An intra-operative checklist for low-impact robotic urologic surgery: a three-round J-ERUS/YAU Delphi consensus

Abstract Enhanced recovery pathways emphasise peri-operative pharmacology, whereas many modifiable intra-operative practices remain under-standardised and supported by heterogeneous evidence. Standardising these practices is central to low-impact robotic surgery, aiming to minimise avoidable procedural and physiological stress, and may improve early recovery, including post-operative pain. A three-round, online modified Delphi was conducted within the J-ERUS/YAU network, inviting 21 experts (19 urologists, 2 anaesthetists). Round-1 presented 21 items (5-point Likert). A priori thresholds—blinded to panellists—were: Include = median ≥ 4 with interquartile range (IQR) ≤ 1; Exclude = median < 3; otherwise = revote. Rounds-2/-3 re-rated non-consensus items and validated new items proposed from R1 free-text; at each revote, the prior round’s median and IQR were shown. Late submissions were excluded in Rounds 1 and 2. R1 analysed 20 valid responses: 5 Include, 2 Exclude, 14 to revote. R2 analysed 19 responses and re-rated 14 carried plus 9 new items from R1 suggestions: 16 reached Include, 7 to revote. R3 analysed 16 responses: 2 reached Include, 5 without consensus. In total, 23 items met Include (5 R1 + 16 R2 + 2 R3). The checklist integrates pharmacologic/anaesthetic measures (multimodal analgesia; regional techniques as appropriate; structured anti-PONV prophylaxis) with non-pharmacologic practices across surgical (pressure-point padding; low pneumoperitoneum/valveless insufflation) and environmental (active temperature management) domains. This Delphi produced a 23-item consensus checklist that standardises modifiable intra-operative practices underpinning low-impact robotic urologic surgery. Prospective implementation should evaluate effects on recovery outcomes, including post-operative pain, opioid use and PONV.

Authors

Institutions

Publication Details

Journal
Journal of Robotic Surgery
Published
2026-09-30
DOI
https://doi.org/10.1007/s11701-026-03983-5
Primary Topic
Anesthesia and Pain Management
Type
article
Field-Weighted Citation Impact
0.00
Controls
|||
ALL TIME
JAN
FEB
MAR
APR
MAY
JUN
JUL
AUG
SEP
article

An intra-operative checklist for low-impact robotic urologic surgery: a three-round J-ERUS/YAU Delphi consensus

Mike Wenzel, Nikolaos Liakos, Alberto Breda, Gabriele Sorce et al.
Journal of Robotic Surgery
Anesthesia and Pain Management
article

An intra-operative checklist for low-impact robotic urologic surgery: a three-round J-ERUS/YAU Delphi consensus

Mike Wenzel, Nikolaos Liakos, Alberto Breda, Gabriele Sorce, Carlo Gandi, Giorgio Ivan Russo, Alessandro Larcher, Paolo Dell’Oglio, Angelo Mottaran, Federico Piramide, Márcio Covas Moschovas, Sij Hemal, Fabrizio Di Maida, José Segarra-Tomás, Gianluca Spena, Manuel Prados-Saavedra, Helena Ascaso-Til, Marco Oderda, Stefano Tappero, Ahmed Eraky, Carlo Andrea Bravi, I. Andras, M. Paciotti, Filippo Turri, C. Würnschimmel, Violeta Petrelli-Tain, Josep Maria Santillana-Altamira, Luigi Nocera, Maria Peraire-Lores, Nicolae Crisan, Alejandro Juarez-Sanchez, Xavier Ruiz-Plazas, Federico Lavagno, Danny Darlington Carbin Joseph, Alex Mottrie, Ruben De Groote, Edward Lambert
article en

Abstract

Abstract Enhanced recovery pathways emphasise peri-operative pharmacology, whereas many modifiable intra-operative practices remain under-standardised and supported by heterogeneous evidence. Standardising these practices is central to low-impact robotic surgery, aiming to minimise avoidable procedural and physiological stress, and may improve early recovery, including post-operative pain. A three-round, online modified Delphi was conducted within the J-ERUS/YAU network, inviting 21 experts (19 urologists, 2 anaesthetists). Round-1 presented 21 items (5-point Likert). A priori thresholds—blinded to panellists—were: Include = median ≥ 4 with interquartile range (IQR) ≤ 1; Exclude = median < 3; otherwise = revote. Rounds-2/-3 re-rated non-consensus items and validated new items proposed from R1 free-text; at each revote, the prior round’s median and IQR were shown. Late submissions were excluded in Rounds 1 and 2. R1 analysed 20 valid responses: 5 Include, 2 Exclude, 14 to revote. R2 analysed 19 responses and re-rated 14 carried plus 9 new items from R1 suggestions: 16 reached Include, 7 to revote. R3 analysed 16 responses: 2 reached Include, 5 without consensus. In total, 23 items met Include (5 R1 + 16 R2 + 2 R3). The checklist integrates pharmacologic/anaesthetic measures (multimodal analgesia; regional techniques as appropriate; structured anti-PONV prophylaxis) with non-pharmacologic practices across surgical (pressure-point padding; low pneumoperitoneum/valveless insufflation) and environmental (active temperature management) domains. This Delphi produced a 23-item consensus checklist that standardises modifiable intra-operative practices underpinning low-impact robotic urologic surgery. Prospective implementation should evaluate effects on recovery outcomes, including post-operative pain, opioid use and PONV.

Journal of Robotic SurgeryVol. 20(1)
Goethe University Frankfurt (DE), Universitat Autònoma de Barcelona (ES), Iuliu Hațieganu University of Medicine and Pharmacy (RO), University Medical Center Freiburg (DE), Northampton General Hospital (GB), AdventHealth Celebration (US), University of Catania (IT), Azienda Ospedaliera Citta' della Salute e della Scienza di Torino (IT), University Hospital Foundation (CA), Azienda Socio Sanitaria Territoriale Grande Ospedale Metropolitano Niguarda (IT), IRCCS Azienda Ospedliero-Universitaria di Bologna Policlinico di Sant'Orsola (IT), Azienda Socio Sanitaria Territoriale degli Spedali Civili di Brescia (IT), Biruni University (TR), Azienda Ospedaliero-Universitaria Careggi (IT), USC Norris Comprehensive Cancer Center (US), Luzerner Kantonsspital (CH), University Hospital Frankfurt (DE), IRCCS Ospedale San Raffaele (IT), Istituto Nazionale Tumori IRCCS "Fondazione G. Pascale" (IT), Puigvert Foundation (ES), Royal Surrey NHS Foundation Trust (GB), Hospital Universitari Joan XXIII de Tarragona (ES), Ospedale San Luigi Gonzaga (IT), IRCCS Humanitas Research Hospital (IT), Icahn School of Medicine at Mount Sinai (US)
Openalex Percentile: Top 9%
Anesthesia and Pain Management
DOIOpen Access PDFOpenAlex
AI Navigator

Ask Laika to Summarize, Analyze, and Connect papers live on the map.

Summarize Papers & Methodologies

Extract key findings, datasets, and comparative methods across publications.

Benchmark Rankings & Visual Analytics

Rank top research institutions, authors, funders, topics, and journals by Field-Weighted Citation Impact (FWCI) and paper volume with instant charts.

Connect Distant Disciplines

Bridge topological clusters on the map to find hidden collaborative intersections.