Application Effect of Different Robotic Surgery Systems in Radical Prostatectomy: A Comparative Study Based on a Network Meta-analysis.

Background and objective: Prostate cancer (PCa) continues to pose significant public health challenges, with rising incidence and mortality rates. Robot-assisted surgery has become a preferred method for radical prostatectomy (RP) due to its precision and minimal invasiveness. This study aims to evaluate the clinical performance of four robotic surgical systems-Da Vinci (DV), KangDuo (KD), Hugo (HG), and Hinotori-in RP for PCa using a network meta-analysis (NMA). Methods: We conducted a systematic review and NMA according to the Preferred Reporting Items for Systematic Reviews and Meta-analyses guidelines, including studies published until January 2025. Studies comparing the four robotic systems in RP for PCa were included, with outcomes including operative time, blood loss, length of hospital stay, complications, 3-mo urinary incontinence rates, and positive surgical margin rates. Data were extracted from randomized controlled trials and observational studies, and statistical analyses were performed using Stata version 18. Key findings and limitations: A total of 2064 patients from 15 studies were included. The results showed that the DV system had the shortest operative time (surface under the cumulative ranking curve [SUCRA] score: 90.7), while the KD system exhibited the longest operative time. There were no significant differences in estimated blood loss, hospital stay, or complication rates between the systems. The KD system showed a slight advantage in hospital stay (SUCRA score: 85.8), while the HG system had the lowest complication rate (SUCRA score: 84.3). No significant differences were found in positive surgical margin rates or 3-mo urinary incontinence rates among the systems. Conclusions and clinical implications: The DV system demonstrated superior efficiency in terms of operative time, while the KD system showed potential advantages in postoperative recovery. However, all robotic systems provided similar safety profiles in terms of blood loss, complications, and long-term functional outcomes. These findings suggest that robotic systems can be selected based on clinical priorities, with further studies needed to optimize system performance and guide personalized treatment strategies. Patient summary: This network meta-analysis compares four robotic surgical systems-Da Vinci, KangDuo, Hugo, and Hinotori-for prostate cancer patients. All platforms achieved comparable outcomes. However, the Da Vinci system demonstrated superior efficiency in terms of operative time, while the KangDuo system showed better postoperative recovery and blood loss control. These findings support safe integration of robotic surgical systems into clinical practice.