The global landscape of robotic-assisted surgery is undergoing rapid transformation as new platforms emerge to challenge the long-standing dominance of the da Vinci (DV) system. Although DV remains the most widely adopted robotic platform worldwide, its high acquisition and maintenance costs have limited diffusion, particularly in resource-constrained regions. Next-generation systems—including Hugo RAS, Versius, Senhance, Hinotori, KangDuo, Sentire, and Micro Hand S—aim to expand access through reduced capital expenditure, reusable instrumentation, alternative cost structures, and modular architectures. This narrative review synthesizes available studies comparing the economic performance of these new technologies – including da Vinci Single-Port - with the DV multiport. A systematic search across PubMed, Scopus, and Cochrane Library identified 14 comparative cost studies through October 2025. Radical prostatectomy was the most frequently evaluated procedure, with additional analyses focused on colorectal surgery, hysterectomy, sacrocolpopexy, total mesorectal excision, and pyeloplasty. Overall, emerging platforms demonstrate heterogeneous but promising economic profiles. Hugo RAS and KangDuo showed lower overall procedural expenses in some series, although early inefficiencies may increase initial non-surgical operative time until team proficiency improved. The da Vinci Single Port platform demonstrated possible cost increases relative to the multiport system, largely influenced by institutional discharge pathways and disposable pricing. Economic outcomes varied markedly across institutions, driven by local procurement policies, instrument pricing, operative workflows, and reimbursement models. Current evidence suggests that new robotic platforms can reduce specific cost components without compromising clinical outcomes, yet generalizability remains limited. Standardized, prospective cost evaluations incorporating acquisition models, non-surgical time, learning curves, and long-term outcomes are essential to determine true value across healthcare settings.

Partial nephrectomy (PN) is preferred treatment for localized renal cell carcinoma (RCC), with shift toward robotic-assisted PN (RAPN) over open PN (OPN). However, high-quality comparative data remain limited. This study aimed to compare intraoperative, perioperative, and oncologic outcomes of RAPN versus OPN using a propensity score-matched cohort. In this retrospective, single-centre study, 386 patients underwent PN between January 2020 and December 2024. After applying exclusion criteria and propensity-score matching, 152 OPN cases were matched with 125 RAPN. Matching variables included age, Charlson Comorbidity Index, RENAL and PADUA scores, cT stage, and location. Primary endpoint was the intraoperative complication rate. Secondary endpoints included estimated blood loss (EBL), operative time, warm-ischemia time, length of hospital stay (LOS), postoperative complications rate (Clavien-Dindo classification), and 5-year oncologic outcomes (overall-survival [OS], cancer-specific survival [CSS], and recurrence-free survival [RFS]). RAPN was associated with a lower intraoperative complication rate compared to OPN (2

The posterior reconstruction (PR) during robot-assisted radical prostatectomy (RARP)—as originally described by Rocco F and coworkers—has been introduced in 2006 aiming to restore anatomical disruption occurring after radical prostatectomy and to improve continence recovery. The original open technique has been adapted to laparoscopy and to robotics thereafter. The approximation achieved after PR may also reduce the anastomotic tension—while tying the suture – and thus enhance the anatomical alignment. The Rocco’s stitch was introduced by October 2024 at a tertiary robotic center previously unfamiliar to the technique; therefore, a comparative study to assess the impact of PR on the self-perceived quality and easiness of VUA of robotic surgeons was performed. This is a retrospective, single-center comparative study performed at Fondazione Policlinico Gemelli IRCCS, Rome, Italy. The Rocco Stitch was introduced in October 2024 using the standardized two-layer technique. Cases before and after the introduction of PR were retrieved from a prospectively maintained database (Protocol ID 7314) and 271 patients undergoing RARP between November 2023 and February 2025 were evaluated. Post-operative cystogram was performed when deemed necessary (7–9 PO day), based on the surgeon’s ease of anastomosis execution and final perceived quality. The primary outcome of the study is the rate of cystogram use; the overall rate of urinary leakage and the need for additional imaging due to suspect urine extravasation are secondary endpoint. Multivariable logistic regression was performed to identify independent predictors of leakage. Overall, 87 patients received PR, 184 did not; PR group had significantly lower cystogram use (34.5

Robotic surgery is a game-changing innovation in urology. Novel multiport robotic systems’s (MRS) benefits and limitations in renal surgery when compared to Da Vinci MRS need to be fully understood. This study aims to identify variations from the well-known Da Vinci MRS in terms of surgical, oncological, and functional outcomes in patients undergoing robot-assisted partial nephrectomy (RAPN). Our systematic review and meta-analysis screened Pubmed, Web of Science, and Scopus databases, analyzing data from eighteen papers. Of them, 6 studies compared RAPN outcomes in patients between the novel MRS and Da Vinci MRS. Surgical outcomes (surgical times, estimated blood loss, length of hospital stay, Clavien-Dindo grade > 2 complications rate) and oncological outcomes (positive surgical margins rate and trifecta achievement rate) were analyzed using a Sidik-Jonkman method in a random-effects model. The abovementioned eighteen studies involved and included 1204 patients (631 novel MRS and 573 Da Vinci). Six of them were comparative studies between novel MRS and Da Vinci. Meta-analysis between novel MRS and Da Vinci revealed statistically significant differences in terms of docking time (Mean Difference 1.95; 95

Background and Objective Posterior reconstruction (PR) during radical prostatectomy was originally introduced to improve early urinary continence. Emerging evidence suggests PR may also facilitate vesico-urethral anastomosis (VUA) by reducing tension and enhancing anatomical alignment. This study aimed to assess the impact of PR on the quality and ease of VUA during robot-assisted laparoscopic prostatectomy (RALP). Methods Retrospective, single-center comparative study at Fondazione Policlinico Gemelli IRCCS, Rome, Italy. Included 271 patients with localized prostate cancer undergoing RALP between November 2023 and February 2025. PR introduced in October 2024 using a standardized two-layer technique. Primary outcomes: rate of cystogram use, urinary leakage, and emergency imaging due to suspect extravasation. Multivariable logistic regression was performed to identify independent predictors of leakage. Key Findings and Limitations Overall, 87 patients received PR, 184 did not; PR group had significantly lower cystogram use (34.5% vs. 52.7%, p=0.005) and leakage rates (6.7% vs. 71.8%, p<0.001). PR was independently associated with lower leakage risk (OR 0.18; 95% CI 0.04–0.80; p=0.024). No emergency cystograms required in either group. Limitations are the retrospective design, single-center setting, non-randomized allocation, relatively small sample size. Conclusions and Clinical Implications Posterior reconstruction improves anastomotic quality by reducing leakage and potentially simplifying VUA. Incorporating PR into standard RALP protocols may enhance perioperative outcomes and reduce the need for postoperative imaging. Further prospective, multi-center studies are warranted to confirm reproducibility.

Background: Elderly and frail patients undergoing surgery for urological cancer have increased vulnerability to postoperative complications, delayed recovery, and functional decline. The da Vinci Single-Port (SP) platform may reduce surgical stress by enabling regionalized extraperitoneal, retroperitoneal, or transvesical access through a single incision. Objective: The objective was to provide a narrative review of the comparative evidence on da Vinci SP versus conventional multi-port (MP) robotic surgery in elderly or frail urological cancer patients. Methods: A structured search was performed to identify comparative studies reporting outcomes in patients defined as elderly by chronological age (≥65 years) or as frail by a validated frailty index. Findings are reported separately according to the vulnerability construct that was actually measured. Because of procedural and methodological heterogeneity, a narrative synthesis was performed, and the risk of bias was appraised qualitatively along the domains of the ROBINS-I tool. Results: Only three retrospective comparative studies are currently available: two on robot-assisted radical prostatectomy (one in patients aged ≥65 years and one in patients stratified by the 5-item modified frailty index) and one on robot-assisted partial nephrectomy in patients aged ≥65 years. Across these studies, SP surgery was associated with fewer early postoperative complications, shorter length of stay, and more favourable recovery-related endpoints, and in the frailty-stratified study the apparent protective effect increased with frailty burden. All estimates are those published by the original authors, are reported descriptively, and were not pooled. Importantly, in none of the three studies was the SP platform compared with MP surgery performed through the same access route: SP procedures were predominantly extraperitoneal or retroperitoneal and MP procedures were predominantly transperitoneal, so the effect of the platform cannot be separated from that of the access route. Conclusions: The available data are compatible with a reduction in early perioperative morbidity after SP robotic surgery in selected elderly or frail urological cancer patients, particularly when the platform enables extraperitoneal or retroperitoneal access. Because this evidence rests on three retrospective studies at serious risk of bias, the findings are preliminary and hypothesis-generating rather than confirmatory. Prospective studies incorporating geriatric screening, validated frailty metrics, patient-reported recovery, cost-effectiveness, and long-term oncological outcomes are needed.

Background: Prostate cancer (PCa) imposes a substantial global health burden, with robot-assisted radical prostatectomy (RARP) established as the gold standard for localized disease. While da Vinci® Xi maintains market dominance, Toumai® MT-1000 offers a potentially cost-competitive alternative lacking prospective validation. Objective: To evaluate perioperative safety, oncologic quality (primary endpoint: positive surgical margins), early functional recovery (continence), and surgeon learning curve between Toumai® MT-1000 (T-RARP) and da Vinci® Xi RARP (DV-RARP) performed in high-volume European practice. Materials and Methods: This is a prospective single-center comparative study carried out at Policlinico Gemelli, Rome (May-November 2025), enrolling 80 patients with localized or locally advanced PCa, elected for radical prostatectomy and casually allocated to receive surgery with Toumai or the da Vinci robotic platform. The primary endpoint was the comparison of positive surgical margin (PSM) rates. Secondary endpoints included the comparison of operative time (skin-to-skin), estimated blood loss, length of hospital stay, 45-day postop outcomes, specifically Clavien-Dindo complications, urinary continence recovery (0-1 pad/day), and IIEF-5 scores. Learning curve was evaluated through the cumulative summation (CUSUM) analysis of operative times and linear regression of operative times (n = 80 cases). The analyses used STATA 19 with two-sided tests at p < 0.05 significance. Results: Baseline characteristics showed balance between cohorts (p > 0.05 for most covariates). Perioperative outcomes proved equivalent: median operative time (OT) was 192.5 min (IQR 165-230) for Toumai® versus 183.5 min (IQR 147-225) for da Vinci® Xi (p = 0.38); estimated blood loss (EBL) was 150 mL in both groups (p = 0.87); length of hospital stay (LOS) was 2 days in both groups (p = 0.92). PSM rates were identical at 17.5% (p = 0.79). Continence recovery reached 72.5% versus 80% (p = 0.43). Complications (Clavien-Dindo ≥ II) occurred in 7.5% versus 12.5% of cases (p = 0.45). The CUSUM analysis demonstrated operative time proficiency after only four procedures; operative time regression showed no significant trend (p = 0.38). Conclusions: Toumai® MT-1000 demonstrates similar performance to da Vinci® Xi across different RARP quality metrics, with no detectable learning curve for surgeons previously experienced with da Vinci. These findings support a safe integration of cost-effective platforms into clinical practice, pending multicenter randomized confirmation.

Background and objective:The use of robotic-assisted radical cystectomy (RARC) with intracorporeal urinary diversion has increased rapidly in the past decade. The approximation of the ileum toward the urethral stump could be a demanding step. Whereas the techniques for reconstruction have been described in detail, a comprehensive depiction of strategies to facilitate neobladder-urethral approximation is lacking. This manuscript and video collection provide a summary of the techniques and maneuvers suggested by RARC surgeons. Methods and surgical procedure:This is a cross-sectional study in collaboration with the European Association of Urology Robotic Urology Section (ERUS) Scientific Working Group that evaluates strategies for ileourethral approximation and anastomosis from surgeons performing RARC with an intracorporeal neobladder. To this purpose, a survey was developed by a single institution with input from experts. The survey included questions on caseload, types of diversions, ileal approximation, and techniques and strategies for overcoming challenges in an ileourethral anastomosis. Responders were recruited among experts from scientific societies and were asked to rate the importance of these tricks on a Likert scale. A video collection was developed thereafter. Key findings and limitations:Twenty-one surgeons were involved, with five of them having an individual caseload of >300 cases. The Studer (n = 9) and Bordeaux (n = 9) reconstructions were most used; four operators declared the use of more than one type of diversion. Ileourethral approximation is considered a demanding part of intracorporeal neobladder reconstruction for 86% of participant surgeons. It is perceived as difficult in approximately one out of four surgical cases. Ten surgeons reported at least one conversion to ileal conduit due to impossible ileal descent. The posterior reconstruction was ranked as a useful trick to aid in an ileourethral anastomosis for ten surgeons (48%); a reduction in the Trendelenburg position by nine (43%), the use of small incisions in the mesentery was useful for six (29%) and opening the ileal segment before the anastomosis for five (24%) surgeons. Conclusions:Some strategies and techniques are available to facilitate ileal descent toward the pelvis to achieve a tension-free ileourethral anastomosis. The knowledge and application of these tricks are important to cope with this demanding step and make intracorporeal neobladder reconstruction easier and safer. Patient summary:The robotic realization of a neobladder through an intracorporeal approach could be demanding. The associated video presents some surgical strategies to make this step easier and safer, to ensure the achievement of a tension-free neobladder-urethral anastomosis.

Introduction: Laparoscopic and robotic bladder diverticulectomy is a successful option to correct bladder diverticula (BD). Nevertheless, the identification of BD could be a tricky step, due to the presence of pneumoperitoneum compressing the bladder. This occurrence could be particularly evident for the posterior or postero-lateral location of BDs. We present a novel technique to overcome this concern based on a rigid guidewire previously endoscopically placed and coiled inside BD, to ensure it expands and remains stable during the dissection. The technique was used in cases of diverticulectomy concomitant to other prostatic procedures. Methods: This is a multicentric series of laparoscopic and robotic diverticulectomy performed with this original technique in 34 patients. The procedure was concomitant to other prostatic intervention in most of the cases: TURP or bladder neck incision (16); radical prostatectomy (three); Millin adenomectomy (four cases). Surgical procedure: The first step of the procedure endoscopic, consisting of the retrograde insertion of a stiff guidewire inside the BD via cystoscopy; the guidewire is pushed in until it coils inside the diverticulum, and then enlarged to make it visible transperitoneally. The guidewire stretches the diverticulum and guides the dissection up to identify its neck. The primary endpoint is to address the feasibility of the technique by considering the operative time (OT, min) and the complication rate. Results: The median size of the BDs was 5.1 cm. The location of the BD was postero-lateral or posterior in all except one case. Bladder diverticulectomy was laparoscopically performed in 25 and robotically assisted in nine cases. Median OT was 179 min (DS 42). The post-operative course was uneventful for all except two patients with symptomatic urinary tract infections. Conclusions: The use of a stiff guidewire coiling and expanding the BD is a simple and useful trick to aid BD’s identification and dissection; it aids diverticulectomy and is also concomitant to other prostatic procedures.

ABSTRACT Objectives: Radical cystectomy (RC) is a surgical procedure associated with high rates of morbidity. The aim of the study is to provide a comparison between robotic (RARC) and open RC (ORC) in patients elected to cutaneous ureterostomy (CUS). Materials and Methods: This is a retrospective single-center cohort study performed at a high-volume institution. The study involved 64 patients undergoing RC with CUS, 42 ORC and 22 RARC. The indication for RC was based on EAU guidelines and the choice of CUS was planned due to advanced oncological stage or patient's frailty. Patient allocation to the robotic or open approach for RC was casual, determined by surgeon preference and/or the availability of a robotic operating room. The Adverse events were systematically graded utilizing the Clavien–Dindo classification system. Results: Complications of Clavien Dindo ≥ 2 occurred in 27 out of 42 (64.2%) ORC and 3/22 (13.6%) RARC (p < 0.001); complications of Clavien Dindo ≥ 3 occurred in 10/42 (23.8%) ORC and only 1/22 (4.5%) RARC, respectively (p = 0.08). Multivariable analysis revealed that robotic surgery was the only variable inversely associated with Clavien Dindo ≤ 2 complications. Conclusions: In conclusion, RARC appears to be associated with lower morbidity and reduced incidence of complications, elements that make it particularly suitable for frail patients with an elective indication for CUS.

Purpose :Partial nephrectomy (PN) is preferred treatment for localized renal cell carcinoma (RCC), with shift toward robotic-assisted PN (RAPN) over open PN (OPN). However, high-quality comparative data remain limited. This study aimed to compare intraoperative, perioperative, and oncologic outcomes of RAPN versus OPN using propensity score-matched cohort. Methods :In this retrospective, single-centre study, 386 patients underwent PN between January 2020 and December 2024. After applying exclusion criteria and propensity-score matching, 152 OPN cases were matched with 125 RAPN. Matching variables included age, Charlson Comorbidity Index, RENAL and PADUA scores, cT stage, and location. Primary endpoint was intraoperative complication rate. Secondary endpoints included estimated blood loss (EBL), operative time, warm-ischemia time, length of hospital stay (LOS), postoperative complications rate (Clavien-Dindo classification), and 5-year oncologic outcomes (overall-survival [OS], cancer-specific survival [CSS], and recurrence-free survival [RFS]). Results :RAPN was associated with lower intraoperative complication rate compared to OPN (2% vs. 10%, p = 0.003). RAPN resulted in lower EBL (200 mL vs. 300 mL, p = 0.001), shorter operative time (147 vs. 170 min, p = 0.001), and reduced LOS (median 6 days, p = 0.001). Postoperative complications were less frequent with RAPN (14% vs. 25%, p = 0.01), with no significant differences in severe complications or positive surgical margins. Five-year OS, CSS, and RFS were similar between groups. Conclusions :RAPN provides significant perioperative advantages over OPN without compromising oncologic safety at 5 years. These findings support broader adoption of RAPN in selected patients. Multicenter studies are warranted to assess cost-effectiveness, long-term functional outcomes, and generalizability.

Renal cell carcinoma (RCC) is a prevalent and increasingly diagnosed malignancy associated with high mortality and recurrence rates. Traditional diagnostic and therapeutic approaches have limitations due to the disease’s molecular heterogeneity. This review aims to explore how the integration of omics sciences—genomics, transcriptomics, proteomics, and metabolomics—can enhance the diagnosis, prognosis, and treatment of RCC. Genomic analyses have uncovered critical mutations, including VHL, PBRM1, and BAP1, which support improved risk stratification and the development of targeted therapies. Transcriptomic and spatial transcriptomic studies have provided deeper insights into RCC heterogeneity and tumor microenvironment dynamics. Proteomic investigations have revealed potential biomarkers, while metabolomic approaches have highlighted RCC-specific metabolic shifts. Despite these advancements, several challenges persist, including intratumoral heterogeneity, difficulties in multi-omics data integration, and the limited clinical validation of biomarkers. Omics-driven approaches hold significant promise for advancing precision medicine in RCC. These technologies can facilitate earlier diagnosis, guide individualized therapies, and enhance prognostic evaluations. Future research must focus on validating multi-omic biomarkers and leveraging artificial intelligence to manage complex datasets, thereby supporting more informed clinical decision-making and personalized treatment strategies.

Telemedicine and telesurgery emerged as transformative innovations in urology. These approaches overcome challenges such as geographic barriers, resource limitations, and increasing demand for specialized care. Telemedicine is applied across the surgical continuum, including preoperative, perioperative, and postoperative phases. Telesurgery during the perioperative phase achieves outcomes comparable to onsite guidance, while postoperative teleconsultations are well-accepted by patients, offering results equivalent to face-to-face visits. Benefits include fewer patient visits, reduced infection risks, enhanced convenience, and economic advantages. The advent of ultrabroadband 5G has significantly expanded telemedicine's scope, enabling real-time remote consultations and advanced telesurgical procedures. Robotic systems such as Toumai, Hinotori, Edge, KangDuo, and Microport Medbot demonstrate promising applications in urological surgery. Despite these advancements, telemedicine faces challenges, including data security, adherence to professional guidelines, and physician adaptability. Legal and ethical issues such as informed consent, patient privacy, licensing, and electronic documentation highlight the need for standardized frameworks. This review analyzes the current state of telemedicine and telesurgery in urology, emphasizing their benefits, challenges, and potential to transform patient care and improve outcomes.