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Background and objective: The Hugo RAS and DaVinci Xi systems are used for performing robot-assisted radical prostatectomy (RARP). This study aims to compare these two platforms providing granular and comprehensive data on their intraoperative performance. Methods: The Comparison of Outcomes of Multiple Platforms for Assisted Robotic surgery—Prostate (COMPAR-P) trial is a prospective post-market study (clinicaltrials.org NCT05766163). Enrollment began in March 2023, allocating patients to DaVinci or Hugo RAS for RARP, without selection criteria, for up to 50 consecutive cases. Two experienced console surgeons performed the procedures, following the same technique. Evaluation focused on timing, learning curves, malfunctioning events, complications, and users’ satisfaction, using standard statistical methods, including the cumulative summation analysis (CUSUM) for the learning curve assessment. Key findings and limitations: Fifty patients each were enrolled for DaVinci (DV-RARP) and Hugo RAS (H-RARP) RARP. Baseline features were balanced. DV-RARP showed significantly shorter “setup” and “console” phase durations than H-RARP (37 vs 55 min and 97 vs 126 min, respectively, p

Objective: To report a case of an off-clamp robot-assisted enucleation of endophytic renal mass performed in a patient with a solitary functioning kidney. Patient and surgical procedure: The patient underwent a contrast-enhanced CT scan following a syncopal episode, which showed a right renal mass of 3 cm at the hilum with a RENAL score of 9. Hypoperfusion of the contralateral kidney was observed due to renal artery stenosis. A radionuclide renal scan confirmed the poor contribution of the left kidney to renal function. The patient was counseled for robot-assisted partial nephrectomy. The arterial vascular pedicle was dissected at the extra-parenchymal level, guided by 3D reconstruction. After identifying the tributary branch of the area of interest, a branch of the renal artery was suspended on a vascular loop with the help of ischemia simulation on the 3D model. Tumor resection was initiated without clamping the renal artery, identifying the plane of the tumor pseudocapsule. Dissection was conducted circumferentially around the lesion to reduce tractions and the likelihood of tumor rupture. After liberating the lateral margins of the lesion, the enucleation of the more endophytic portion was completed. A hybrid cortico-medullary suture was performed using the ''sliding clips'' technique. Results: The surgery was uneventful. Console time was 65 min. Blood loss was 300 ml. The final pathology showed a papillary renal cell carcinoma, grade 2, with negative margins. Functional follow-up showed no immediate impact of the intervention, and at a three-month follow-up, there were no variations in serum creatinine levels and glomerular filtration rate. Conclusions: Our approach combined an off-clamp technique with anatomical resection and minimal renorrhaphy. Given the case's complexity, the arterial pedicle was selectively prepared according to the 3D model to be ready for selective clamping on demand. Our experience emphasizes the importance of advanced imaging and simulation in complex surgical planning and execution.

Background and Objectives: We sought to investigate whether the 2012 Briganti nomogram may represent a potential prognostic factor of prostate cancer (PCa) progression after surgical treatment beyond European Association of Urology (EAU) risk categories. Materials and Methods: From January 2013 to December 2021, data on PCa patients treated with robot-assisted radical prostatectomy at a single tertiary referral center were extracted. The 2012 version of the Briganti nomogram assessing the risk of pelvic lymph node invasion was used. Here, the nomogram score was evaluated both as a continuous and a categorical variable. The association between variables and disease progression after surgery was evaluated through Cox regression models. Results: Overall, 1047 patients were identified. According to the EAU classification system, 297 (28.4%) patients were low-risk, 527 (50.3%) intermediate-risk, and 223 (21.3%) high-risk. The median (interquartile range) 2012 Briganti nomogram score within the investigated population was 3% (2–8%). Median (95% Confidence Interval [CI]) follow-up was 95 (91.9–112.4) months. Disease progression occurred in 237 (22.6%) patients, who were more likely to have an increasing 2012 Briganti nomogram score (Hazard Ratio [HR]: 1.03; 95%CI: 1.01–1.81; p = 0.015), independently of unfavorable issues at clinical presentation. Moreover, the nomogram score stratified according to tertiles (p < 0.001) up to the third (HR: 3.26; 95%CI: 2.26–4.72; p < 0.001) tertile. Conclusions: Beyond EAU risk categories, the 2012 Briganti nomogram represented an independent predictor of PCa progression after surgery. Likewise, as the nomogram score increased so patients were more likely to experience disease progression. Accordingly, it may allow further stratification of patients within each risk category to modulate appropriate treatment paradigms.