Feasibility and safety of Toumai® robot‐assisted radical prostatectomy: initial experience from a European referral centre

Abbreviations

IQR

interquartile range

ISUP

International Society of Urological Pathology

PLND

pelvic lymph node dissection

RARP

robot‐assisted radical prostatectomy

Robot‐assisted radical prostatectomy (RARP) has become the standard surgical treatment for localised prostate cancer in high‐volume centres, offering advantages over open and conventional laparoscopic approaches in terms of reduced blood loss, lower perioperative morbidity, shorter hospital stay, and improved functional recovery [1, 2]. In recent years, the European surgical landscape has seen the introduction of novel robotic platforms aimed at increasing competition, reducing costs, and expanding technological capabilities. Among these, the Toumai® Laparoscopic Surgical Robot (Shanghai MicroPort MedBot (Group) Co., Ltd., Shanghai, China), approved for clinical use in Europe in 2024, incorporates a high‐definition three‐dimensional vision system, four robotic arms with seven degrees of freedom, and advanced safety features such as latency compensation and redundant emergency controls [3].

Alongside these developments, telesurgery has re‐emerged as a promising application of robotic technology. The Toumai platform has already enabled the first European RARP performed remotely, demonstrating the feasibility of telesurgical procedures in humans [4]. However, regulatory, technical, and medico‐legal challenges still limit its widespread adoption [3]. In this evolving context, we prospectively evaluated our initial institutional experience with the Toumai system for on‐site RARP, focusing on perioperative outcomes, operative efficiency, and short‐term safety.

This prospective study was conducted at the OLV Hospital, Aalst (Belgium), a high‐volume European referral centre for robotic surgery. Here, we collected data of consecutive patients undergoing RARP with the Toumai system from May 2025 to November 2025 with curative intent. Patients undergoing concomitant procedures or performed via telesurgery were excluded, resulting in a final cohort of 60 patients.

All procedures were performed transperitoneally by five surgeons with extensive prior robotic experience (>200 cases). The primary endpoint was feasibility, defined as completion of the procedure without conversion to open or conventional laparoscopic surgery. Secondary endpoints included operative times, perioperative safety, and early postoperative recovery.

The study population had a median (interquartile range [IQR]) age of 64 (59.5–70) years and a median (IQR) body mass index of 27 (25–29.8) kg/m², and 37 (61.7%) patients had a Charlson Comorbidity Index >3. The median preoperative PSA level was 7.2 ng/mL. The majority of patients 54/60 (90%) had clinical stage ≤T2N0M0, while 20/60 patients had preoperative biopsy International Society of Urological Pathology (ISUP) Grade Group ≥3 (33.9%) and six patients also underwent bilateral pelvic lymph node dissection (PLND) due to suspected lymph node involvement on preoperative prostate‐specific membrane antigen‐positron emission tomography (PSMA‐PET) imaging.

Procedural feasibility was achieved in all cases, with no conversions or interruptions of the robotic approach. No procedure required interruption or modification of the robotic approach. The trocars were placed during surgery as follows: one 11‐mm camera port trocar, and three 8‐mm trocars for the robotic arms; two assistant trocars: one 5‐mm port trocar inserted just above the umbilicus and a 12‐mm trocar inserted ~2 cm cranially to the right iliac crest. Robot positioning was guided using the laser projecting from the robot's boom, with the crosshair aligned ~16 cm above the camera trocar in all procedures.

The median times for each step were as follows: median trocar placement time was 12 min, while median (IQR) docking time was 8 (7–10) min, with a marked reduction from 45 min in the first case to <10 min in the most recent cases (Fig. 1). Operative time was 150 min for RARP and 215 min for RARP + PLND. The median undocking time and median closure time were 2 and 10 min, respectively.

Fig. 1.

Trend of docking time across consecutive cases performed with the Toumai system. A progressive reduction in docking time is observed, from 45 min in the initial case to <10 min in later procedures, reflecting a rapid system‐specific learning curve.

Minor technical issues occurred in five cases, including a transient network fault, endoscope dislodgements, and one episode of instrument unresponsiveness; none had clinical consequences. As per internal protocol, all patients had their urinary catheter removed after 2 days. Postoperatively, no Clavien–Dindo Grade ≥III complications were observed. The median length of hospital stay was 3 days, and all patients were discharged without major events. At 30 days, 29 patients (48.3%) had regained urinary continence, defined as no pad use, and no biochemical recurrences were detected.

On final pathology, 22 patients (38.6%) had ISUP Grade Group 3–5, 22 patients had evidence of extraprostatic extension. Among the six patients with RARP + PLND, three had evidence of lymph‐node invasion. In all, 22 patients had positive surgical margins.

Our findings demonstrate that RARP performed using the Toumai system is both safe and feasible, with perioperative outcomes comparable to those reported for established robotic platforms [1, 2]. These results are consistent with early clinical experiences reported in the literature, which have similarly shown high completion rates and low complication profiles with this technology [5]. A notable finding of our experience is the rapid improvement in operative efficiency, particularly regarding the sharp reduction in docking time from 45 min in the initial case to <10 min in the most recent procedures. This trend reflects what has been observed in comparative reviews of emerging robotic platforms, where surgeons already experienced with robotic systems display a short system‐specific learning curve and rapid adaptation to different interfaces and arm configurations [6, 7].

The variability in learning curves reported for RARP, ranging from 10 to 250 cases depending on the outcome assessed, highlights the complexity of surgical proficiency [8]. Nevertheless, our data indicate that the transition to a novel robotic system can be achieved with minimal impact on patient safety when performed in high‐volume centres by experienced surgeons. The minor technical issues observed in our series, including a single transient network fault and sporadic endoscope dislodgements had no clinical impact and are consistent with reports from other early experiences with emerging robotic technologies [5, 6]. These events are expected to diminish further with progressive software optimisation and increasing surgeon familiarity.

The main limitation of this study is the short follow‐up period, which precludes assessment of long‐term oncological and functional outcomes. Additionally, the single‐centre design may limit generalisability. However, this series represents one of the largest early Western experiences with the Toumai system and provides meaningful real‐world evidence of its perioperative performance.

In conclusion, our initial experience confirms that the Toumai robotic system is a safe and feasible platform for RARP, with encouraging perioperative outcomes and a rapid learning curve. These findings support its integration into high‐volume robotic programmes and warrant further investigation in larger multicentre studies with long‐term follow‐up.

Disclosure of Interests

The authors declare that no conflicts of interest exist.