In Japan, robot-assisted radical prostatectomy (RARP) has been covered by national health coverage since 2012 and become as a common modality. In recent years, the development of surgical robots has been remarkable, Da Vinci series S, Si, Xi, X, Davinci SP which enables single-port surgery, Hugo RAS which features an independent arm, and two Japanese domestic model hinotori and Saroa have all been obtained for pharmaceutical approval in Japan.

Our facility started performing RARP in August 2009 and has experienced 1,950 cases by early August 2024. The number of cases for each model was 1,767 for da Vinci (S, Si, Xi), 93 for hinotori from Sep. 2021, 61 for da Vinci SP from Apr. 2023, and 29 for Hugo RAS from Sep. 2023. Preoperative evaluation (age, PSA, Gleason score, clinical stage, D'Amico risk classification, presence or absence of preoperative hormone therapy), perioperative outcomes (operative time, console time, blood loss, presence or absence of nerve preservation and lymph node dissection), pathological stage and Gleason score, and postoperative evaluation were compared and examined. Differences and characteristics of settings and operations for each model were also examined.

The median age was da Vinci: 67 (43-80), hinotori: 70 (52-79), da Vinci SP: 69 (51-79), Hugo RAS: 68 (54-77). The rate of D'Amico high risk, % (n) was 41.5 (734), 40.9 (38), 62.3 (38), 58.6 (17). Operative time, min was 172 (72-540), 204 (144-322), 178 (117-289), 215 (169-337). Console time, min was 124 (53-388), 139 (93-233), 128 (86-251), 140 (114-232). Estimated blood loss, mL was 150 (5-1000), 100 (5-400), 60 (5-500), 150 (5-450). The rate of pT3≦, % (n) was 20.0 (354), 23.7 (22), 29.5 (18), 10.3 (3). The rate of Radial Margin positive, % (n) was 20.0 (354), 23.7 (22),29.5 (18), 10.3 (3).

We compared four different devices of robot-assisted radical prostatectomy in our facility. Although there were differences in surgery time, all devices can be considered no significant difference in safety.