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Standardising these practices is central to low-impact robotic surgery, aiming to minimise avoidable procedural and physiological stress, and may improve early recovery, including post-operative pain. A three-round, online modified Delphi was conducted within the J-ERUS\/YAU network, inviting 21 experts (19 urologists, 2 anaesthetists). Round-1 presented 21 items (5-point Likert). A priori thresholds\u2014blinded to panellists\u2014were: Include\u2009=\u2009median\u2009\u2265\u20094 with interquartile range (IQR)\u2009\u2264\u20091; Exclude\u2009=\u2009median\u2009&lt;\u20093; otherwise\u2009=\u2009revote. Rounds-2\/-3 re-rated non-consensus items and validated new items proposed from R1 free-text; at each revote, the prior round\u2019s median and IQR were shown. Late submissions were excluded in Rounds 1 and 2. R1 analysed 20 valid responses: 5 Include, 2 Exclude, 14 to revote. R2 analysed 19 responses and re-rated 14 carried plus 9 new items from R1 suggestions: 16 reached Include, 7 to revote. R3 analysed 16 responses: 2 reached Include, 5 without consensus. In total, 23 items met Include (5 R1\u2009+\u200916 R2\u2009+\u20092 R3). The checklist integrates pharmacologic\/anaesthetic measures (multimodal analgesia; regional techniques as appropriate; structured anti-PONV prophylaxis) with non-pharmacologic practices across surgical (pressure-point padding; low pneumoperitoneum\/valveless insufflation) and environmental (active temperature management) domains. This Delphi produced a 23-item consensus checklist that standardises modifiable intra-operative practices underpinning low-impact robotic urologic surgery. Prospective implementation should evaluate effects on recovery outcomes, including post-operative pain, opioid use and PONV.<\/jats:p>","DOI":"10.1007\/s11701-026-03983-5","type":"journal-article","created":{"date-parts":[[2026,9,30]],"date-time":"2026-09-30T07:36:10Z","timestamp":1790753770000},"update-policy":"https:\/\/doi.org\/10.1007\/springer_crossmark_policy","source":"Crossref","is-referenced-by-count":0,"title":["An intra-operative checklist for low-impact robotic urologic surgery: a three-round J-ERUS\/YAU Delphi 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