Early Experience in Extraperitoneal Robotic Assisted Radical Prostatectomy with HUGO RAS System: A Comparative Analysis with Laparoscopic Radical Prostatectomy

Introduction:The Hugo™ RAS system represents a novel robotic platform recently implemented in our department. Despite its introduction, there is still a scarcity of data regarding extraperitoneal robot-assisted radical prostatectomy (eRARP) carried out using this system. Our primary aim is to compare perioperative, early functional, and oncological outcomes of eRARP with the Hugo RAS System during our centre’s initial foray into robotic surgery with our standard three-dimensional extraperitoneal laparoscopic radical prostatectomy (eLRP). Methods:We conducted a retrospective analysis, comparing men diagnosed with localized prostate cancer who underwent either eRALP or eLRP at a tertiary referral centre in Portugal. These procedures were carried out by the same major surgeons between 2022 and 2023. Urinary continence was defined as no pads used and was assessed up to 3 months post-surgery. Oncologic outcomes were determined by evaluating the positive surgical margin (PSM) rate and PSA levels >0.1 ng/mL at 6 weeks. Secondary outcomes included the usage of protective pads at 6 weeks and 3 months post-surgery, total operative time, estimated blood loss, length of hospital stay, and catheterization time. Complications within 3 months post-surgery were classified according to the Clavien-Dindo system. Statistical analysis was conducted using SPSS Statistics 28, with significance set at a two-sided p-value <0.05. Results:Patients who underwent eRALP (n=50) and eLRP (n=59) were analysed and compared. Postoperative continence rates at 6 weeks and 3 months after surgery were 52.0% and 70.0% for eRALP and 42.4% and 64.4% for eLRP, respectively (p>0.05). PSA persistence was observed in 16.7% and 23.7% for the eRALP and eLRP, respectively (p=0.369). There was no statistically significant difference in the rates of positive surgical margins (PSM) between the two surgical modalities. Regarding perioperative outcomes, the median total operative time was greater for eRALP compared to eLRP (261 min [238–294] vs 177 min [157–200], p<0.001). For eRALP, the median console time was 137 min (119–196), and the mean docking time was 4.6 min (IQR 4.1–5.2). The median estimated blood loss was 200 mL (250–575) vs 150 mL (100–200) for eRALP and eLRP, respectively (p=0.151). The median time to remove the vesical catheter was lower for eRARP (7 days [7–8] vs 8 days [8–10], p<0.001). A percentage of 92% of patients undergoing eRALP had a length of stay less than or equal to two days, while only 52.5% of those undergoing eLRP met this criterion (p<0.001). The only intraoperative complication registered was mechanical failure in one robotic arm, which required conversion to laparoscopy. No intraoperative complications for eLRP were registered. There was also no statistically significant difference in the rates of complication frequency within 3 months after surgery (eRALP 10.0% vs eLRP 10.2%, p=0.459). Conclusion:Robotic-assisted extraperitoneal radical prostatectomy with the Hugo™ RAS demonstrates comparable oncological outcomes and early urinary continence to our standard laparoscopic extraperitoneal radical prostatectomy. eRARP with this novel robotic system seems to allow a seamless transition into robotic surgery.