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Robot-Assisted Surgery: Current Trends and Future Directions
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Robot-Assisted Surgery: Current Trends and Future Directions

A special issue of Journal of Clinical Medicine (ISSN 2077-0383). This special issue belongs to the section "General Surgery".

Deadline for manuscript submissions: 25 April 2026 | Viewed by 1089

Special Issue Editors

Dr. Michele Di Dio

E-Mail Website
Guest Editor
Division of Urology, Department of Surgery, Annunziata Hospital, 87100 Cosenza, Italy
Interests: urology; oncology; robotics; laparoscopy; AI
Special Issues, Collections and Topics in MDPI journals
Dr. Claudio Bisegna

E-Mail Website
Guest Editor
Division of Urology, Department of Surgery, Annunziata Hospital, 87100 Cosenza, Italy
Interests: uro-oncology; minimally invasive surgery; surgical technology; robotics
Prof. Dr. Michele Morelli

E-Mail Website
Guest Editor
Division of Gynecology, Department of Surgery, Annunziata Hospital, 87100 Cosenza, Italy
Interests: uro-ginecology; minimally invasive surgery; surgical technology; robotics

Special Issue Information

Dear Colleagues,

The world is constantly changing, and every day we experience new technologies. Robotics in surgery is nearing a quarter century old, and its evolution is evident. It is important for us to understand where we are going and what is happening around this world.

Scope of the Special Issue: The focus of this Special Issue is to know what is established and what is going on. The new entry of novel robotic platforms that are in progress to demonstrate their value and the industrial interest in supporting demonstrations of what can work better than others can create confusion. It is important to take a look at this “overexcited universe” to find the right planet to land on without disappointment.

Key objectives: With this Special Issue, we hope to understand if there are really clinical benefits in the use of robotics in surgery, if there are sufficient data to compare the clinical outcomes of different robots, and if the socio-economical global situation could interrupt or reduce innovation in robotic surgery.

Contributions: We await contributions that let us analyze the reality and expectations of today and tomorrow and where to invest in the professional future.

We hope that you will contribute with your research to enrich data in robotic surgery research.

As we said at the beginning, the world is changing. We are currently facing significant challenges, including economic burdens, social conflicts, public health insurance issues, and other controversies. Therefore, it is of crucial interest to know what to carry out and how to achieve it.

Dr. Michele Di Dio
Dr. Claudio Bisegna
Prof. Dr. Michele Morelli
Guest Editors

Manuscript Submission Information

Manuscripts should be submitted online at www.mdpi.com by registering and logging in to this website. Once you are registered, click here to go to the submission form. Manuscripts can be submitted until the deadline. All submissions that pass pre-check are peer-reviewed. Accepted papers will be published continuously in the journal (as soon as accepted) and will be listed together on the special issue website. Research articles, review articles as well as short communications are invited. For planned papers, a title and short abstract (about 250 words) can be sent to the Editorial Office for assessment.

Submitted manuscripts should not have been published previously, nor be under consideration for publication elsewhere (except conference proceedings papers). All manuscripts are thoroughly refereed through a single-blind peer-review process. A guide for authors and other relevant information for submission of manuscripts is available on the Instructions for Authors page. Journal of Clinical Medicine is an international peer-reviewed open access semimonthly journal published by MDPI.

Please visit the Instructions for Authors page before submitting a manuscript. The Article Processing Charge (APC) for publication in this open access journal is 2600 CHF (Swiss Francs). Submitted papers should be well formatted and use good English. Authors may use MDPI's English editing service prior to publication or during author revisions.

Keywords

  • robotic surgery
  • minimally invasive surgery
  • urology
  • artificial intelligence
  • augmented reality
  • public health
  • innovation
  • laparoscopic surgery
  • surgical platforms
  • surgical outcomes

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Published Papers (2 papers)

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Research

15 pages, 801 KB  
Article
Outcomes of Cervical Cancer Treatment Using Total Mesometrial Resection (TMMR) Performed with the Robotic System—A Preliminary Report
by Marcin Opławski, Krzysztof Mawlichanów, Agnieszka Golec-Cera, Anna Jedrzejczyk, Kazimierz Pitynski and Radovan Pilka
J. Clin. Med. 2025, 14(24), 8667; https://doi.org/10.3390/jcm14248667 - 7 Dec 2025
Viewed by 322
Abstract
Background/Objectives: Cervical cancer remains a major cause of cancer-related morbidity and mortality among women worldwide. The introduction of total mesometrial resection (TMMR), based on the ontogenetic compartment theory, has redefined the concept of surgical radicality in cervical cancer treatment. This study aimed to [...] Read more.
Background/Objectives: Cervical cancer remains a major cause of cancer-related morbidity and mortality among women worldwide. The introduction of total mesometrial resection (TMMR), based on the ontogenetic compartment theory, has redefined the concept of surgical radicality in cervical cancer treatment. This study aimed to evaluate the perioperative, histopathological, and early oncologic outcomes of TMMR performed using the da Vinci Xi robotic system in patients with early-stage cervical carcinoma. Methods: A pilot, prospective, single-center study was conducted between 2021 and 2023 and included 20 consecutive patients diagnosed with Fédération Internationale de Gynécologie et d’Obstétrique (FIGO) stage IA2–IIA1 cervical carcinoma. All patients underwent robotic surgery: 4 classic radical robotic hysterectomies, 12 radical robotic hysterectomies using the TMMR technique with pelvic lymphadenectomy, and—given the young age of selected patients, fertility considerations, and tumor characteristics—4 radical trachelectomies. Surgical parameters, histopathological data, and 24-month follow-up outcomes were analyzed. Statistical analyses included Spearman’s correlation, Fisher’s exact test, and Mann–Whitney U test, with p < 0.05 considered statistically significant. Results: All procedures were completed robotically without conversion to laparotomy. The mean operative time was 178 ± 42 min, mean blood loss 112 ± 61 mL, and mean hospital stay 4.2 ± 1.6 days. No intraoperative complications occurred. Minor postoperative complications (Clavien–Dindo grade I–II) were observed in 10% of cases. Negative surgical margins (R0) were achieved in 17 cases, while positive margins (R+) were observed in 4 cases. Lymph node metastases were present in 20.0% of patients, and both lymphovascular space invasion (LVSI) and Vascular Endothelial Growth Factor (VEGF) expression were detected in 33.3%. No significant correlations were found between VEGF expression, LVSI, or nodal status. During the 24-month follow-up period, no local or distant recurrences were documented. Conclusions: Robotic TMMR for early-stage cervical cancer is feasible, safe, and provides complete oncologic radicality with low perioperative morbidity. Although these preliminary results are promising, larger multicenter studies are needed to validate long-term oncologic outcomes and to establish standardized protocols for robotic compartment-based surgery. Full article
(This article belongs to the Special Issue Robot-Assisted Surgery: Current Trends and Future Directions)
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11 pages, 935 KB  
Article
How to Minimize Hyper-Continence After Intracorporeal Robotic Neobladder Configuration in Women? The Three-Layer Posterior Reconstruction During Florence Robotic IntraCorporeal Neobladder (FloRIN)
by Fabrizio Di Maida, Luca Lambertini, Antonio Andrea Grosso, Vincenzo Salamone, Daniele Paganelli, Laura Di Stefano, Francesca Conte, Filippo Lipparini, Matteo Salvi, Rino Oriti, Andrea Mari and Andrea Minervini
J. Clin. Med. 2025, 14(23), 8397; https://doi.org/10.3390/jcm14238397 - 26 Nov 2025
Viewed by 284
Abstract
Background: Orthotopic neobladder in women presents functional challenges, notably hyper-continence requiring intermittent self-catheterization. Here, we describe a three-layer urethro-ileal anastomosis incorporating a peritoneal flap and evaluate its impact on functional outcomes at the time of robot-assisted radical cystectomy (RARC) and Florence Robotic Intracorporeal [...] Read more.
Background: Orthotopic neobladder in women presents functional challenges, notably hyper-continence requiring intermittent self-catheterization. Here, we describe a three-layer urethro-ileal anastomosis incorporating a peritoneal flap and evaluate its impact on functional outcomes at the time of robot-assisted radical cystectomy (RARC) and Florence Robotic Intracorporeal Neobladder (FloRIN) reconfiguration. Methods: Clinical data from consecutive patients treated with non-sexual-sparing RARC and FloRIN were prospectively collected between March 2016 and January 2024. Hyper-continence was defined as intermittent self-catheterization or postvoid residual > 200 cc at last follow-up. A three-layer anastomosis was performed incorporating a peritoneal flap and utilizing a three-step barbed suture technique for posterior reconstruction: (1) the peritoneum of the rectouterine pouch was sutured to the paraurethral ligaments, (2) the external ileal layer was approximated to the paraurethral ligaments, and (3) the ileal mucosa was anastomosed to the urethra. Urodynamic evaluation was performed 6 months postoperatively. Results: Overall, 32 patients entered the study. Median age was 72 (IQR 67–75) years, and median BMI was 24 (IQR 22–27) kg/m2. Preoperative incontinence was reported in 10% of cases, while no hyper-continence was recorded preoperatively. Median console time was 334 (IQR 305–363) minutes. Early major complications (<30 days) occurred in three (9.4%) patients, while delayed major complications (>30 days) were observed in four (12.5%) cases. After a median follow-up of 36 (IQR 30–42) months, hyper-continence was observed in 7.2% of patients with a median self-catheterization number of 3 (IQR 2–5) per day. Multivariable analysis confirmed BMI > 25 kg/m2 (OR: 1.24, p = 0.03) and age > 70 years (OR: 1.18, p = 0.04) as independent predictors of hyper-continence after FloRIN. Conclusions: Robot-assisted three-layer posterior reconstruction during FloRIN configuration in female patients demonstrated low rates of hyper-continence and no cases of permanent catheterization in long-term follow-up. Full article
(This article belongs to the Special Issue Robot-Assisted Surgery: Current Trends and Future Directions)
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