Emerging Robotic Platforms in Radical Prostatectomy: A Comparative Systematic Review and Network Meta-Analysis

Introduction and Objective: Throughout the last several years various robotic platforms have emerged with increasing relevance in clinical practice. However, direct comparisons of their perioperative outcomes in robot-assisted radical prostatectomy (RARP) are limited. To address this gap, we conducted a systematic review and network meta-analysis of RARP outcomes across different robotic platforms. Methods: A systematic search was carried out using PubMed, CINAHL, Scopus, and Cochrane for cohort studies, randomized controlled trials (RCTs), and non-RCTs, focusing on patients undergoing RARP for localized prostate cancer. Key outcomes included operative time (OT), estimated blood loss (EBL), and length of stay (LOS). Results: Eighteen studies with 3511 patients were included, representing 9 robotic platforms. LOS was reported in 11 studies, with a mean range of 1.34 to 9.5 days. Compared with the da Vinci Multiport (MP) platforms (XI and SI), the MP1000 platform showed the lowest mean difference (MD) of 1.08 days (95% confidence interval [95% CI]: 0.04-2.13), although this was not statistically significant. OT, reported in 16 studies, showed significant differences. Da Vinci MP platforms had longer OT than Shurui Single-Port (SP), KangDuo, Revo-i, and da Vinci SP, with MDs ranging from 17.16 to 111.83 minutes. In contrast, Senhance showed a shorter OT, with an MD of -34.5 minutes (95% CI: 9.02-59.98). EBL data from 15 studies revealed no significant differences across platforms. Conclusion: This is the first network meta-analysis comparing perioperative outcomes of RARP across emerging robotic platforms. Our findings suggest no clinically significant differences in LOS and EBL, but significant variation in OT, potentially reflecting the impact of novel robotic technologies.