Abstract

Robot-assisted minimally invasive surgery has transformed urologic surgery. The da Vinci and ZEUS systems have evolved, contributing to improved outcomes and shorter learning curves. However, long-term outcomes and their economic impact remain insufficiently characterized. This review evaluated long-term functional outcomes of robot-assisted urologic surgery and assessed its clinical and economic implications to guide future practice and policy. This review was conducted based on PubMed searching for studies published between 2014 and 2025. The studies included English-language articles on robot-assisted urologic surgeries reporting clinical and perioperative outcomes, including original research, systematic reviews, or high-quality narrative reviews. Primary outcomes included operative time, blood loss, complications, and urological results; secondary outcomes included functional recovery, quality of life, learning curve, and cost-effectiveness. Robotic assisted urologic surgeries were associated with significantly reduced estimated blood loss (an average reduction of 200-500 ml), shorter hospital stays (by 1-2 days on average), and lower, though non-significant, postoperative complication rates. Functional outcomes such as continence and sexual function improved following robot-assisted radical prostatectomy, with an earlier return to baseline function. Evidence regarding long-term oncological outcomes and cost-effectiveness varies, with limited high-quality data and inconsistent reporting across studies. Robot-assisted surgery offers clear perioperative and early functional benefits. The adoption of this technology might enhance patient recovery and surgical precision; however, high costs and uncertain long-term outcomes remain concerns. Future research should prioritize large-scale, long-term comparative studies to evaluate oncological durability, patient-reported outcomes, and economic viability.

Key words: Cost-effectiveness, functional recovery, minimally invasive surgery, robotic-assisted surgery, surgical innovation, urologic oncology