Robotic-assisted microsurgery in andrology: a systematic review

Abstract

Robot-assisted surgery is the gold standard of treatment in many fields of urology. In this systematic review, we aim to report its usage in andrology and to evaluate any advantages. A systematic search of the PubMed and Cochrane Library databases was conducted to identify articles referring to robotic-assisted microsurgery in andrology. The search strategy was in line with the Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) guidelines and the Cochrane Handbook. The articles were then reviewed by two authors. A qualitative analysis of the articles that met the inclusion criteria was performed. Thirty-one articles that met the inclusion criteria were reviewed. The first results for robot-assisted vasovasostomy (RAVV) are encouraging as excellent patency rates, short operative times, and learning curves were achieved. Interestingly, patency rates were greater in some case series for RAVV than for microsurgical vasovasostomy, with a statistically significant difference. In addition, robot has been shown to be of great use in bypassing fibrotic changes in cases of iatrogenic vasal injuries, difficulties encountered with traditional microsurgery. In addition, the feasibility of robot-assisted microsurgery has been proven for varicocelectomy and microsurgical denervation of the spermatic cord, with acceptable improvement in sperm parameters and pain, respectively. The current evidence suggests that there are potential advantages of the use of robots in andrology. However, for robotic surgery to become incorporated into the daily use of the andrologists, large, multicenter randomized trials are needed. As robotics systems are becoming standard in urology practice, it is reasonable for one to believe that they will also find their place in andrology.

Role of varicocele repair in the era of assisted reproductive technologies: Lessons from 2000 cases of microsurgical varicocele repair

“…As robotics systems are becoming standard in urology practice, the introduction of robotic systems for microsurgical varicocele repair, vasovasostomy, and microsurgical denervation of the spermatic cord has been reported. 44 The potential advantages of incorporating robotic platforms in microsurgery include the following: the elimination of surgeon tremors and improved stability, improved motion scalability, better surgeon ergonomics, multi‐input visual interphases, enhanced magnification, and the ability to manipulate three surgical instruments and cameras simultaneously. Indeed, there are limited reports available at present regarding the utility of robotic‐assisted surgery in microsurgery, and further validation is necessary to ascertain its effectiveness and benefits.…”

Revolutionizing Reproduction: The Impact of Robotics and Artificial Intelligence (AI) in Assisted Reproductive Technology: A Comprehensive Review

“…Particularly in the field of andrology, robotic-assisted microsurgery has demonstrated promising outcomes, notably in procedures like vasectomy reversal. Research has underscored the advantages of robotic assistance in vasectomy reversal surgeries, illustrating shorter operative times, comparable setup times to traditional microsurgery, and eliminating the necessity for a skilled microsurgical assistant due to the additional robotic arm [ 18 ]. Furthermore, robotic systems have proven valuable in circumventing fibrotic changes in cases of iatrogenic vasal injuries, as well as in procedures such as varicocelectomy and microsurgical denervation of the spermatic cord, resulting in enhancements in sperm parameters and pain management [ 18 ].…”

“…Research has underscored the advantages of robotic assistance in vasectomy reversal surgeries, illustrating shorter operative times, comparable setup times to traditional microsurgery, and eliminating the necessity for a skilled microsurgical assistant due to the additional robotic arm [ 18 ]. Furthermore, robotic systems have proven valuable in circumventing fibrotic changes in cases of iatrogenic vasal injuries, as well as in procedures such as varicocelectomy and microsurgical denervation of the spermatic cord, resulting in enhancements in sperm parameters and pain management [ 18 ]. The utilization of robotics in sperm retrieval procedures, encompassing vasovasostomy and vasoepididymostomy, has yielded favorable outcomes, with a significant percentage of cases experiencing pain alleviation and reduced operative times [ 18 ].…”

“…Furthermore, robotic systems have proven valuable in circumventing fibrotic changes in cases of iatrogenic vasal injuries, as well as in procedures such as varicocelectomy and microsurgical denervation of the spermatic cord, resulting in enhancements in sperm parameters and pain management [ 18 ]. The utilization of robotics in sperm retrieval procedures, encompassing vasovasostomy and vasoepididymostomy, has yielded favorable outcomes, with a significant percentage of cases experiencing pain alleviation and reduced operative times [ 18 ]. These advancements in robotic technology are elevating the precision, efficiency, and outcomes of ART procedures, ushering in new avenues for male infertility treatments.…”