Robotic Urology in 2026: How New Robots, AI and Augmented Reality Are Changing Surgery

By Mr Neil Haldar, Consultant Urological Surgeon

Robotic surgery has transformed urology more extensively than almost any other surgical speciality.

Procedures that once required a large abdominal incision can now frequently be performed through several small access points using highly articulated robotic instruments. Robotic techniques are now widely used in prostate, kidney and bladder cancer surgery, as well as in selected reconstructive operations.

However, robotic surgery is entering a new phase.

For much of the past two decades, one manufacturer and one basic type of multi-port surgical robot dominated the field. By 2026, a growing number of competing systems have entered clinical practice. At the same time, single-port surgery, three-dimensional modelling, augmented reality, fluorescence imaging and artificial intelligence are beginning to change not only how surgeons operate, but how operations are planned, assessed and taught.

The most important development may not be a robot that replaces the surgeon. It is more likely to be an increasingly intelligent surgical environment that helps the surgeon see more clearly, plan more precisely and make better-informed decisions.

In brief

Robotic surgery does not mean that a robot performs an operation independently.

The surgeon remains in control throughout the procedure, operating from a console and translating hand movements into precise instrument movements inside the patient.

The next generation of robotic surgery is likely to involve:

• greater competition between robotic manufacturers;
• more sophisticated multi-port and single-port systems;
• patient-specific three-dimensional surgical planning;
• augmented-reality guidance during an operation;
• artificial intelligence that analyses surgical video and instrument movement;
• automation of carefully defined technical tasks;
• remote mentoring and, in selected circumstances, remote surgery.

These advances are promising, but the surgeon’s quality and experience, and the wider surgical team, remain more important than the robot’s name.

What does robotic surgery actually involve?

The phrase “robotic surgery” can be misleading.

Current surgical robots do not independently diagnose a condition, decide what operation to perform or carry out an operation without human control. They are better understood as highly sophisticated surgical instruments.

During a conventional robotic operation:

1. the patient is anaesthetised and positioned;
2. small ports are placed through the abdominal wall;
3. a camera and robotic instruments are introduced;
4. the surgeon sits at a nearby console;
5. the surgeon’s hand movements are translated into precise movements of the instruments;
6. the operating-room team remains beside the patient throughout.

The system provides a magnified, high-definition, three-dimensional view of the operative field. Its articulated instruments can move with greater freedom than conventional straight laparoscopic instruments, while software filters out natural hand tremor.

The robot therefore enhances the surgeon’s vision and dexterity. It does not replace the surgeon’s judgement.

Why urology adopted robotic surgery so rapidly

Urology was one of the earliest specialities to adopt robotic surgery at scale.

Robot-assisted radical prostatectomy became particularly well suited to the technology because the prostate lies deep within the pelvis, surrounded by structures that influence urinary control, sexual function and cancer clearance. A magnified view and highly manoeuvrable instruments are valuable in this confined space.

Robotic techniques were subsequently extended to:

• partial nephrectomy for kidney tumours;
• radical cystectomy for bladder cancer;
• nephroureterectomy for upper urinary tract cancer;
• pyeloplasty for obstruction of the kidney;
• ureteric reconstruction;
• selected pelvic-floor procedures;
• complex reconstructive surgery.

The original evidence comparing robotic with open radical prostatectomy showed lower blood loss and shorter hospital stays with robotic surgery, but did not establish that the robotic approach automatically produces superior cancer control or long-term functional results when both procedures are performed by experienced surgeons.

That distinction remains important: a technically advanced platform does not remove the effect of surgical experience, patient selection or operative technique.

A new generation of surgical robots

For many years, the da Vinci system from Intuitive Surgical was effectively synonymous with robotic surgery.

That is no longer the case.

The da Vinci Xi remains widely used, while the newer da Vinci 5 platform received European CE marking in July 2025. Da Vinci 5 incorporates improved vision, ergonomics, computing capability and force-feedback technology.

Other systems now include:

• Hugo RAS, developed by Medtronic;
• Versius, developed by the UK company CMR Surgical;
• Hinotori, developed in Japan;
• Toumai, developed by MicroPort in China;
• KangDuo, another Chinese robotic system;
• Avatera, developed in Germany;
• Dexter, a hybrid laparoscopic-robotic platform;
• several other systems at different stages of adoption and regulatory approval.

Hinotori received European CE marking in July 2026, while Toumai had already obtained European approval for urological and other laparoscopic procedures in 2024.

The Versius Plus system received US clearance for selected general-surgical use in late 2025, although approved procedures and availability vary by country.

Johnson & Johnson’s Ottava system received US market authorisation in July 2026 for specified upper-abdominal general-surgery procedures. It is not currently an established urological system, but its arrival illustrates how rapidly the wider surgical-robotics market is evolving.

Are newer surgical robots better than da Vinci?

Currently, no convincing evidence shows that one robotic platform consistently produces better patient outcomes than every other platform.

A large 2025 systematic review identified more than 5,000 patients treated using nine newer multi-port robotic systems. The results suggested that several platforms can reproduce major urological procedures with broadly comparable short-term perioperative, functional and cancer outcomes in experienced centres. However, much of the evidence came from early observational studies rather than large randomised trials.

This means that the newer robots appear increasingly credible, but claims of superiority should be treated cautiously.

A hospital may consider factors such as:

• acquisition price;
• maintenance and instrument costs;
• operating-room footprint;
• whether the arms are mounted on one unit or separate carts;
• whether instruments are reusable;
• the availability of training;
• compatibility with imaging and digital systems;
• ease of moving the robot between operating theatres;
• the manufacturer’s technical support;
• the amount and quality of published clinical evidence.

For the patient, the surgeon’s experience with the chosen system likely matters more than small engineering differences between modern platforms.

Robotic prostate cancer surgery

Robot-assisted radical prostatectomy is now one of the most commonly performed robotic urological operations.

The prostate and seminal vesicles are removed, and the bladder is rejoined to the urethra. Depending on the characteristics and location of the cancer, the surgeon may also preserve some or all of the nerves involved in erectile function and remove pelvic lymph nodes.

Modern refinements include:

• more individualised nerve-sparing;
• improved reconstruction around the bladder neck and urethra;
• Retzius-sparing prostatectomy;
• extraperitoneal approaches;
• transvesical and single-port approaches;
• the use of MRI-derived three-dimensional prostate models;
• fluorescence or molecular imaging to help identify specific tissues.

Retzius-sparing prostatectomy approaches the prostate from behind and preserves more of the structures in front of the bladder and prostate. Evidence suggests that it can accelerate early recovery of urinary continence in appropriately selected patients, although differences become less clear with longer follow-up and the procedure requires specific expertise.

Regardless of approach, patients should remember that recovery of urinary control and erectile function depends on many factors, including age, preoperative function, tumour position, the extent of nerve preservation, and the surgeon’s experience.

Robotic kidney cancer surgery

One of the clearest applications of robotic technology is partial nephrectomy.

Rather than removing the entire kidney, the surgeon removes the tumour while preserving as much functioning kidney tissue as possible. This can require precise control of the renal blood supply, accurate tumour removal and reconstruction of both the kidney and its collecting system.

Robotic instruments can make these reconstructive steps easier than conventional keyhole instruments, particularly for:

• posterior tumours;
• deeply embedded tumours;
• tumours close to major blood vessels;
• multiple tumours;
• larger or anatomically complex masses;
• patients with only one functioning kidney.

Not every tumour is suitable for partial nephrectomy, and open surgery or complete kidney removal may remain the safest treatment in selected cases.

However, robotic surgery has helped experienced teams extend kidney-preserving surgery to some tumours that would previously have required a larger incision or removal of the whole kidney.

Robotic bladder cancer surgery

Radical cystectomy is among the most complex urology operations.

It involves removing the bladder and creating a new route for urine, commonly an ileal conduit or, in selected patients, an orthotopic neobladder.

Earlier robotic cystectomy operations still required part of the urinary reconstruction to be performed through an abdominal incision. More recently, specialist centres have developed totally intracorporeal techniques in which the robot constructs the urinary diversion inside the abdomen.

The UK iROC randomised trial compared robotic cystectomy with intracorporeal urinary diversion against open cystectomy in 317 patients. Patients in the robotic group spent a modest but statistically significant greater number of days alive and outside hospital during the first 90 days, with several early recovery measures also favouring robotic surgery.

Nevertheless, cystectomy remains major surgery regardless of the approach. Patient fitness, cancer stage, anaesthetic care, enhanced-recovery pathways and the experience of the whole multidisciplinary team remain crucial.

Reconstructive and paediatric robotic urology

Robotic surgery is also increasingly used to reconstruct parts of the urinary tract.

Examples include:

• pyeloplasty for obstruction where the kidney joins the ureter;
• reimplantation of the ureter into the bladder;
• repair of ureteric injuries;
• psoas-hitch and Boari-flap reconstruction;
• repair of selected urinary fistulas;
• complex bladder and urinary diversion procedures.

Robotic pyeloplasty is used in both adults and children. The technology is particularly helpful when a fine, watertight anastomosis must be created deep inside the body.

Paediatric robotic surgery has developed more slowly because children are smaller and existing robotic instruments were largely designed for adults. Instrument diameter, the distance required between ports and the physical size of the robotic system can limit its use in very small children.

Miniaturised instruments and robots designed specifically for paediatric surgery may eventually broaden its role.

What is single-port robotic surgery?

Most current robotic operations use several separate access ports: one for the camera and others for the working instruments.

A single-port system passes a flexible camera and several articulated instruments through one larger access channel. Once inside the body, the instruments spread out and move independently.

The da Vinci SP system received European CE marking in 2024 and is now being introduced selectively outside North America.

Potential applications include:

• extraperitoneal prostatectomy;
• transvesical prostatectomy;
• surgery in patients with extensive previous abdominal operations;
• selected kidney operations;
• re-operative pelvic surgery;
• operations where avoiding the main abdominal cavity may be beneficial.

Single-port surgery may reduce the number of skin incisions and, in some settings, postoperative pain or length of stay. However, it is not automatically less invasive internally, and the single access point is larger than an individual multi-port incision.

A meta-analysis of more than 5,000 patients found broadly similar perioperative outcomes between single-port and multi-port urological surgery. Single-port surgery was associated with shorter hospital stays, slightly lower blood loss and lower postoperative opioid use, but the underlying studies were heterogeneous and largely non-randomised.

Single-port surgery is therefore promising, but it has not made conventional multi-port robotic surgery obsolete.

Three-dimensional models: seeing the operation before it begins

CT and MRI scans are conventionally displayed as a sequence of two-dimensional images.

Modern software can combine these images to create a patient-specific three-dimensional model. In kidney surgery, this model may show:

• the tumour;
• the renal arteries and their branches;
• the veins;
• the kidney’s drainage system;
• the depth of the tumour;
• the relationship between the tumour and important structures.

For prostate surgery, a model may show:

• the outline of the prostate;
• MRI-visible tumour;
• areas where the cancer may be close to the capsule;
• the urethra;
• neighbouring structures;
• potential nerve-sparing planes.

The surgeon can rotate and explore the model before surgery, helping to plan the direction of dissection and identify anatomical variations.

This is particularly valuable because no two patients have identical anatomy.

Augmented reality in robotic surgery

Augmented reality goes a step beyond preoperative three-dimensional planning.

The aim is to display the virtual model over, or beside, the live operative image. In principle, the surgeon could look at the surface of a kidney while simultaneously seeing the estimated position of a tumour or blood vessel beneath it.

This has obvious attractions. Surgeons could potentially:

• locate deeply embedded tumours;
• identify the most appropriate artery to control;
• preserve more healthy kidney tissue;
• avoid important blood vessels;
• adapt nerve-sparing around a prostate tumour;
• improve the precision of surgical margins.

The main technical challenge is registration: keeping the virtual model accurately aligned with an organ that moves, deforms and changes shape during an operation.

Machine-learning systems are now being developed to automate this alignment. Early clinical research in robotic partial nephrectomy has demonstrated automated or semi-automated co-registration of three-dimensional kidney models with the live operative view, but this remains specialist and developing technology rather than routine practice.

The eventual goal is something similar to satellite navigation for surgery—not replacing the person in control, but providing a more informative map.

Fluorescence-guided surgery

Near-infrared fluorescence imaging is already more established than augmented reality.

A fluorescent dye called indocyanine green can be injected into the bloodstream and visualised using a compatible robotic camera.

In kidney surgery, this may help the surgeon confirm which areas of the kidney continue to receive blood after a particular artery has been temporarily controlled. It can also assist with tissue perfusion, ureteric identification and selected lymphatic procedures.

The next stage is tumour-targeted fluorescence.

Researchers are developing compounds that attach to molecules associated with particular cancers, such as prostate-specific membrane antigen in prostate cancer. In future, these agents may help surgeons identify cancerous tissue or involved lymph nodes that cannot be distinguished reliably by sight alone.

This is a potentially important advance, but microscopic disease cannot yet be made consistently visible during routine surgery.

How artificial intelligence could assist the surgeon

Artificial intelligence is likely to influence robotic surgery in several different ways.

Recognising the stages of an operation

Computer-vision systems can be trained to recognise instruments, anatomy and different phases of a procedure from surgical video.

A future system might recognise that the surgeon has reached a particular step and automatically display:

• the relevant scan;
• a three-dimensional model;
• a safety checklist;
• previous operative measurements;
• a warning about nearby structures.

Measuring surgical performance

Robotic platforms generate detailed information about instrument movements.

Algorithms can analyse factors such as:

• economy of motion;
• instrument speed;
• unnecessary movements;
• smoothness;
• camera control;
• tissue handling;
• the time taken for individual steps.

Automated performance metrics have already been studied in radical prostatectomy and may help assess technical skill and predict selected postoperative outcomes.

Used responsibly, these systems could improve training by replacing some subjective assessment with objective feedback.

Used poorly, however, simplistic performance scores could penalise surgeons for treating more difficult cases or encourage speed at the expense of judgement. Any assessment system must account for the complexity of the patient and operation.

Identifying anatomy and risk

AI may eventually highlight structures such as:

• blood vessels;
• ureters;
• nerves;
• tissue planes;
• tumours;
• areas of possible bleeding.

It might also identify when an operation is departing from an expected pathway or when the pattern of movement suggests technical difficulty.

These systems should initially be viewed as decision-support tools rather than decision-makers.

Could a robot eventually perform surgery independently?

Experimental robots have already performed defined surgical tasks in laboratory and animal models.

The Smart Tissue Autonomous Robot programme demonstrated supervised autonomous intestinal anastomosis in porcine models. The system could plan and perform parts of the suturing process while adapting to soft tissue.

That is an important scientific achievement, but it is a very long way from a robot independently performing a complex cancer operation on a patient.

Human surgery involves much more than repeating a series of movements. The surgeon must continually interpret:

• unexpected anatomy;
• scar tissue;
• tissue quality;
• bleeding;
• findings that differ from the scans;
• anaesthetic changes;
• oncological priorities;
• competing functional risks;
• the consequences of changing the operative plan.

The more realistic near-term future is partial autonomy.

A surgeon might define and supervise a task while the system assists with:

• placing spaced sutures evenly;
• holding a camera in an optimal position;
• maintaining tension;
• aligning images;
• measuring tissue;
• controlling a defined dissection boundary;
• automatically stopping if safety limits are exceeded.

The surgeon would remain responsible and able to intervene throughout.

Remote surgery and remote expertise

Robotic systems also allow the surgeon to be geographically separated from the patient.

Remote surgery has been demonstrated across considerable distances, including modern telesurgical programmes using fibre, broadband and 5G connectivity. Toumai, for example, has integrated telesurgery capability and has been involved in remote demonstrations and clinical programmes across national and international networks.

Potential applications include:

• supporting hospitals without a local specialist;
• providing expert surgery in remote regions;
• allowing a specialist to assist during an unexpected difficulty;
• remote proctoring while another surgeon performs the operation;
• distributing expertise through regional hub-and-spoke networks.

However, the technical ability to operate remotely is only one part of the problem.

Remote surgery also requires:

• extremely reliable and low-latency communication;
• cybersecurity protection;
• backup systems;
• a trained team physically present with the patient;
• clear arrangements for conversion to conventional surgery;
• appropriate licensing across jurisdictions;
• professional indemnity;
• agreement about legal responsibility.

Remote mentoring and proctoring are therefore likely to expand more rapidly than fully remote operating.

The unresolved issues: cost, training and access

Robotic surgery is expensive.

Costs may include:

• purchasing or leasing the robot;
• service contracts;
• disposable or limited-use instruments;
• staff training;
• additional operating time during implementation;
• data and software systems;
• theatre modifications;
• maintaining adequate case volume.

Some costs may be offset by shorter hospital stays, fewer complications, increased theatre utilisation or the ability to perform complex minimally invasive procedures. However, the economic case varies substantially by operation, healthcare system and number of cases performed.

Competition between manufacturers may reduce prices and encourage reusable instruments, more flexible purchasing arrangements and greater interoperability.

It could also create new difficulties. Hospitals may need to train teams on several different systems, manage incompatible instruments, and decide which robot to use for each procedure.

Access is another important concern.

Advanced robotic surgery is concentrated in wealthier health systems and larger centres. Within the same country, patients may have very different access depending on geography, referral pathways and hospital resources.

Technology will only represent genuine progress if it improves outcomes for a broad patient population rather than widening existing inequalities.

Does the type of robot matter to the patient?

It can matter, but usually less than patients imagine.

Patients considering robotic surgery should ask:

• How experienced is the surgeon in this particular operation?
• How many similar procedures does the surgeon perform?
• What are the surgeon’s results and complication rates?
• Is robotic surgery genuinely the best approach for my individual case?
• What alternatives are available?
• Will the surgeon personally perform the important parts of the procedure?
• Is the wider hospital team experienced in my postoperative care?
• What would make the surgeon convert to open surgery?

A highly experienced surgeon using a familiar platform is generally preferable to a surgeon using the newest robot without equivalent procedural experience.

It is also important to understand that open surgery has not become obsolete. There are situations in which open surgery remains appropriate or safer, including selected very large tumours, extensive previous surgery, complex vascular involvement or circumstances in which robotic positioning and access are unsuitable.

The correct objective is not to use a robot whenever possible. It is to choose the operation and approach most likely to produce the best result for the individual patient.

What will robotic urology look like over the next decade?

Several changes appear likely.

More choice of robotic platforms

The market will continue to diversify, reducing dependence on a single manufacturer and potentially lowering costs.

Growth of single-port surgery

Single-port systems are likely to gain a larger role in selected prostate, kidney and reconstructive procedures, although multi-port systems will remain important.

Patient-specific digital planning

Three-dimensional models derived from CT, MRI and molecular imaging are likely to become easier and faster to produce.

More intelligent intraoperative imaging

Augmented reality, fluorescence and image recognition may help surgeons identify structures that are difficult to see directly.

Objective assessment and personalised training

Surgical video and robotic movement data may provide detailed feedback to trainees and established surgeons.

Automation of selected tasks

Rather than an autonomous robot performing an entire operation, tightly defined subtasks are likely to become increasingly automated under direct supervision.

Greater connection between hospitals

Remote mentoring, proctoring and carefully governed telesurgery may allow specialist expertise to reach a wider population.

The future is surgeon-led, but increasingly data-assisted

Robotic urology has already changed how many major operations are performed.

The next phase will not be defined simply by smaller incisions or more flexible instruments. It will be shaped by integrating robotics with imaging, data, artificial intelligence, and communications technology.

The greatest potential lies in combining:

• the surgeon’s experience and judgement;
• the robot’s precision and dexterity;
• detailed patient-specific imaging;
• computer-assisted navigation;
• continuous measurement and feedback.

The challenge will be to demonstrate that each innovation improves outcomes that matter to patients—not merely that it is technically impressive.

For the foreseeable future, the surgeon will remain responsible for selecting the operation, interpreting what is found and making the critical decisions.

The robot is likely to become more intelligent. But the quality of robotic surgery will continue to depend on the surgeon and the team using it.

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Considering Robotic Urological Surgery?

If you have been diagnosed with a prostate, kidney or other urological condition and would like to understand whether robotic surgery is appropriate for you, I offer specialist consultations for patients seeking an individual assessment of their treatment options.

As a Consultant Urological Surgeon with extensive experience in both robotic and open urological surgery, I can review your diagnosis, imaging, and previous investigations, and explain the advantages and limitations of robotic, laparoscopic, and open approaches in your particular circumstances.

I see private patients in various locations in Buckinghamshire, Oxfordshire, Berkshire and London, including patients seeking specialist advice about prostate cancer, robotic radical prostatectomy and complex urological surgery.

Arrange a consultation with Mr Neil Haldar to discuss your diagnosis and the most appropriate treatment options.

Frequently asked questions

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Mr Neil Haldar is a Consultant Urological Surgeon specialising in prostate cancer, robotic and open prostate surgery, uro-oncology and general urology. He sees private patients in Buckinghamshire, London and the Thames Valley.

This article provides general information and does not replace an individual medical consultation. The most appropriate treatment depends on the diagnosis, stage of disease, general health, previous surgery and the experience of the treating team.