Da Vinci Xi in urology

The Da Vinci Xi system, introduced in 2014 and updated in 2021 with the Xi 2.0 version, is the reference robotic platform for complex minimally invasive urological surgery. Our Unit has completed 3,200 robotic procedures between 2015 and 2025, with a documented learning curve and outcomes that mirror — and in some areas exceed — data from international reference centres.

System architecture

The Da Vinci Xi differs from the Si predecessor through its 360° rotating boom arm, which eliminates patient repositioning in multi-quadrant cases, and fourth-generation instruments (EndoWrist Xi) with 7 degrees of freedom and 540° wristing. 3D-HD vision with up to 10× magnification and the integrated endoluminal surgery system (Firefly for NIR fluorescence) complete the technological set.

Robotic radical prostatectomy (n=1,847)

RARP represents 57.7% of the volume. Conversion to open: 0.2%. Positive surgical margins at pT2: 7.8% (EAU benchmark: < 10%). Reoperation within 30 days: 1.1%. Urinary continence (pad-free) at 12 months: 91.4%. Learning curve plateau reached at 150 procedures for isolated prostatectomy, at 250 for systematic intrafascial nerve-sparing.

Robotic partial nephrectomy (n=894)

RAPN with mean warm ischaemia 14.2 minutes (ERUS benchmark: < 20 min). Conversion to radical rate: 1.9%. Clavien ≥ III complications: 3.4%. Renal function preservation (eGFR -12% at 12 months vs preoperative): in line with the literature. Off-clamp technique adopted for lesions < 3 cm from 2022, reducing warm ischaemia in 31% of cases.

Robotic radical cystectomy (n=459)

RARC with extended pelvic lymph node dissection. Intracorporeal urinary diversion (orthotopic neobladder or Bricker) in 387/459 cases (84.3%). Mean hospital stay 7.2 days vs 11.4 days for open cystectomy in comparative literature. Positive margins: 4.6%. 90-day complications: 22% (Clavien ≥ III in 6.1%).