Initial application of the Versius Surgical System (CMR Surgical, Cambridge, UK) in the urological practice of a tertiary referral center

Objective: To report our initial experience with Versius Surgical System (CMR Surgical, Cambridge, UK) in the urological practice of a tertiary referral center. Materials and methods: From April 2024 to May 2025, 40 consecutive patients underwent several robot-assisted (RA) urological procedures adopting the Versius Surgical System. Intraoperative data included total operative time, estimated blood loss, and intraoperative complications classified according to Satava classification. Postoperative complications were recorded according to Clavien-Dindo classification. IPSS score (International Prostate Symptom Score) and ICIQ-UI SF score (International Consultation on Incontinence Questionnaire-Urinary Incontinence Short Form) were used to assess the severity of urinary symptoms and urinary incontinence at baseline and after the surgery. Results: Twenty-eight patients had RA-sacropexy (RACP); six patients had RA-simple prostatectomy (RASP); RA-partial nephrectomy (RAPN) and RA-radical prostatectomy (RARP) were performed in two cases each; the remaining two surgeries were a case of RA-simple nephrectomy and a pyeloureteroplasty. The median patient’s age was 68 years (IQR 63 - 72.3), and the median BMI was 25.4 kg/m2 (23.6 – 27). All female patients receiving RACP had either high-grade, symptomatic hysterocele or vaginal vault prolapse; the median baseline IPSS score was 25 (18 – 26.5), and median ICIQ-UI SF score was 5 (3 – 10). Patients receiving RASP had a median prostate volume of 135 cc (105 – 180) and a median total PSA of 5.5 ng/ml (4.8 – 7). Among patients undergoing RARP, median preoperative PSA was 6.2 ng/ml (5.7 – 6.7) and median prostate volume was 41.5 cc (40.8 – 42.3). For RASP and RARP patients, the median baseline IPSS score was respectively 17 (15 – 26.5) and 7 (3.5 – 10.5); the median ICIQ-UI-SF score was respectively 3 (1.5 – 5.3) and 1 (1 – 1). All the procedures were completed robotically, without converting to pure laparoscopy or open surgery. In the whole cohort, median operative time was 237.5 minutes (215 – 271). Median estimated blood loss was negligible during all surgeries except during RASP. We observed only a single case of Satava grade 1 intraoperative complication. Median in-hospital length of stay was 2 days (1 – 3). The median duration of the postoperative catheterization was 1 day (1 – 1) for RACP patients and 17 days (15 – 19) after RASP. Within 90 days after surgery, we observed complications in 8 patients, including 1 case of Clavien-Dindo grade 1 (2.5%) complications, 6 cases of grade 2 (15%) complications (mostly urinary tract infections), and a single case of grade 3 (2.5%) complications. At follow-up, none of the patients who underwent RACP had clinically significant uterus or vaginal vault prolapse, while 21.4% had persistence or recurrent prolapse (mostly grade 2 cystocele); the majority of RASP patients were voiding properly (Qmax >20ml/s) and were fully continent; the available pathology reports showed negative resection margins. In RACP and RASP patients, the IPSS score significantly improved after surgery (p<0.01), while the ICIQ-UI SF score didn’t worsen significantly (p>0.5). Conclusions: Our initial experience with the Versius Surgical System showed promising results in terms of technical feasibility and safety. All the procedures were completed robotically without any major malfunctions. Intraoperative and postoperative complication rates, as well as functional results, were acceptably good.