The Availability, Cost, Limitations, Learning Curve and Future of Robotic Systems in Urology and Prostate Cancer Surgery

Abstract

Robot-assisted surgical systems (RASS) have revolutionised the management of many urological conditions over the last two decades with robot-assisted radical prostatectomy (RARP) now being considered by many to be the preferred surgical approach. Intuitive Surgical has dominated the market during this time period with successive iterations of the da Vinci model. The expiration of patents has opened the RASS market and several new contenders have become available or are currently in development. This comprehensive narrative review aims to explore the merits of each robotic system as well as the evidence and barriers to their use. The newly developed RASS have increased the versality of robotic surgical systems to a wider range of settings through advancement in technology. The increased competition may result in an overall reduction in cost, broadening the accessibility of RASS. Learning curves and training remain a barrier to their use, but the situation appears to be improving through dedicated training programmes. Outcomes for RARP have been well investigated and tend to support improved early functional outcomes. Overall, the rapid developments in the field of robot-assisted surgery indicate the beginning of a promising new era to further enhance urological surgery.

Simulation and Training in Robot-Assisted Urological Surgery: From Model to Patient

“…Novel robotic systems [ 47 ] are now introducing dedicated training programs as well. For instance, Medtronic’s Hugo Ascend training pathway offers both online and in-person training, allowing trainees to practice in a virtual environment and progress from pre-console training to preceptored surgical cases.…”

Robotic surgery education in Australia and New Zealand: primetime for a curriculum

“…15 Initial investments for a robotic unit range from $2-4 million AUD, with annual maintenance costs between $200,000-$600,000 and a cost per procedure averaging $19,000. 16,17 The range exists due to variation between countries, regions, and individual contracts with each hospital. 17 Training for a single robotic procedure adds an extra $880,000 during the initial year.…”

“…16,17 The range exists due to variation between countries, regions, and individual contracts with each hospital. 17 Training for a single robotic procedure adds an extra $880,000 during the initial year. 18 Proficiency requires a substantial learning curve and operative experience, ranging from a minimum of 20 cases to over 250 cases for robotic accreditation.…”

“…However, other companies have introduced their own versions, which may improve availability and reduce costs in the future 15 . Initial investments for a robotic unit range from $2–4 million AUD, with annual maintenance costs between $200,000–$600,000 and a cost per procedure averaging $19,000 16,17 . The range exists due to variation between countries, regions, and individual contracts with each hospital 17 .…”

Evolution of Surgical Robot Systems Enhanced by Artificial Intelligence: A Review

“…[47] Notable examples include da Vinci, Sensei X, Ottava, Versius, and ApolloKnee. [48,49] Categorized by indications, SRS can be divided into various types. These include navigation and positioning robots used in orthopedics and neurosurgery, [50,51] image-guided puncture robots, [52] ophthalmic micromanipulation robots, [53] natural orifice transluminal endoscopic surgery (NOTES) robots, [54] and pan-vascular intervention robots.…”