# Intraoperative outcomes of robotic surgery across multiple multimodal systems

## TL;DR

This study compares anesthesiological outcomes of three robotic surgical systems and finds they are generally comparable, with minor differences in urine output and positioning.

## Contribution

The study provides new insights into anesthesiological outcomes across different robotic surgical platforms.

## Key findings

- No major differences in anesthesiological outcomes across robotic platforms.
- Versius showed higher intraoperative urine output in gynecological surgery.
- Da Vinci used a steeper Trendelenburg position in colorectal surgeries.

## Abstract

The emergence of new multi-modular robotic surgical systems, such as Hugo RAS and Versius, introduces architectural and ergonomic variations compared with the established Da Vinci platform. While their surgical performance has been widely investigated, limited data exist regarding anesthesiological outcomes. This study aimed to compare intraoperative anesthetic parameters across three robotic platforms in a tertiary academic center.

A retrospective observational analysis was conducted on 258 consecutive patients who underwent robotic abdominal, urological, or gynecological surgery between January 2024 and June 2025. Patients were stratified according to the robotic platform used—Da Vinci, Hugo RAS, or Versius. Intraoperative variables, including Trendelenburg angle, anesthesia duration, pneumoperitoneum time, urine output, and fluid balance, were compared among groups.

The Da Vinci system was used in 68.6% of cases, followed by Versius (15.9%) and Hugo RAS (15.5%). No major differences were observed in anesthesiological or postoperative outcomes across platforms, except for a higher intraoperative urine output with Versius in gynecological surgery. Minor variations included a steeper Trendelenburg position in colorectal surgeries performed with Da Vinci and shorter operative and pneumoperitoneum times with Versius in abdominal wall procedures.

Despite structural and ergonomic differences, the Hugo RAS and Versius systems demonstrated anesthesiological safety and intraoperative performance comparable to the Da Vinci platform, supporting their safe integration into clinical practice.

The online version contains supplementary material available at 10.1007/s11701-025-03060-3.