Department of Urology, Campus Bio-Medico University, Rome, Italy -
Department of Urology, Campus Bio-Medico University, Rome, Italy.
Minerva Urol Nephrol. 2021 Dec;73(6):700-710. doi: 10.23736/S2724-6051.21.04240-3. Epub 2021 Jul 26.
Robotic technologies are being increasingly implemented in healthcare, including urology, and holding promises for improving medicine worldwide. However, these new approaches raise ethical concerns for professionals, patients, researchers and institutions that need to be addressed. The aim of this review was to investigate the existing literature related to bioethical issues associated with robotic surgery in urology, in order to identify current challenges and make preliminary suggestions to ensure an ethical implementation of these technologies.
We performed a review of the pertaining literature through a systematic search of two databases (PubMed and Web of Science) in August 2020.
Our search yielded 76 articles for full-text evaluation and 48 articles were included in the narrative review. Several bioethical issues were identified and can be categorized into five main subjects: 1) robotic surgery accessibility (robotic surgery is expensive, and in some health systems may lead to inequality in healthcare access. In more affluent countries the national distribution of several robotic platforms may influence the centralization of robotic surgery, therefore potentially affecting oncological and functional outcomes in low-volume centers); 2) safety (there is a considerable gap between surgical skills and patients' perception of competence, leading to ethical consequences on modern healthcare. Published incidence of adverse events during robotic surgery in large series is between 2% and 15%, which does not significantly differ amongst open or laparoscopic approaches); 3) gender gap (no data about gap differences in accessibility to robotic platforms were retrieved from our search); 4) costs (robotic platforms are expensive but a key reason why hospitals are willing to absorb the high upfront costs is patient demand. It is possible to achieve cost-equivalence between open and robotic prostatectomy if the volume of centers is higher than 10 cases per week); and 5) learning curve (a validated, structured curriculum and accreditation has been created for robotic surgery. This allows acquisition and development of basic and complex robotic skills focusing on patient safety and short learning curve).
Tech-medicine is rapidly moving forward. Robotic approach to urology seems to be accessible in more affluent countries, safe, economically sustainable, and easy to learn with an appropriate learning curve for both sexes. It is mandatory to keep maintaining a critical rational approach with constant control of the available evidence regarding efficacy, efficiency and safety.
机器人技术在医疗保健领域（包括泌尿科）的应用日益广泛，有望改善全球医疗水平。然而，这些新方法引发了专业人士、患者、研究人员和机构的伦理关注，需要加以解决。本综述旨在调查与机器人泌尿外科手术相关的生物伦理问题的现有文献，以确定当前的挑战，并提出初步建议，以确保这些技术的伦理实施。
我们于 2020 年 8 月通过对两个数据库（PubMed 和 Web of Science）的系统检索，对相关文献进行了综述。
我们的搜索共得到 76 篇全文评估文章，其中 48 篇文章被纳入叙述性综述。确定了几个生物伦理问题，并可分为五个主要主题：1）机器人手术的可及性（机器人手术费用昂贵，在一些医疗体系中可能导致医疗服务获取的不平等。在更富裕的国家，几种机器人平台的国家分布可能影响机器人手术的集中化，从而可能影响低容量中心的肿瘤学和功能结果）；2）安全性（手术技能和患者对能力的感知之间存在相当大的差距，这对现代医疗保健产生了伦理后果。在大型系列中，机器人手术不良事件的发生率在 2%至 15%之间，与开放或腹腔镜方法没有显著差异）；3）性别差距（我们的搜索未检索到有关机器人平台可及性差距的差异数据）；4）成本（机器人平台昂贵，但医院愿意承担高昂的前期成本的一个关键原因是患者需求。如果每周中心的手术量高于 10 例，则可以实现开放和机器人前列腺切除术之间的成本等效）；5）学习曲线（已为机器人手术创建了经过验证的结构化课程和认证。这允许获得和发展基本和复杂的机器人技能，重点是患者安全和较短的学习曲线）。
技术医学正在迅速发展。机器人泌尿外科似乎在较富裕的国家更容易获得，安全、经济可持续，并且易于学习，对于男女来说，学习曲线都很平坦。必须保持对证据的批判性理性方法，并不断控制有关疗效、效率和安全性的现有证据。
