Implementation of Systematic Fourth-Arm Traction and Articulating-Needle Drivers in Senhance Robotic Radical...

We evaluated the impact of incorporating systematic fourth-arm traction and articulating-needle drivers on the perioperative and oncological outcomes of Senhance robotic radical prostatectomy.

We conducted a retrospective single-center analysis of 30 consecutive patients who underwent Senhance robotic radical prostatectomy procedures between October 2024 and December 2025. The patients were stratified into an initial cohort (cases 1-15), which underwent surgery using a three-arm robotic configuration and conventional straight needle drivers, and a refined cohort (cases 16-30), in which continuous fourth-arm traction and articulating-needle drivers were used. The primary endpoints were operative time and positive surgical margin rate.

The median operative time decreased significantly, from 260 min in the initial cohort to 200 min in the refined cohort (p < 0.01). This figure was further reduced, from 244 to 194 min (p < 0.01), after all cases involving lymphadenectomy were excluded. The positive surgical margin rate showed a non-significant trend toward reduction from 33% to 7% (p = 0.17). Early urinary continence was also evaluated as an initial functional outcome, with no significant difference between the two cohorts. A learning curve analysis demonstrated a progressive improvement in operative efficiency (R² = 0.57, p < 0.01). No major complications (Clavien-Dindo grades ≥ III) occurred in either cohort.

The refined protocol was associated with shorter operative time and a non-significant trend toward a lower positive surgical margin rate. These findings should be interpreted cautiously, as our refinement of the surgical protocol overlapped with the learning curve of the surgeon who performed the procedures.