A Survey on Twenty Years of Robotic Surgery in Italy: Evaluating Distribution, Bioetic Impact, and Future Directions

The Italian Society of Urology conducted a comprehensive survey across Italy's urology specialists to assess the prevalence and integration of robotic surgery in the country's medical landscape. The survey aimed to examine the diffusion and acceptance of robotic surgical platforms and to ascertain surgeons' preferences regarding the most frequently performed urological procedures.

The Italian Society of Urology surveyed Italian urologists via SURVEYMONKEY. Emails were sent to society members and clinic heads, covering geographic location, robotic practices, and procedures. The 44-question survey, open from March to June 2023, gathered data on clinic location, equipment, cases, and techniques. Descriptive statistics were used, reporting median and inter-quartile range for continuous variables, and rates for categorical ones. Analysis included respondent characteristics, robotic surgery availability, applications, and technical modifications. Stata 16 conducted statistical analyses (StataCorp LP, College Station, TX, USA).

The study included 339 urologists with varied institutional and professional backgrounds, investigating aspects like the availability of robotic technology, preferences in procedures, surgical methodologies, and training programs. Participants included 50% affiliated with university hospitals, 25% with non-university hospitals, and 25% with IRCCS institutions and accredited private hospitals. The survey showcased significant geographic diversity, receiving responses from urologists across all regions of Italy, with Lombardy being the most represented (19.7%), followed by Lazio (12.9%) and Veneto (11.2%). Notably, 93.7% of respondents associated robotic surgery with economic benefits, attributing to reduced hospital stays and increased facility attractiveness. Among urological procedures, robotic-assisted techniques were preferred for Radical Prostatectomies (88%), partial nephrectomy (87%), and pyeloplasty (79%), while cystectomies and radical nephrectomy were commonly performed using open or lap-aroscopic approaches.

The survey findings highlight the widespread use and influence of robotic surgery in Italian urology, showcasing enhanced patient care but also indicating technique discrepancies and restricted access in certain facilities. Standardization, accessibility, and ongoing training are vital for maximizing robotic surgery's potential across specialties.