Implementation of Systematic Fourth-Arm Traction and Articulating-Needle Drivers in Senhance Robotic Radical Prostatectomy: Initial Experience.

OBJECTIVE: We evaluated the impact of incorporating systematic fourth-arm traction and articulating-needle drivers on the perioperative and oncological outcomes of Senhance robotic radical prostatectomy. METHODS: We conducted a retrospective single-center analysis of 30 consecutive patients who underwent Senhance robotic radical prostatectomy procedures between October 2024 and December 2025. The patients were stratified into an initial cohort (cases 1-15), which underwent surgery using a three-arm robotic configuration and conventional straight needle drivers, and a refined cohort (cases 16-30), in which continuous fourth-arm traction and articulating-needle drivers were used. The primary endpoints were operative time and positive surgical margin rate. RESULTS: The median operative time decreased significantly, from 260 min in the initial cohort to 200 min in the refined cohort (p < 0.01). This figure was further reduced, from 244 to 194 min (p < 0.01), after all cases involving lymphadenectomy were excluded. The positive surgical margin rate showed a non-significant trend toward reduction from 33% to 7% (p = 0.17). Early urinary continence was also evaluated as an initial functional outcome, with no significant difference between the two cohorts. A learning curve analysis demonstrated a progressive improvement in operative efficiency (R2 = 0.57, p < 0.01). No major complications (Clavien-Dindo grades ≥ III) occurred in either cohort. CONCLUSIONS: The refined protocol was associated with shorter operative time and a non-significant trend toward a lower positive surgical margin rate. These findings should be interpreted cautiously, as our refinement of the surgical protocol overlapped with the learning curve of the surgeon who performed the procedures.