Beyond Da Vinci: Comparative Review of Next-Generation Robotic Platforms in Urologic Surgery

Abstract

Robotic surgery has become a cornerstone of modern urologic practice, with the da Vinci system maintaining dominance for over two decades. In recent years, however, a new generation of robotic platforms has emerged, introducing greater competition and innovation into the field. These systems aim to address unmet needs through features such as modular architectures, enhanced ergonomics, haptic feedback, and cost-containment strategies. Several platforms—including Hugo™ RAS, Versius™, Avatera™, REVO-I, Hinotori™, Senhance™, KangDuo, MicroHand S, Dexter™, and Toumai®—have entered clinical use with early results demonstrating perioperative and short-term oncologic outcomes broadly comparable to those of established systems, particularly in procedures such as radical prostatectomy, partial nephrectomy, and radical cystectomy. At the same time, they introduce unique advantages in workflow flexibility, portability, and economic feasibility. Nevertheless, important challenges remain, including the need for rigorous comparative trials, standardized training curricula, and long-term cost-effectiveness analyses. The integration of artificial intelligence, augmented reality, and telesurgery holds the potential to further expand the role of robotics in urology, offering opportunities to enhance precision, improve accessibility, and redefine perioperative care models. This review summarizes the evolving landscape of robotic platforms in urology, highlights their clinical applications and limitations, and outlines future directions for research, training, and global implementation.