Robotic-assisted urological surgery has revolutionized patient care by providing minimally invasive alternatives to traditional surgical techniques, offering the promise of faster recovery and fewer complications. Despite these advantages, the post-operative recovery period remains critical for ensuring optimal patient outcomes. The Enhanced Recovery After Surgery (ERAS) protocol, designed to streamline care and improve recovery times, has shown promise in various surgical specialties, including urology. However, the optimal implementation of ERAS principles for robotic urology procedures remains under investigation. This qualitative review explores the current strategies, challenges, and considerations in refining an ERAS protocol specifically tailored to urological robotic surgeries, with a particular emphasis on post-operative pain control.

This qualitative review synthesizes existing literature, expert opinions, and clinical experiences from institutions implementing the ERAS protocol in robotic urological surgeries. The review seeks to identify key factors that contribute to optimizing the ERAS protocol for prostatectomy, nephrectomy, and cystectomy procedures, including the right balance of analgesia, surgical timing, and patient factors. Insights are drawn from case studies, expert commentary, and best practice guidelines.

While research on the precise application of ERAS in robotic urology is still evolving, preliminary findings suggest that the integration of ERAS principles leads to faster recovery and fewer complications. However, challenges remain in determining the ideal protocol due to the variability in patient needs, surgical complexity, and institutional resources. For instance, multimodal analgesia strategies such as nerve blocks, regional anesthesia, and non-opioid analgesics have been found to improve pain control and reduce opioid consumption, but the optimal combination of these approaches for robotic urological procedures is yet to be fully defined. In addition, early ambulation, another cornerstone of the ERAS protocol, has demonstrated benefits in reducing complications like deep vein thrombosis and pulmonary embolism, but it may need to be tailored to the specific demands of robotic surgery recovery.

While current evidence supports the integration of ERAS protocols into urological robotic surgeries, further refinement is necessary to identify the most effective and tailored approach for each procedure. The ability to optimize post-operative recovery will depend on continuously evaluating and adjusting the components of ERAS—such as multimodal pain control, early mobilization, and individualized care—based on the specific needs of patients undergoing robotic surgery. This qualitative review emphasizes the need for further research to establish the ideal ERAS framework for urological robotic procedures and improve overall patient outcomes.