Hugo TM RAS vs Da Vinci® Xi Robot-Assisted Partial Nephrectomy: First Propensity Score-Matched Comparison of Perioperative and Functional Outcomes

Purpose: To report the first multicentric comparison between Hugo™ robot-assisted surgery/system (RAS) and Da Vinci® Xi for robot-assisted partial nephrectomy (RAPN). Methods: Between October 2022 and March 2024, a total of 258 patients underwent off-clamp RAPN (Hugo RAS = 52 patients, and Da Vinci = 206 patients). Da Vinci and Hugo cases were matched in a 1:1 ratio using propensity score matching (PSM), adjusting for the Radius Exophytic Nearness Anterior Location score and renorrhaphy technique. Trifecta was defined as the coexistence of negative surgical margin status, no Clavien–Dindo grade ≥ 3 complications, and ≤ 30% estimated glomerular filtration rate (eGFR) reduction at discharge. Results: After 1:1 PSM, two comparable populations of 52 patients each were selected. No intraoperative blood transfusion occurred in any group. The Hugo cohort displayed a higher rate of postoperative transfusions (7.7% vs 0%, p = 0.04). Nevertheless, perioperative complications were comparable ( p = 0.32). The median length of stay (LOS) was shorter in the Da Vinci group (2 days vs 3 days, p < 0.001), as for median eGFR at discharge (74.5 mL/min/1.73m 2 vs 87.3 mL/min/1.73m 2 , p = 0.03). No significant difference in positive surgical margins was shown between the two groups ( p = 0.08). Finally, a comparable Trifecta rate was achieved for both platforms (88.5% in the Hugo RAS group and 90.4% in the Da Vinci group, p = 0.75). Conclusions: Despite the hierarchical role of Da Vinci in the robotic surgical landscape, RAPN can be safely carried out with the new Hugo RAS System, with satisfactory perioperative surgical outcomes comparable to the Da Vinci Xi System.