KangDuo system versus da Vinci system for robot-assisted radical prostatectomy: a systematic review and meta-analysis based on prospective studies

Abstract

The da Vinci robotic platform, as the earliest operative platform implemented in routine clinical use, has been employed for various complex surgical conditions owing to its precision in manipulation. However, its prohibitive costs have restricted widespread adoption in certain regions. Consequently, China's domestically developed KangDuo robotic surgical platform was developed to address this need. Currently, comparative studies on perioperative outcomes between these two platforms for performing robot-assisted radical prostatectomy (RARP) remain scarce. This meta-analysis aims to systematically compare perioperative outcomes among these robotic platforms. A structured search of the literature was undertaken across several principal online databases-such as PubMed, Web of Science, the Cochrane Library, and SpringerLink-to locate prospective investigations comparing K-RARP with D-RARP published before August 1, 2025. The comparative outcomes across the two robotic systems consisted of total operating time, estimated intraoperative blood loss, length of hospitalization, urinary continence recovery, post-operative complications, and positive surgical margin rates. This quantitative synthesis included four comparative studies encompassing an aggregate of 188 participants. The results revealed no significant differences in PSM rates (OR 1.06, 95% CI 0.55-2.04; p = 0.86), estimated intraoperative blood loss (WMD - 1.04 ml, 95% CI - 21.72 to 19.63; p = 0.92), length of hospitalization (WMD - 0.32 days, 95% CI - 1.33 to 0.70; p = 0.54), urinary continence (OR 0.96, 95% CI 0.50-1.83; p = 0.90), when contrasting K-RARP with D-RARP. Moreover, no meaningful differences were detected in the incidence of Clavien-Dindo grade I complications (OR 1.14, 95% CI 0.33-3.89; p = 0.84), grade II complications (OR 1.11, 95% CI 0.39-3.18; p = 0.84), or overall complication incidence (OR 1.28, 95% CI 0.59-2.76; p = 0.53). However, for K-RARP, operative duration was significantly longer (WMD 41.34 min, 95% CI 22.42-60.26; p < 0.05). As the inaugural comparative assessment of perioperative outcomes between KangDuo and da Vinci robotic systems, this study demonstrated that while K-RARP required significantly longer operative times, it achieved comparable outcomes to D-RARP in EBL, positive surgical margin rate, hospital stay, continence, and complication rates. This evidence positions the KangDuo platform as a viable future option for localized prostate cancer management. However, this conclusion remains preliminary and exploratory, and will need to be confirmed through large-scale, multicenter, multi-regional randomized controlled trials combined with long-term follow-up.

Keywords: Da Vinci platform; KangDuo platform; Radical prostatectomy; Robot.