AGIBOT AM1000 versus da Vinci Xi systems for robot-assisted partial nephrectomy: A retrospective propensity score–matched noninferiority study.

Abstract

e16540 Background: Robot-assisted partial nephrectomy (RAPN) has become a new standard option for clinical T1 renal tumors. Whether outcomes with the AGIBOT AM1000 system are comparable to those with the da Vinci Xi platform remains uncertain. Methods: This single-center, retrospective, propensity score-matched noninferiority study included adults who underwent RAPN between December 2023 and December 2025. The primary endpoint was the operative success rate, defined as completion of the planned RAPN without conversion to laparoscopy or open surgery. Secondary endpoints included docking time, operation time, warm ischemic time (WIT), estimated blood loss (EBL), intraoperative complications, postoperative complications, hemoglobin, serum creatinine, eGFR level, surgical workload assessed by NASA-TLX, and surgical margin status. Postoperative complications were evaluated using the Clavien-Dindo classification. The caliper width for propensity score matching was set at 0.02. The noninferiority margin was set at -10%. Results: Overall, 54 patients in AGIBOT group and 521 patients in da Vinci group were enrolled. After propensity score-matching, 49 patients were matched in each group. All procedures were completed without conversion. Operative success was 100% in both groups; the risk difference was 0.0% (95% CI, -7.3% to 7.3%), meeting the noninferiority criterion. No significant difference was found in operation time, WIT, docking time, intraoperative complications, postoperative complications, serum creatinine, eGFR level, or positive surgical margin. AGIBOT AM1000 was associated with lower EBL (median 30 vs 50 mL; p = 0.014) and a smaller hemoglobin decrease (-3.60% vs -6.02%; p = 0.017). As for the NASA-TLX, significant differences were found in temporal demand and effort. Higher temporal demand when operating with the da Vinci Xi system could be attributed to the high-volume and demanding surgical schedule, while higher effort likely reflected the surgeons’ intension to achieve optimal outcomes while adapting to a new surgical platform. Conclusions: The AGIBOT AM1000 system is safe and effective for RAPN, and its operative success rate, short-term functional and oncological outcomes are comparable to those of da Vinci Xi robotic system.