Emerging robotic platforms in partial nephrectomy: a comparative systematic review and network meta-analysis

Robotic-assisted partial nephrectomy (RAPN) is the preferred minimally invasive nephron-sparing technique, with outcomes comparable to open and laparoscopic surgery. While most evidence derives from the da Vinci system, newer robotic platforms such as Hugo, Hinotori, KangDuo and MP1000 are emerging. This systematic review and network meta-analysis evaluated perioperative outcomes across available RAPN platforms. A systematic search of PubMed, Cochrane Library, CINAHL, and Scopus identified studies reporting RAPN outcomes across available robotic platforms. Eligible studies included randomized and observational cohorts. Risk of bias was assessed with ROBINS-I. Outcomes included in the analysis operative time (OT), estimated blood loss (EBL), and length of hospital stay (LOS). A frequentist NMA using the "netmeta" R package generated standardized mean differences (SMD) with 95% CIs, and P-scores ranked platform performance. The review was registered on PROSPERO (ID: CRD420251032233). This review was conducted in accordance with PRISMA guidelines. Thirteen studies (n = 2,450) were included. Under fixed-effects model, da Vinci SP (SMD - 0.63, 95% CI - 0.87 to - 0.40) and Xi (-0.52, 95% CI - 0.67 to - 0.38) revealed shorter operative times; however, under random-effects models these differences were not statically significant due to substantial heterogeneity. Heterogeneity (I² ≈ 84%) attenuated these effects. For ischemia time, Hugo RAS (-0.88, 95% CI - 1.45 to - 0.30) and Xi (-0.58, 95% CI - 0.73 to - 0.44) outperformed Si, though differences lost significance under random-effects (I² >90%). No significant differences were found for length of stay, blood loss, or R.E.N.A.L. nephrometry scores, although ranking differences were observed. Preoperative outcomes were revealed a comparable outcome using emerging robotic system with the established system. Favourable trends in operative and ischemia times were showed in some platforms; however, these differences were not vigorous under random-effects models and are limited by substantial heterogeneity. This raised the need for long-term, comparative follow-up studies, as the current evidence remains elementary.