Transition to robotic surgery in urologic oncology: a comparative analysis between pre-robotic and robotic eras in a high-volume tertiary center

The transition from open and laparoscopic techniques to robotic-assisted surgery has transformed the landscape of urologic oncology. However, few studies have directly compared institutional outcomes before and after the adoption of robotic platforms. The objective is to evaluate the clinical and organizational impact of implementing robotic surgery by comparing perioperative outcomes and hospital metrics between the pre-robotic era (2019-2020) and the robotic era (2021-2023) in a high-volume tertiary referral center. A retrospective cohort analysis was conducted on patients undergoing radical prostatectomy (RP), partial nephrectomy (PN), or radical cystectomy (RC) between January 2019 and December 2023. Surgical approach was laparoscopic (RP, PN) or open (RC) during 2019-2020, and robotic for all procedures from 2021 onward. Data on operative time, length of stay (LOS), extended hospitalizations (> 15 days), and 30-day readmissions were collected and compared between the two periods. A total of 1179 procedures were performed, with a marked increase in surgical volume after the implementation of robotic platforms (189 procedures in 2019-2020 vs. 990 in 2021-2023). The robotic era was associated with a significant reduction in median LOS across all procedures: RP (7.5-3.0 days), PN (6.5-4.1 days), and RC (15.5-7.3 days). The rate of extended hospitalizations dropped from 20.3 to 2.1% overall. Readmission rates remained stable, except for RC, which maintained a higher rate in both eras. Operative times remained comparable between the two periods. The transition to robotic-assisted surgery was associated with a substantial increase in surgical volume and significant improvements in perioperative outcomes, including shorter hospital stays and fewer prolonged admissions, while maintaining surgical safety. These results underscore that such improvements are primarily linked to the structured implementation of the program under the guidance of experienced robotic surgeons, rather than to the technology itself.