Derya Tilki: Martini-Klinik Prostate Cancer Center, University Medical Centre Hamburg-Eppendorf (UKE), Germany
Citation: EMJ Urol. 2026;14[Suppl 1]:23-24. https://doi.org/10.33590/emjurol/W6Y110U3
Looking at the field today, what do you see as the greatest advances in robotic prostate cancer surgery over the past decade?
Higher-resolution 3D visualisation, refined nerve-sparing techniques, and single-port/multi-arm platform advances have improved precision, reduced blood loss, and shortened recovery compared to open and early laparoscopic approaches.
As robotic technology continues to evolve, how do we ensure that innovation translates into meaningful improvements in oncological, functional, and quality-of-life outcomes for patients?
By anchoring adoption in prospective, outcome-driven trials and registries that track cancer control, continence, and potency rather than just perioperative metrics, so technology serves patients rather than being a novelty for its own sake.
New robotic technologies and surgical techniques are introduced very rapidly. What level of evidence do you believe is needed before these innovations should become part of routine clinical practice?
Ideally, prospective comparative data and registries demonstrating non-inferiority or benefit in oncological and functional outcomes before a technology replaces standard practice, though reasonable surgeons disagree on how strict that bar should be for incremental refinements.
With advances in imaging, genomics, and risk stratification, how has patient selection for robotic surgery changed, and where do you see it evolving in the future?
Multiparametric MRI, targeted biopsy, and genomic risk classifiers have allowed more precise identification of who truly needs surgery versus active surveillance; the trend is towards increasingly individualised, biology-driven selection rather than prostate-specific antigen test/Gleason score alone.
As robotic surgery becomes the norm for many trainees, how can we make sure they develop not only technical proficiency, but also good oncological judgement and decision-making?
Structured simulation curricula, proctored case volumes, and deliberate case-based discussion of margins, staging, and decision-making (not just console time) are needed so judgement develops.
Looking ahead, which developments, whether in robotic platforms, imaging integration, AI, or surgical planning, do you believe have the greatest potential to improve robotic prostate cancer surgery?
Real-time imaging fusion, AI-assisted intraoperative guidance for margin assessment, and haptic feedback likely offer the biggest near-term gains in precision and outcomes.
What unanswered research questions in robotic uro-oncology do you think should be the highest priority over the next 5–10 years?
Priorities include better real-time margin detection, standardised functional outcome reporting, and long-term comparative data on newer single-port and next-generation platforms versus established systems.
If you could change one aspect of robotic prostate cancer surgery over the next decade to improve patient care, what would it be?
Standardising outcome reporting and quality benchmarks across centres, so patients and surgeons alike can meaningfully compare functional and oncological results.
