Simultaneous step-by-step comparison of four robotic platforms in radical prostatectomy: da Vinci Xi, da Vinci SP, Hugo™ RAS, and TOUMAI®

Objective The growing number of robotic platforms in urologic surgery introduces variability in ergonomics, docking, instrumentation and workflow, yet direct visual comparisons between systems are scarce. This video presents a simultaneous step-by-step comparison of robot-assisted radical prostatectomy (RARP) performed with the da Vinci Xi, da Vinci SP, Hugo™ RAS and TOUMAI® platforms. Patients and surgical procedure Four RARPs were performed by two high-volume robotic surgeons, each operating two platforms. Three procedures were transperitoneal and multiport; the da Vinci SP procedure was single-port and extraperitoneal. The synchronized video shows the same operative steps side by side, from development of the space of Retzius to the urethrovesical anastomosis, and records for each step the specific advantages and limitations observed with each platform. Results All procedures were completed without conversion or intraoperative complications, with negative surgical margins. The da Vinci Xi provided the most stable triangulation and the widest instrument portfolio at the cost of multiple incisions. The da Vinci SP allowed a single-incision extraperitoneal procedure with minimal traction, but working space was reduced and retraction and suturing required adaptation. Hugo™ RAS offered flexible modular docking with the longest initial set-up and a risk of external arm collision. TOUMAI® delivered smooth motion scaling and force feedback with a narrower instrument portfolio and limited availability. Platform characteristics are summarized in a table. Conclusion RARP can be performed safely with each platform. The synchronized format makes platform-specific strengths and constraints visible at the same operative step, which may help surgeons and trainees transitioning between systems.