Robot-assisted Radical Prostatectomy with the KangDuo Surgical System Versus the da Vinci Si System: A Prospective, Double-center, Randomized Controlled Trial

We present the first trial comparing the KangDuo Surgical Robot (KD-SR) and the da Vinci Si Surgical System (DV-SS-Si) for robot-assisted radical prostatectomy. The outcomes of the KD-SR were not inferior to those of the DV-SS-Si regarding safety and efficacy for T1-T2 prostate cancers. The KangDuo Surgical Robot (KD-SR) is a newly developed surgical robot. To compare the safety and efficacy of robot-assisted radical prostatectomy (RARP) using the KD-SR with those of the da Vinci Si Surgical System (DV-SS-Si). A prospective double-center noninferiority randomized controlled trial was conducted among 18–75-yr-old patients with suspected T1-2N0M0 prostate cancer (PCa) scheduled for RARP. RARP with the KD-SR (KD-RARP) versus RARP with the DV-SS-Si (DV-RARP). The primary outcome was surgical success, defined as follows: surgery can be performed according to the established protocol, without switching to other surgical modalities, and without secondary surgery due to surgical complications after surgery. The secondary outcome was short-term functional and oncological outcomes. The noninferiority threshold was set at 10%. Eighty patients were enrolled, while the full analysis set finally included 79 patients (40 with KD-RARP and 39 with DV-RARP). The success rate was 100% in both groups. We could not find differences in urinary continence rate at 1, 2, 3, and 4 wk after catheter removal between the groups (p > 0.05). The rate of Clavien-Dindo grade II adverse events was 20% in the KD-RARP group and 17.9% in the DV-RARP group (p = 0.82), and no grade ≥III adverse events occurred. The median operation time was significantly longer in the KD-RARP group than in the DV-RARP group (177.5 vs 145 min, p = 0.012). The main limitations were the short follow-up period and that survival was not considered as the primary outcome. The KD-SR is a viable option for RARP, with acceptable short-term outcomes compared with the DV-SS-Si for T1–2 PCa. This is the first prospective randomized controlled trial to compare the KangDuo Surgical Robot (KD-SR) versus the da Vinci Si Surgical System (DV-SS-Si) for robot-assisted radical prostatectomy, which determines that the KD-SR is noninferior to the DV-SS-Si regarding safety and efficacy for T1-T2 prostate cancer.