Comparison of da Vinci SP and Xi surgical systems in urologic surgery: a systematic review and meta-analysis

To evaluate the perioperative outcomes, functional safety, and feasibility of the da Vinci SP versus the da Vinci XI surgical system in urologic surgeries (radical prostatectomy and adrenalectomy), and to provide updated evidence for clinical decision-making. A systematic literature search was conducted in Embase, PubMed, the Cochrane Library, and ClinicalTrials.gov for English-language publications up to September 2025. Data were analyzed using Review Manager 5.4.1. The study protocol was registered in PROSPERO (CRD42025114844). This meta-analysis included 7 studies involving 928 patients, comprising 5 studies on robotic prostatectomy and 2 on robotic adrenalectomy. Compared with the XI system, the SP system was associated with significantly less intraoperative blood loss (SMD: - 0.19; 95% CI: - 0.37 to - 0.01; P = 0.04) and shorter operative time in the adrenalectomy subgroup (SMD: - 0.43; 95% CI: - 0.84 to - 0.03; P = 0.04). No significant differences were observed between the two systems in operative time for prostatectomy, length of hospital stay, nerve preservation rate, positive surgical margin rate, postoperative pain score, or rate of pelvic lymph node dissection. In patients undergoing radical prostatectomy or adrenalectomy, the da Vinci SP system demonstrates superior perioperative effectiveness over the da Vinci XI system, particularly in reducing operative time (in adrenalectomy) and intraoperative blood loss, while achieving comparable functional, oncological, and surgical margin outcomes. The SP approach represents a minimally invasive alternative in selected urologic procedures. However, these findings should be further validated by large-scale, multicenter, prospective randomized controlled trials with long-term follow-up.