New Robotic Surgical Systems in Urology: An Update

Theodore Cisu; Fabio Crocerossa; Umberto Carbonara; Francesco Porpiglia; Riccardo Autorino

Disclosures

Curr Opin Urol. 2021;31(1):37-42. 

In This Article

Abstract and Introduction

Abstract

Purpose of Review: The landscape of robotic surgical systems in urology is changing. Several new instruments have been introduced internationally into clinical practice, and others are in development. In this review, we provide an update and summary of recent surgical systems and their clinical applications in urology.

Recent Findings: Robotic-assisted laparoscopic surgery is increasingly becoming a standard skillset in the urologist's technical armamentarium. The current state of the robotic surgery market is monopolized because of a number of regulatory and technical factors but there are several robotic surgical systems approved for clinical use across the world and numerous others in development. Next-generation surgical systems commonly include a modular design, open access consoles, haptic feedback, smaller instruments, and machine learning.

Summary: Numerous robotic surgical systems are in development, and several have recently been introduced into clinical practice. These new technologies are changing the landscape of robotic surgery in urology and will likely transform the marketplace of robotic surgery across surgical subspecialties within the next 10--20 years.

Introduction

The use of robotic-assisted surgery has proliferated in urology in the past two decades. Since the commercialization of the first FDA-approved da Vinci robotic system and the creation of the first structured program for robotic radical prostatectomy in 2000, urologists have rapidly adopted robotic surgery into their technical armamentarium and is now a major domain in uro-oncologic surgery.[1,2] Indeed, by 2013, robotic prostatectomies represented 85% of all radical prostatectomies performed by board-certified urologists.[3] Practically, all this operative volume has been performed on an iteration of the Intuitive Surgical da Vinci robotic system (S, Si, Xi, SP). Intuitive Surgical owns more than 1500 robotic device patents, but several key patents expired in 2019.[4]

Competing manufacturers are now permitted to adopt these technologies, introduce novel robotic platforms, and apply for Food and Drug Administration (FDA) approval in the United States or CE marking in the European Union for clinical use, which may led to a transformation in the landscape of robotic surgery over the next two decades (Table 1). This review highlights alternative surgical robots approved for clinical use, as well as several undergoing testing for clinical applicability and in development.

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