Patient positioning in robot-assisted pelvic urologic surgery: bibliometric mapping of physiologic changes, positioning-related complications, and preventive strategies.

Authors

Gongping Wu, Debo Li, Chengwei Fan, Junqiang Tian

Published in

Journal of robotic surgery. Volume 20. Issue 1. Sep 17, 2026. Epub Sep 17, 2026.

Abstract

Patient positioning is essential for surgical exposure during robot-assisted pelvic urologic surgery, but evidence spans physiologic effects, complications, and preventive strategies. We combined bibliometric and knowledge-mapping analyses with a publication-level clinical evidence map to examine field development and the clinical questions studied. English-language articles and reviews indexed in the Web of Science Core Collection (WoSCC; Science Citation Index Expanded) through 5 August 2026 were screened, yielding 175 publications. R (bibliometrix), VOSviewer, and CiteSpace assessed publication trends, collaboration, intellectual structure, and thematic evolution; publications were the unit of analysis for clinical coding of procedure, positioning exposure, physiologic and safety domains, preventive strategy, strategy status, research purpose, and study design. Publication output rose to a peak of 18 publications in 2021 and was lower but variable during 2022-2025 (6-15 publications/year); 2026 was a partial year. Themes broadened to include respiratory management, perioperative complications, monitoring, and prevention. Robot-assisted prostatectomy accounted for 85-88% of publications across the three study periods. Steep Trendelenburg was the primary exposure in 126 publications, most often involving respiratory, cerebral/intracranial pressure-related, and ocular domains. No targeted preventive strategy was identified in 77 publications (44%); 67 (38%) empirically evaluated or implemented a preventive strategy, most commonly ventilation/positive end-expiratory pressure (PEEP) or anesthetic, hemodynamic, or fluid management. Respiratory studies were predominantly randomized, whereas cerebral and ocular studies more often used prospective observational designs. Within this WoSCC-indexed corpus, research increasingly addressed perioperative risk management but remained concentrated on prostatectomy and steep Trendelenburg; as a publication-level mapping study, these findings do not establish comparative effectiveness.

PMID:
42753023
Bibliographic data and abstract were imported from PubMed on 18 Sep 2026.

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