INTRODUCTION: Robotic technologies are being increasingly implemented in healthcare, including urology, and holding promises for improving medicine worldwide. However, these new approaches raise ethical concerns for professionals,patients, researchers and institutions that need to be addressed. The aim of this review was to investigate the existingliterature related to bioethical issues associated with robotic surgery in urology, in order to identify current challenges andmake preliminary suggestions to ensure an ethical implementation of these technologies.
EVIDENCE ACQUISITION: We performed a review of the pertaining literature through a systematic search of twodatabases (PubMed and Web of Science) in August 2020.
EVIDENCE SYNTHESIS: Our search yielded 76 articles for full-text evaluation and 48 articles were included in thenarrative review. Several bioethical issues were identified and can be categorized into five main subjects: 1) roboticsurgery accessibility (robotic surgery is expensive, and in some health systems may lead to inequality in healthcareaccess. In more affluent countries the national distribution of several robotic platforms may influence the centralizationof robotic surgery, therefore potentially affecting oncological and functional outcomes in low-volume centers); 2)safety (there is a considerable gap between surgical skills and patients’ perception of competence, leading to ethicalconsequences on modern healthcare. Published incidence of adverse events during robotic surgery in large series isbetween 2% and 15%, which does not significantly differ amongst open or laparoscopic approaches); 3) gender gap(no data about gap differences in accessibility to robotic platforms were retrieved from our search); 4) costs (roboticplatforms are expensive but a key reason why hospitals are willing to absorb the high upfront costs is patient demand.It is possible to achieve cost-equivalence between open and robotic prostatectomy if the volume of centers is higherthan 10 cases per week); and 5) learning curve (a validated, structured curriculum and accreditation has been createdfor robotic surgery. This allows acquisition and development of basic and complex robotic skills focusing on patientsafety and short learning curve).
CONCLUSIONS: Tech-medicine is rapidly moving forward. Robotic approach to urology seems to be accessible in moreaffluent countries, safe, economically sustainable, and easy to learn with an appropriate learning curve for both sexes. It is mandatory to keep maintaining a critical rational approach with constant control of the available evidence regardingis mandatory to keep maintaining a critical rational approach with constant control of the available evidence regardingefficacy, efficiency and safety.(Cite this article as: Esperto F, Prata F, Antonelli A, Alloni R, Campanozzi L, Cataldo R, et al. Bioethical implications of roboticsurgery in urology: a systematic review. Minerva Urol Nephrol 2021;73:700-10. DOI: 10.23736/S2724-6051.21.04240-3)Key words: Robotics; Ethics; Minimally invasive surgical procedures; Urology.
