Extraperitoneal robot-assisted radical prostatectomy by the da Vinci and Versius System: first comparative analysis

BACKGROUND: Robotic-assisted surgery (particularly with the da Vinci Surgical System) has revolutionized urological interventions. The advent of the Versius Surgical System introduces a compelling alternative. This study compares outcomes of extraperitoneal robot-assisted radical prostatectomy (eRARP) using da Vinci and Versius, presenting the largest case series to date. METHODS: A retrospective analysis of 106 consecutive patients undergoing eRARP (July 2021-July 2023) with da Vinci and Versius. Surgical techniques involved extraperitoneal approaches, with a single surgeon ensuring consistency. Baseline characteristics, perioperative outcomes, and pathology results were analyzed. RESULTS: Baseline characteristics were comparable between da Vinci and Versius groups. While no significant differences were observed in overall operative time, estimated blood loss, and length of hospital stay, variations were noted in pelvic lymphadenectomy rates and nerve-sparing procedures. Pathology results revealed no significant disparities in International Society of Urological Pathology (ISUP) grades and positive surgical margins. However, a notable difference emerged in pathological N stage, with Versius showing a higher percentage of positive lymph nodes. CONCLUSIONS: This study provides a comprehensive comparative analysis of da Vinci and Versius in eRARP, representing the largest case series to date. While overall outcomes were similar, nuances in lymphadenectomy rates and Pathological N stage merit attention. Ongoing research and longer-term follow-up will refine our understanding, guiding urological surgeons in optimal robotic system selection.