open. Median blood loss was 200 (IQR 100-250) mL. Median total operative time was 105 (IQR 100-110) minutes. Median console time was 75 (IQR 66-80) minutes. Median set-up time was 13 (IQR 12-14) minutes. No intraoperative complications were reported. The median hospitalization time was 4 (IQR 3.5-4) days. None of the patients were transfused and none of the patients required readmission. In a pathology report, one patient had a positive surgical margin. Our initial experience suggests that performing PN using VRSS is feasible with good short-term outcomes.

Robotic-assisted radical prostatectomy: a multicenter experience with the Senhance Surgical System

PURPOSE

Robotic-assisted surgery for radical prostatectomy is becoming a standard treatment, and respective implementations are expanding. The Senhance Surgical System is a robotic system with existing but limited data on radical prostatectomy, including a lack of multicenter study experiences. The TRUST study aims to fill this gap and explores observations for radical prostatectomy with the Senhance Surgical System.

METHODS

Between August 2019 and November 2022, 375 patients met inclusion criteria from two European sites. Patients' surgical procedure times, data on conversion, malfunction, adverse events, and pain scores were registered and evaluated. Outcomes were calculated for both sides, combined as a total and compared between the initial (1st-150th case) and later (> 150th case) period.

RESULTS

The median operating time was 190 min (IQR: 167.5-215.0) and the median docking time was 3 min (IQR: 2.0-5.0). Eighteen cases (4.8%) were converted to standard laparoscopy and two (0.5%) to open. Two perioperative (0.5%) and eleven postoperative adverse events (2.9%) occurred, mostly (83.3%) categorized as mild. Pain scores were reduced from an average of 3.4 (± 1.4) on the postoperative day to 0.9 (± 0.7) at discharge. Compared to our previous data and based on a comparison between our initial and later period, operating time seems to plateau. However, docking time, complication, and conversion rates were successfully reduced.

CONCLUSION

We demonstrate progressing safety and efficiency for robotic-assisted radical prostatectomy with the Senhance Surgical System.

The use of Versius CMR for pelvic surgery: a multicentric analysis of surgical setup and early outcomes

INTRODUCTION

Versius CMR is a novel robotic system characterized by an open surgical console and independent bedside units. The system has potentials of flexibility and versatility, and has been used in urological, gynecological, and general surgical procedure. The aim is to depict a comprehensive analysis of the Versius system for pelvic surgery.

METHODS

This is a study involving two Institutions, ASST Santi Paolo and Carlo, Milan, and Apuane Hospital, Massa, Italy. All interventions performed in the pelvic area with the Versius were included. Data about indications, intra-, and post-operative course were prospectively collected and analyzed.

RESULTS

A total of 171 interventions were performed with the Versius. Forty-two of them involved pelvic procedures. Twenty-two had an oncological indication (localized prostate cancer), the remaining had a non-oncological or functional purpose. The mostly performed pelvic procedure was radical prostatectomy (22) followed by annexectomy (9). No intra-operative complication nor conversion to other approaches occurred. A Clavien II complication and one Clavien IIIb were reported. Malfunctioning/alarms requiring a power cycle of the system occurred in 2 different cases. An adjustment in trocar placement according to patients' height was required in 2 patients undergoing prostatectomy, in which the trocar was moved caudally. In two cases, a pelvic prolapse was repaired concomitant with other gynecological procedures.

CONCLUSIONS

Pelvic surgery with the Versius is feasible without major complications; either dissection and reconstructive steps could be accomplished, provided a proper OR setup and trocar placement are pursued. Versius can be easily adopted by surgeons of different disciplines and backgrounds; a further multi-specialty implementation is presumed and long-term oncological and functional outcomes are awaited.

Navigating Now and Next: Recent Advances and Future Horizons in Robotic Radical Prostatectomy

Robotic-assisted radical prostatectomy (RARP) has become the leading approach for radical prostatectomy driven by innovations aimed at improving functional and oncological outcomes. The initial advancement in this field was transperitoneal multiport robotics, which has since undergone numerous technical modifications. These enhancements include the development of extraperitoneal, transperineal, and transvesical approaches to radical prostatectomy, greatly facilitated by the advent of the Single Port (SP) robot. This review offers a comprehensive analysis of these evolving techniques and their impact on RARP. Additionally, we explore the transformative role of artificial intelligence (AI) in digitizing robotic prostatectomy. AI advancements, particularly in automated surgical video analysis using computer vision technology, are unprecedented in their scope. These developments hold the potential to revolutionize surgeon feedback and assessment and transform surgical documentation, and they could lay the groundwork for real-time AI decision support during surgical procedures in the future. Furthermore, we discuss future robotic platforms and their potential to further enhance the field of RARP. Overall, the field of minimally invasive radical prostatectomy for prostate cancer has been an incubator of innovation over the last two decades. This review focuses on some recent developments in robotic prostatectomy, provides an overview of the next frontier in AI innovation during prostate cancer surgery, and highlights novel robotic platforms that may play an increasing role in prostate cancer surgery in the future.