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Autonomous surgery in the era of robotic urology: friend or foe of the future surgeon?

Nature Reviews Urology volume 17, pages 643–649 (2020)Cite this article

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Abstract

Despite advances in robotic-assisted surgery (RAS) in the past two decades, control of the robotic system currently remains under the command of a human surgeon. Historically, urology has pioneered new surgical techniques and technologies. Now, autonomous RAS is on the horizon and the first data from clinical trials of autonomous RAS in urology are being published. Automation takes control away from the surgeon but promises standardization of techniques, increased efficiency, potentially reduced complication rates and new ways of integrating intra-operative imaging. Preclinical and clinical evidence is emerging that supports the use of autonomous robotic-assisted urological surgery. Use of autonomous technologies in the operating theatre will directly affect the role of the urological surgeon. Integration of autonomous RAS can be viewed as a positive aid, but it might also be perceived as a threat to the future urological surgeon.

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Fig. 1: The AquaBeam platform.
Fig. 2: The EUCLIDIAN system for autonomous robotic-assisted prostate brachytherapy.
Fig. 3: Automating soft-tissue surgery using the STAR system.

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Author information

Authors and Affiliations

  1. Division of Surgery, Imperial Prostate, Department of Surgery and Cancer, Imperial College London, Charing Cross Campus, London, UK

    Martin J. Connor & Hashim U. Ahmed

  2. Department of Urology, Charing Cross Hospital, Imperial College Healthcare NHS Trust, London, UK

    Martin J. Connor & Hashim U. Ahmed

  3. MRC Centre for Transplantation, Faculty of Life Sciences and Medicine, King’s College London, London, UK

    Prokar Dasgupta

  4. Department of Urology, London North West University Healthcare NHS Trust, London, UK

    Asif Raza

  5. Faculty of Health: Medicine, Dentistry and Human Sciences, University of Plymouth, Plymouth, UK

    Asif Raza

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Contributions

A.R. and M.J.C. researched data for the article and made substantial contributions to discussion of its content. All authors participated in writing and reviewing and/or editing the manuscript before submission.

Corresponding author

Correspondence to Martin J. Connor.

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Competing interests

M.J.C. receives funding from the Wellcome Trust & University College London Hospitals (UCLH) Charity. P.D. receives funding from MRC, Wellcome Trust, NIHR BRC, EPSRC, EUFP7, Vattikuti Foundation, PCRC and TUF. H.U.A. receives funding from Sonacare Medical, Sophiris Inc. and Trod Medical for trials, personal fees for trial/research consultancy from Sophiris Inc, funding for travel, lectures and proctoring fees from Sonacare Inc. and BTG Medical (previously Galil), funding from the Wellcome Trust, and he receives infrastructure support provided by the NIHR Imperial Biomedical Research Centre. A.R. declares no competing interests.

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Nature Reviews Urology thanks R. Autorino and K. Zorn for their contribution to the peer review of this work.

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Connor, M.J., Dasgupta, P., Ahmed, H.U. et al. Autonomous surgery in the era of robotic urology: friend or foe of the future surgeon?. Nat Rev Urol 17, 643–649 (2020). https://doi.org/10.1038/s41585-020-0375-z

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