Outcomes of robot-assisted radical prostatectomy with novel robotic platforms vs da Vinci multiport systems: a systematic review and network meta-analysis

Introduction: The introduction of novel robotic platforms has expanded surgical options for robot-assisted radical prostatectomy (RARP). However, comparative outcomes with da Vinci multiport (MP) system remain unclear. This systematic review and network meta-analysis aimed to compare perioperative, early oncological, and functional outcomes of RARP performed with novel robotic platforms versus the da Vinci MP system. Methods: A systematic literature search was conducted in PubMed, Scopus, and Embase (updated December 22, 2024) following PRISMA guidelines. Eligible studies compared RARP performed with alternative robotic platforms versus da Vinci MP, reporting perioperative, oncological, or functional outcomes. A network meta-analysis was conducted using a random-effects model. Outcomes were expressed as mean differences for continuous variables and odds ratios (OR) for dichotomous variables, with 95% confidence intervals (CI). Results: Thirty-three studies for a total of 5987 patients were included. Compared to da Vinci MP, da Vinci SP had lower odds of lymph node dissection (OR 0.39, 95% CI 0.26–0.61) and nerve-sparing (OR 0.11, 95% CI 0.02–0.61) but was associated with shorter catheterization (−1.18 days, 95% CI −2.05 to -0.31) and hospital stay (−0.68 days, 95% CI −1.05 to −0.31). Versius, KangDuo, and SHURUI SP had significantly longer operative times (MD 74.00, 95% CI 42.49–105.51; MD 53.96, 95% CI 18.26–89.67; MD 103.88, 95% CI 69.99–137.78, respectively). Hugo RAS had higher intraoperative malfunction rates (OR 6.53, 95% CI 2.17–19.63). Positive surgical margin rates were lower for da Vinci SP (OR 0.70, 95% CI 0.53–0.92) but higher with the perineal approach (OR 6.30, 95% CI 1.53–25.94). PSA persistence, biochemical recurrence, continence and erectile function rates were comparable across platforms. Conclusion: This is the first network meta-analysis comparing robotic platforms for RARP. While perioperative differences exist, oncological and functional outcomes appear comparable. Future studies should address learning curve effects, cost-effectiveness, and long-term functional outcomes to optimize robotic platform selection.