Surgical outcomes of robotic surgery for kidney stones: a systematic review and meta-analysis from section of YAU and EAU endourology.

BACKGROUND

Urinary tract stone disease is quite common in the population, and treatment modalities are constantly evolving. Technological advancements in endourology have led to a shift towards more minimally invasive treatments. Nowadays, robotic flexible ureteroscopy is becoming increasingly popular, showing promising results. This systematic review and meta-analysis aimed to evaluate the outcomes of robotic flexible ureteroscopy.

MATERIALS AND METHODS

We conducted a systematic review in the PubMed, Scopus and Web of Science databases based on the 2020 Preferred Reporting Items for Systematic Review and Meta-Analyses guideline. Study protocol was registered at PROSPERO (CRD420251017383). All robotic flexible studies published until April 2025, which defined and provided the stone-free rate, were included. To assess surgical efficacy and reliability, stone size, operation time, and complications were also evaluated. Stone size was measured in a one-dimensional manner, based on the maximum length.

RESULTS

A total of 320 studies were initially identified, with 11 full-text articles meeting the inclusion criteria, involving 656 patients and 660 renal units. The analysis included data from various robotic systems, including the Roboflex Avicenna, ILY, Senhance, and MONARCH platforms. The mean pooled stone-free rate was 86.0%, with a range from 57.7 to 96.5%, indicating variability across studies. The use of a random-effects model was justified by the presence of moderate-to-substantial heterogeneity across studies (I² = 63.5%, τ² = 0.627), and a statistically significant Q-test (p = 0.0022). The studies defined stone-free status as either complete stone clearance or residual fragments smaller than 2 mm.

CONCLUSION

The analysis suggests that robotic URS is an effective and feasible treatment option for selected patients with urinary stones. Future research should focus on standardized reporting, comparative effectiveness studies, and cost-benefit analyses, while also addressing surgeon-centered outcomes such as ergonomic strain and musculoskeletal pain, to better define the role of robotic technology in endourological practice.