Patient positioning in robot-assisted pelvic urologic surgery: bibliometric mapping of physiologic changes, positioning-related complications, and preventive strategies

Patient positioning is essential for surgical exposure during robot-assisted pelvic urologic surgery, but evidence spans physiologic effects, complications, and preventive strategies. We combined bibliometric and knowledge-mapping analyses with a publication-level clinical evidence map to examine field development and the clinical questions studied. English-language articles and reviews indexed in the Web of Science Core Collection (WoSCC; Science Citation Index Expanded) through 5 August 2026 were screened, yielding 175 publications. R (bibliometrix), VOSviewer, and CiteSpace assessed publication trends, collaboration, intellectual structure, and thematic evolution; publications were the unit of analysis for clinical coding of procedure, positioning exposure, physiologic and safety domains, preventive strategy, strategy status, research purpose, and study design. Publication output rose to a peak of 18 publications in 2021 and was lower but variable during 2022-2025 (6-15 publications/year); 2026 was a partial year. Themes broadened to include respiratory management, perioperative complications, monitoring, and prevention. Robot-assisted prostatectomy accounted for 85-88% of publications across the three study periods. Steep Trendelenburg was the primary exposure in 126 publications, most often involving respiratory, cerebral/intracranial pressure-related, and ocular domains. No targeted preventive strategy was identified in 77 publications (44%); 67 (38%) empirically evaluated or implemented a preventive strategy, most commonly ventilation/positive end-expiratory pressure (PEEP) or anesthetic, hemodynamic, or fluid management. Respiratory studies were predominantly randomized, whereas cerebral and ocular studies more often used prospective observational designs. Within this WoSCC-indexed corpus, research increasingly addressed perioperative risk management but remained concentrated on prostatectomy and steep Trendelenburg; as a publication-level mapping study, these findings do not establish comparative effectiveness.