Autonomous surgery in the era of robotic urology: friend or foe of the future surgeon?

Despite advances in robotic-assisted surgery (RAS) in the past two decades, control of the robotic system currently remains under the command of a human surgeon. Historically, urology has pioneered new surgical techniques and technologies. Now, autonomous RAS is on the horizon and the first data from clinical trials of autonomous RAS in urology are being published. Automation takes control away from the surgeon but promises standardization of techniques, increased efficiency, potentially reduced complication rates and new ways of integrating intra-operative imaging. Preclinical and clinical evidence is emerging that supports the use of autonomous robotic-assisted urological surgery. Use of autonomous technologies in the operating theatre will directly affect the role of the urological surgeon. Integration of autonomous RAS can be viewed as a positive aid, but it might also be perceived as a threat to the future urological surgeon.