Robotic adrenalectomy: comparison of Da-Vinci, HUGOTM-RAS and Versius® platforms

Abstract

Abstract Background Robotic adrenalectomy (RA) has emerged as an advantageous approach in challenging cases and suspicious lesions, although high costs represent the main drawback to its broader application. Besides Da-Vinci, new platforms have been recently launched on the market and need to be validated in clinical practice. Da-Vinci, HUGOTM-RAS and Versius® platforms were introduced in our center in 2012, 2022 and 2024, respectively. We aimed to compare the perioperative outcomes of these robotic platforms. Methods Among 727 adrenalectomies (2012-2024), 147 (20.2%) RAs were performed. All procedures performed by means of HUGOTM-RAS and Versius® platforms were compared with similar procedures (in terms of patient’s and lesion’s features) performed with DaVinci technology in the same period (2022-2024). Results Ten patients were included in each group. Patients’ and lesions’ features were similar. Median BMI and lesion’s size were 27.9, 24.9 and 26.1 kg/m2 and 42.5, 42.5 and 32.5 mm in DaVinci, HUGOTM-RAS and Versius® groups, respectively (p=0.360, p=0.236). The groups were comparable for docking time, console time, and operative time (5vs.5vs.7 minutes, p=0.059, 58.5vs.58vs.39 minutes, p=0.393, 109.5vs.110.5vs.104.1 minutes, p=0.668, respectively). No conversion or perioperative complications were registered. Postoperative hospital stays were similar (2 days in all groups, p=0.629). Conclusions RA, whatever platform is used, confirmed to be a safe and effective approach, potentially expanding indications for minimally invasive adrenalectomy. Even though new platforms have been applied in less demanding patients in our learning curve phase, the introduction of new different platforms may lead to a costs reduction that could determine the implementation of RA.