Background: Prostate cancer (PCa) imposes a substantial global health burden, with robot-assisted radical prostatectomy (RARP) established as the gold standard for localized disease. While da Vinci^® Xi maintains market dominance, Toumai^® MT-1000 offers a potentially cost-competitive alternative lacking prospective validation. Objective: To evaluate perioperative safety, oncologic quality (primary endpoint: positive surgical margins), early functional recovery (continence), and surgeon learning curve between Toumai^® MT-1000 (T-RARP) and da Vinci^® Xi RARP (DV-RARP) performed in high-volume European practice. Materials and Methods: This is a prospective single-center comparative study carried out at Policlinico Gemelli, Rome (May–November 2025), enrolling 80 patients with localized or locally advanced PCa, elected for radical prostatectomy and casually allocated to receive surgery with Toumai or the da Vinci robotic platform. The primary endpoint was the comparison of positive surgical margin (PSM) rates. Secondary endpoints included the comparison of operative time (skin-to-skin), estimated blood loss, length of hospital stay, 45-day postop outcomes, specifically Clavien–Dindo complications, urinary continence recovery (0–1 pad/day), and IIEF-5 scores. Learning curve was evaluated through the cumulative summation (CUSUM) analysis of operative times and linear regression of operative times (n = 80 cases). The analyses used STATA 19 with two-sided tests at p < 0.05 significance. Results: Baseline characteristics showed balance between cohorts (p > 0.05 for most covariates). Perioperative outcomes proved equivalent: median operative time (OT) was 192.5 min (IQR 165–230) for Toumai^® versus 183.5 min (IQR 147–225) for da Vinci^® Xi (p = 0.38); estimated blood loss (EBL) was 150 mL in both groups (p = 0.87); length of hospital stay (LOS) was 2 days in both groups (p = 0.92). PSM rates were identical at 17.5% (p = 0.79). Continence recovery reached 72.5% versus 80% (p = 0.43). Complications (Clavien–Dindo ≥ II) occurred in 7.5% versus 12.5% of cases (p = 0.45). The CUSUM analysis demonstrated operative time proficiency after only four procedures; operative time regression showed no significant trend (p = 0.38). Conclusions: Toumai^® MT-1000 demonstrates similar performance to da Vinci^® Xi across different RARP quality metrics, with no detectable learning curve for surgeons previously experienced with da Vinci. These findings support a safe integration of cost-effective platforms into clinical practice, pending multicenter randomized confirmation.

Background and Objective: Liquid biopsy has transformed the management of advanced prostate cancer, yet its clinical role in non-metastatic disease remains uncertain. Conventional biomarkers such as PSA, imaging, and pathology have limited ability to capture minimal residual disease and biological aggressiveness. The objective of this review was to critically evaluate the current evidence on circulating tumor cells (CTCs) and circulating tumor DNA (ctDNA) in non-metastatic prostate cancer, focusing on feasibility, prognostic value, and potential clinical applications. Methods: A narrative review of PubMed-indexed original studies evaluating liquid biopsy in clinically localized or non-metastatic prostate cancer was performed. Eligible studies included patients treated with curative-intent local therapy or experiencing biochemical recurrence without radiologic metastases. Study designs were predominantly prospective or retrospective observational cohorts. Liquid biopsy analytes included CTCs and ctDNA assessed from peripheral blood plasma using EpCAM-based enrichment, targeted next-generation sequencing, whole-genome sequencing, or ultra-sensitive tumor-informed assays. Primary outcomes included detection rates, associations with clinicopathologic features, biochemical recurrence, metastasis-free survival, and overall survival. Key Findings and Limitations: Across 11 studies, CTC detection using EpCAM-based platforms was infrequent in localized disease and biochemical recurrence and showed limited prognostic value (10–11% in preoperative settings). In contrast, ctDNA was detectable in a minority of patients but consistently identified biologically aggressive disease and a higher risk of recurrence when present, particularly using tumor-informed ultra-sensitive assays. Limitations include low detection rates, heterogeneous methodologies, small sample sizes, and predominantly exploratory study designs. Conclusions and Clinical Implications: Currently, its most promising application is not broad screening, but as a selective, biology-driven tool for detecting minimal residual disease and refining risk assessment. CtDNA acts as a biological risk modifier, potentially guiding the escalation or de-escalation of adjuvant therapy. However, prospective biomarker-driven trials are required to validate these strategies before routine clinical implementation.

Minimally invasive ablative therapies have emerged as effective and safe alternate approach for the management of renal cell carcinoma (RCC), particularly in patients who are ineligible for surgery due to comorbidities or high operative risk. Techniques such as radiofrequency ablation (RFA), microwave ablation (MWA), cryoablation (CA), and high-intensity focused ultrasound (HIFU) offer kidney-sparing treatment with reduced morbidity. Current evidence suggests that for cT1a tumors (<4 cm), thermal ablation achieves technical success rates exceeding 95%, with local recurrence rates ranging from 1% to 9% and major complication rates generally below 5–7%. RFA is particularly suitable for small peripheral tumors, MWA enables rapid and deeper heating for larger or more vascular lesions, and CA provides precise control near critical structures. HIFU remains largely experimental with limited clinical applicability. Overall, these strategies demonstrate favorable oncological outcomes, emphasizing the importance of careful patient selection, multidisciplinary evaluation, and further studies to refine technique-specific indications and integration with systemic therapies.

We present the Toumai Surgical System's first clinical use for robot-assisted radical prostatectomy (RARP) at a high-volume multiplatform academic institution. As new robotic platforms arise, their integration into existing surgical workflows necessitates an accurate assessment of feasibility, safety, and efficiency. This prospective single-case evaluation involved a patient with clinically localized prostate cancer who underwent RARP with the Toumai system. The procedure was performed by a senior surgeon proficient across multiple robotic platforms, following a brief dry-lab simulation with the Toumai console. The Toumai system, characterized by 4 independent arm carts, immersive HD 3D vision, and wrist instruments akin to the Da Vinci system, facilitated a standardized operating room workflow. Procedural assessment used the validated Educational Working Group Metrics Initiative (ERUS/ORSI Academy), which standardizes RARP into 12 surgical steps and evaluates for critical and metric errors. The RARP was completed successfully without intraoperative complications. Interestingly, none of the 12 assessed steps showed any critical or metric errors. The estimated blood loss was less than 50 mL, the console time was 95 minutes, and the patient was discharged without complication on postoperative day 2. Setup and docking were straightforward, and instrument responsiveness was stable, with seamless transition from prior Da Vinci platform experience. This first clinical experience demonstrates the Toumai system's safety, reproducibility, and adequate reliability for RARP, showing its feasibility and effectiveness in the hands of an experienced robotic surgeon.

Background/Objectives: To evaluate the feasibility and the learning curve of an insourced, clinician-performed three-dimensional (3D) image reconstruction workflow using Synapse3D™ software in a robotic urologic surgery setting. Methods: In this prospective single-centre case series, 20 consecutive patients scheduled for robotic kidney surgery were enrolled over a 30-day period. Three urology residents without prior experience in 3D reconstruction completed a structured two-day training programme including eight supervised practice reconstructions. Subsequently, each one reconstructed all 20 study cases independently. Reconstruction time was recorded for every reconstruction. After surgery, the two operating surgeons independently rated each model on a 5-point Likert scale for anatomical fidelity, defined as the correspondence between the model and the anatomy encountered intraoperatively. Results: All 60 reconstructions were completed successfully, with no failed reconstructions, no DICOM (Digital Imaging and Communications in Medicine) import errors and no software crashes; assistance from the manufacturer was never required. Mean reconstruction time was 19 min (range 11–29 min). Reconstruction time decreased by 0.63 min per case (95% CI 0.51–0.74; p < 0.001). Median time fell from 23 min in the first ten cases to 15 min in the last ten (p < 0.001), and the reduction was significant for each operator analysed separately. Anatomical fidelity was rated 4 (IQR 1) by both surgeons. The two surgeons rated overall system usability 3/5 and 5/5. Conclusions: Insourced 3D reconstruction with Synapse3D™ is technically feasible and is learned rapidly and reproducibly by urology residents after limited training.