Robot-assisted (RA) surgery has many advantages for urinary tract and pelvic floor reconstruction (UTPFR) but its application is only slowly increasing. Studies are limited in number, patients and follow-up duration. The low-volume high-complexity nature of UTPFR warrants specific research to evaluate the potential role of the RA approach.
During its 2024 meeting in Bristol, the International Consultation on Incontinence-Research Society (ICI-RS) reviewed the current literature on RA UTPFR. Priority research questions and strategies were explored in a proposal.
Four different topics were discussed. (1) Large multicentre prospective studies on RA UTPFR are needed to evaluate clinical effectiveness and safety. The RA approach needs to be prioritized in specific procedures and patients, to first improve patient care where gains are highest. (2) Models for cost-utility analysis for RA UTPFR are needed to (re)direct limited resources as efficiently as possible in a quickly changing technological field. (3) A modular curriculum for training UTPFR surgeons to become RA certified needs to be developed, to allow valid interpretation and comparison of outcomes. (4) Technological improvements to address tissue handling, accessibility, efficiency and sustainability are needed. Digitalization can be a gamechanger for RA UTPFR through telesurgery (training and expertize coverage), augmented reality and artificial intelligence providing intra-operative assistance, assessment and feedback.
The proposal discussed the need for studies on clinical and cost effectiveness, safety, and training curriculum development for RA UTPFR. Recent technological developments hold great promise for RA UTPFR. High-priority research questions were identified.
Neurourology and urodynamics. 2024 Nov 19 [Epub ahead of print]
Michel Wyndaele, Arun Sahai, George Bou Kheir, François Hervé, D Carolina Ochoa, Kevin Rademakers, Thomas van Steenbergen, Qi-Xiang Song, Alan Wein, Paul Abrams
Department of Urology, ERN eUROGEN Accredited Center, University Medical Center Utrecht, Utrecht, The Netherlands., Department of Urology, Guy's and St Thomas' NHS Foundation Trust, King's College London, London, UK., Department of Urology, ERN eUROGEN Accredited Center, Ghent University Hospital, Ghent, Belgium., Bristol Urological Institute, North Bristol NHS Trust, Southmead Hospital, Bristol, UK., Department of Urology, Zuyderland Medical Center Sittard/Heerlen, Heerlen, the Netherlands., Department of Urology, Renji Hospital, Shanghai Jiao Tong University School of Medicine, Shanghai, China., Division of Urology, Perelman School of Medicine, Penn Medicine, University of Pennsylvania, Philadelphia, Pennsylvania, USA.