Six-month outcomes of a three-arm prospective study comparing Da Vinci vs. Hugo RAS vs. versius robotic radical prostatectomy: (the COMPAR-P trial)

TL;DR

This study compares three robotic systems for prostate surgery, finding similar outcomes after six months despite early differences in sexual function scores.

Contribution

The study provides a direct comparison of three CE-marked robotic platforms for radical prostatectomy in a real-world clinical setting.

Findings

All three robotic platforms achieved comparable safety and oncological outcomes at six months.

Early sexual function scores were lower for Hugo RAS and Versius but normalized over time.

Physical functioning scores for Hugo RAS were temporarily better at one month.

Abstract

To compare postoperative, oncological, and patient-reported outcomes of robot-assisted radical prostatectomy (RARP) performed with three CE-marked robotic platforms: Da Vinci Xi, Hugo RAS, and Versius. The COMPAR-P trial is a prospective, monocentric, post-market study conducted at the Azienda Ospedaliera Universitaria Integrata of Verona, Italy (ClinicalTrials.gov NCT05766163). From March 2023, 150 patients with organ-confined prostate cancer were consecutively enrolled and allocated to undergo RARP with Da Vinci Xi (n = 50), Hugo RAS (n = 50), or Versius (n = 50). Two high-volume robotic surgeons performed all procedures, experienced with Da Vinci but naïve to Hugo RAS and Versius before trial initiation. Surgical technique, perioperative protocols, and follow-up were standardized across cohorts. Outcomes at 6 months included serum PSA, complications (Clavien–Dindo classification), late sequelae (> 90 days), and health-related quality of life (SF-36 and UCLA-PCI questionnaires). Longitudinal analyses used linear mixed-effects models. Baseline demographics and disease characteristics were comparable across groups. At 6 months, PSA was undetectable in most patients, with no significant intergroup differences. Complication rates and late sequelae were low and evenly distributed. Questionnaire completion exceeded 90% at all time points. No significant long-term differences emerged in most SF-36 and UCLA-PCI domains. However, at 1 month, Hugo RAS and Versius patients reported lower Sexual Function scores than Da Vinci (–20 and − 28 points, respectively), and Versius patients reported lower Sexual Bother scores (–25 points, all p < 0.05). These differences disappeared at 3 and 6 months. Hugo RAS patients showed a temporary advantage in Physical Functioning at 1 month (+ 17 points vs. Da Vinci). Within the present study, and notwithstanding its inherent limitations, Da Vinci, Hugo RAS, and Versius achieved comparable safety, oncological, and short-term patient-reported outcomes in RARP. Early functional differences were transient and resolved over time. Surgical expertise, rather than the platform type, appears to be the primary determinant of outcomes.

The online version contains supplementary material available at 10.1007/s11701-026-03260-5.

Figures