Samir S. Taneja, MD, Consulting Editor

Although there is ongoing controversy regarding the degree of improvement in surgical outcomes achieved with robotics, I believe there is general consensus that recovery from minimally invasive surgery is easier for patients, that short-term complications related to recovery are fewer, and that robotics, while costly, is a tool that facilitates a surgeon’s transition to minimally invasive techniques. In the case of the latter, the current controversies may be misdirected. While measuring outcome improvement on an individual case basis is unlikely to show benefit (after all, a great open surgeon should not be any different than a great robotic surgeon), the true impact of robotic technology may be at a population level. By providing surgeons a comfort level in attempting procedures with which they may not have otherwise been comfortable, robotic assistance has increased access to procedures for which competent surgeons may have not previously been available. This assumes, of course, that surgeons can be trained to perform these procedures safely.

A number of challenges remain in implementation of robotic surgery. The first on everyone’s mind is cost. Can the cost of robotics be sustained by a struggling health care economy? If not demonstrable in the direct, measurable, cost of care, the justification of cost could be measured, perhaps, in opportunity cost and improvement in quality of care—difficult, but necessary metrics. Surgeon training and safety of the transition to robotics-assisted surgery are major hurdles for the community. Adaptation of simulators, training programs, and standardized credentialing will be necessary. Finally, maintaining the ability of young surgeons to perform open surgery when needed is a unique challenge created by the introduction of robotics into our field. It is important not only from the perspective of being able to salvage a case not progressing robotically but also for the purpose of ensuring proper candidate selection for robotic procedures. Our ability to solve these challenges, in my opinion, will determine the fate of technological advance in surgery.

In this issue of Urologic Clinics of North America , edited by Dr Ashok Hemal, a global leader in the field of robotic-assisted surgery, we attempt to demonstrate the progress robotic surgeons have made in utilizing the approach across urologic practice. In creating the table of contents, Dr Hemal has included discussion of a number of the aforementioned controversies as well as a critical discussion of the public health impact of robotic surgery. He has invited a number of the most critical minds in the field to offer perspective on robotic surgery, its current practice, its limitations, and future directions. I am extremely indebted to Dr Hemal, and the esteemed article contributors, for what should be a very informative issue of Urologic Clinics of North America.