Patient benefits for robot-led procedures should be closely examined

There are distinct benefits for the surgeon using robot-assisted surgical procedures in kidney stone diagnosis and removal but the gains for patients have to be proven and closely examined as shown during a plenary discussion at the 3rd Meeting of the EAU Section of Urolithiasis (EULIS) in Alicante, Spain.

“Felixible ureteroscopy is nowadays one of the major indications in upper urinary tract pathology therapy and have significantly improved our ability to effectively treat a great number of this pathology,” said Petrisor Geavlete (RO) during his presentation on the use of robotic-led procedures in kidney stone treatment.

Citing technologies as the Avicenna robot, Geavlete gave a list of benefits such as a “surgeon-perfect” position which provides better ergonomic and better control of instruments, less irradiation for the surgeon, dexterity in instrument handling and less damage on surgical equipment, among others.

But during the Q&A session that followed the main critique focused on the clear benefits, if any, for the patient, considering the high costs of robotic instrument.

“I agree there are concerns about the costs and surgical outcomes, and we could not at this point say conclusively that robotics deliver better surgical results. But I do feel that in terms of physical comfort for the surgeon and with regards the evolutionary development of minimally invasive surgery we do have something to gain,” said Geavlete.

Session chairman Alberto Breda (ES), however, gave a precautionary word that it is crucial to first look into the proven benefits of robotic-led procedures.

“I’m not against evolution or progressive changes in technology but before we give strong conclusions on benefits, we have to consider the benefits for the patients. Stone-free results are the same, for example, and we still have to examine potential complications or adverse effects,” Breda pointed out.

The audience joined in the discussion with views alternating between favourable and cautious statements regarding the use of advanced technology. Some of the participants noted the high costs of robotic equipment, while others hammered on the continuing lack of evidence-based results on these new procedures.

Conceding that pros and cons are all valid and that the discussion will certainly continue, Geavlete pointed out there is a need for more studies to monitor the efficacy of new technologies. “Pilot centres are now working on these technologies and we need more data," he added

In another presentation, the entry of online tools and so-called e-medicine were discussed by A. Trinchieri (IT) who mentioned the emerging role of digital applications (Apps) and online network tools.

“Compliance by patients in stone prevention is one of the most important items, and I believe that digital tools such as Apps and podcasts have a role in promoting or encouraging patients to closely follow up on doctor’s advice, “ said Trinchieri.