Open versus robot-assisted surgery in reconstructive urology: lessons from vesicourethral anastomotic stenosis and...

While robot-assisted surgery has rapidly expanded within reconstructive urology, debate persists regarding where it can be applied most effectively and where open surgery remains the more suitable option. The question is no longer whether robot-assisted reconstruction is feasible, but rather when it represents the most appropriate approach.

Recent evidence indicates that both open and robot-assisted techniques achieve comparable short-term outcomes in the management of vesicourethral anastomotic stenosis, despite addressing a highly heterogeneous condition. Similarly, robot-assisted intracorporeal radical cystectomy offers no demonstrable advantage over open radical cystectomy with respect to key clinical outcomes. A notable emerging trend is the decline in continent urinary diversions, possibly reflecting the technical challenges of robot-assisted intracorporeal reconstruction and evolving institutional preferences.

Open surgery remains the standard for perineal and external genital reconstructive procedures, whereas robot-assisted approaches are best suited for transabdominal reconstructions. Deep vesicourethral anastomotic stenoses involving the external sphincter should be managed through an open transperineal approach. Notably, during the decade of widespread robotic adoption, the rate of continent urinary diversions has declined significantly.