This study used the preferred reporting items for systematic reviews and meta-analyses (PRISMA) guidelines for protocol creation, and was registered on the Prospective Register of Systematic reviews [11] with the reference: CRD42024504844.

We used a comprehensive search strategy to identify relevant articles comparing the safety and efficacy of other robotic surgical systems for prostate cancer (Appendix 1). Population was defined as patients aged 18 years or older with prostate cancer (clinical stage T1 to T3, N0, M0), who underwent RARP; intervention was the Medtronic Hugo™ RAS system; for comparator, where possible or published, Hugo™ data compared with the existing robotic surgical outcome data using other robotic-assisted surgical systems and outcomes operatively, functionally, and oncologically. Following a scoping search, terms were adapted to include relevant synonyms. The following databases were used to carry out the search: MEDLINE, EMBASE, Cochrane Central Register of Controlled Trials, Scopus, Web of Science, clinicaltrials.gov, and World Health Organization (WHO) international clinical trials registry platform (ICTRP). Manual forward and backward citation searching was conducted for eligible studies, as well as hand searching of the five most cited urological/robotic journals (European Urology, BJUI, World Journal of Urology, The International Journal of Medical Robotics and Computer assisted Surgery, and Journal of Endourology [2018–2024]). Studies were collated using Endnote Clarivate, where duplicates were removed. The initial search was conducted on 22/01/2024, with a following top-up search carried out on 09/09/2024 finding additional articles included.

Two authors independently conducted each stage of screening (MST, AS), with any differences resolved in consensus meetings, or through consulting a third reviewer, (BC) if needed. An initial screening tool was applied to the titles and abstracts to include studies with direct comparisons between data from robotic platforms or descriptive comparisons between Hugo™ RAS experiences and current practise (other robotic platforms, laparoscopy, or open surgery). We included case-series, cohort studies, case–control studies, randomised control trials, systematic reviews, and meta-analyses meeting our inclusion criteria. We then conducted full-text review of included papers according to our predetermined PICO criteria [12]. Furthermore, we did not exclude relevant studies that do not report outcomes of interest of this review; and rather, summarised the key findings of any such studies. Reasons for exclusion were recorded and can be viewed in Fig. 3. Whilst there were no limitations based on language, logistical constraints necessitated the retrieval of non-English papers only if they had an accessible English abstract or full-text translation.

The same reviewers (MST, AS) then extracted data based on study characteristics, participant characteristics, intervention characteristics and outcomes, as well as any study funding sources for analysis. Risk-of-bias assessment implemented the ROBINS-I (Risk of Bias in non-randomised Studies of Interventions) [13] approach to assess methodological quality, appraising the following domains: confounding, participant selection, intervention classification, intervention deviations, missing data, measurement of outcomes, and reporting of results. Data analysis for quantitative findings included risk ratios (RR) for dichotomous outcomes and mean differences (MD) for continuous outcomes, accompanied by 95% confidence intervals (CI). In the case of observational studies such as case–control studies, non-randomised trials and cohort studies, we intended to highlight effect estimates as adjusted RR or odds ratios (OR), with corresponding 95% CI. If such data were unavailable, we used unadjusted RR or with 95% CI, P values only, or percentages in tabular format.