Robot assisted radical prostatectomy (RARP) is the standard of care for localized prostate cancer worldwide, but the most important barrier to widespread availability of robotic systems is the associated high cost. Recent availability of newer robotic systems has brought down the cost, but limited data is available about their efficacy and safety. We present our experience and outcomes of RARP with CMR Versius® surgical system and a comparison of cost-effectiveness to RARP with Da Vinci® surgical system in India.

Consecutive patients undergoing RARP in our department between January 2023 to October 2024 were included. Operative time, docking time of system, anastomosis time, blood loss and other parameters were assessed. Postoperative recovery data and follow up data including days to socially acceptable continence (defined as single diaper use in 24 hours) were recorded.

Seventeen patients underwent RARP during the study period. The median age was 67 years (Range 58 – 73) and the median BMI was 31.4 (range 26.8 – 39.1). The median prostate size was 48 g (range 28-80) and median PSA was 8.9 ng/dL (4.7 – 18.2). The median operating time was 290 minutes (range 240 – 330) and median vesicourethral anastomosis time was 50 minutes (range 40 – 60). The median docking time was 15 minutes (range 10-25). The median blood loss was 350 ml (250 – 750 ml) and 2 patients (11.7%) required blood transfusion. The robotic malfunction was limited to errors in instruments bedside units which were 5 times in first case which came down to zero by fourth case. There was no major intraoperative or postoperative complications and median hospital stay was 4 days (range 4-6). The median time for return to socially acceptable continence was 10 days (range 3 – 30). The median cost of RARP at our centre was 4470 USD (4117 – 5085 USD) as compared to average 7500 USD for RARP in India with Da Vinci® Surgical system.

To our knowledge, this is the largest reported series of RARP on CMR Versius® system in India. It is feasible and safe to perform RARP with this system with comparable perioperative and functional recovery outcomes and significant cost benefits compared to Da Vinci® system. The errors encountered during the surgery leads to longer operating times initially but they improve gradually with technical modifications as we get accustomed to the system.