Open vs. robotic prostatectomy using Versius^®: perioperative, oncologic & learning curve outcomes

Area of Science:

• Urology
• Surgical Oncology
• Robotic Surgery

Background:

• Radical prostatectomy is a standard treatment for prostate cancer.
• Evaluating new robotic platforms like Versius® is crucial for surgical advancement.
• Comparing robotic-assisted radical prostatectomy (RARP) with open radical prostatectomy (ORP) provides insights into surgical outcomes and learning curves.

Purpose of the Study:

• To compare perioperative, oncologic, and learning curve outcomes between ORP and Versius®-assisted RARP in Jordan.
• To assess the efficiency and safety of adopting a new robotic surgical system.
• To provide an evidence-based framework for centers implementing Versius®.

Main Methods:

• Prospective observational case series of 133 patients (58 ORP, 75 RARP).
• Comparison of perioperative parameters, pathologic outcomes, and complications using statistical tests.
• Learning curve analysis using operative time, console time, and CUSUM analysis.

Main Results:

• RARP had longer operative time (360 vs. 255 min) but lower blood loss (200 vs. 700 mL) compared to ORP.
• Hospital stay was similar, but ORP patients were more likely to stay ≥4 days.
• Positive surgical margin rates were comparable; lymph node yield was lower in RARP (9 vs. 19).
• Operative efficiency improved beyond case 30 for RARP; blood-loss advantage was immediate, but lymph node deficit persisted.

Conclusions:

• Versius®-assisted RARP demonstrates reduced blood loss and comparable short-term oncologic outcomes to ORP.
• Operative efficiency with Versius® improves significantly after approximately 30 cases.
• Prospective monitoring of lymph node yield is recommended during the early adoption phase of this robotic platform.