Revo-i vs Da Vinci in Robotic Partial Nephrectomy: First Human Comparison

While the da Vinci surgical system has dominated robot-assisted partial nephrectomy (RAPN), its high cost limits accessibility. The Revo-i surgical robot offers a cost-effective alternative with approximately 42% lower cost, but clinical experience in partial nephrectomy (PN) remains limited. This study provides the first clinical comparison of perioperative outcomes between Revo-i and da Vinci Xi systems for RAPN.

This retrospective study included 124 patients who underwent RAPN between September 2023 and October 2025 at a single tertiary center. Patients were informed about both platforms, and the final system was selected through shared decision-making. Revo-i was preferentially used in patients with cost concerns and low- to intermediate-complexity tumors. Patients were treated using da Vinci Xi (n = 79) or Revo-i (n = 45) systems. Tumor complexity was stratified by R.E.N.A.L. nephrometry score into low (<7), intermediate (7-10), and high (>10) groups. The primary outcome was trifecta achievement (negative surgical margins, warm ischemia time [WIT] <25 minutes, and no complications).

Baseline characteristics were comparable, although the Revo-i group had a lower R.E.N.A.L. score (7 vs 8, p = 0.004) and fewer hilar tumors (11.1% vs 35.4%, p = 0.003). Operative time, blood loss, and hospital stay were similar. No perioperative complications occurred. Overall trifecta achievement was 66.7% for Revo-i and 57.0% for da Vinci (p = 0.342). The percentage change in estimated glomerular filtration rate was similar between groups (-0.50% vs -0.49%, p = 0.410), with no significant differences across tumor complexity subgroups. In low-complexity cases, Revo-i showed shorter WIT (8 vs 17 minutes, p = 0.003) because of a higher rate of zero-ischemia cases (45.0% vs 9.5%, p = 0.015). In high-complexity cases, Revo-i showed longer WIT (50 vs 33 minutes, p = 0.005) and no trifecta cases.

Revo-i demonstrates comparable outcomes with da Vinci Xi for low- and intermediate-complexity PN. However, caution is warranted for high-complexity cases because of prolonged WIT.