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Minimally Invasive Surgery: Challenges and Solutions in Clinical Practice
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Minimally Invasive Surgery: Challenges and Solutions in Clinical Practice

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

Deadline for manuscript submissions: 20 September 2026 | Viewed by 2138

Special Issue Editors

Dr. Giuseppe Cavallaro

E-Mail Website
Guest Editor
1. Department of Surgery, Sapienza University, 00185 Rome, Italy
2. General Surgery Unit, ICOT Hospital, 04100 Latina, Italy
Interests: colorectal surgery; endocrine surgery; abdominal wall surgery; bariatric surgery; robotic surgery; laparoscopic surgery
Special Issues, Collections and Topics in MDPI journals
Dr. Alessia Fassari

E-Mail Website
Guest Editor Assistant
General Surgery Unit, Centre Hospitalier de Luxembourg, L-1210 Luxembourg, Luxembourg
Interests: colorectal surgery; bariatric surgery; hbp surgery; robotic surgery; laparoscopic surgery; abdominal wall surgery

Special Issue Information

Dear Colleagues,

Minimally invasive approaches (first laparoscopic and then robotic) have revolutionized modern surgical practice, offering patients effective alternatives with reduced postoperative pain, shorter hospital stays, and faster recovery times. Despite these benefits, mini-invasive procedures come with distinct challenges, including steep learning curves, technical limitations, and complex intraoperative decision-making. Surgeons must navigate issues including limited depth perception, a restricted range of motion, and potential complications such as iatrogenic injuries or pneumoperitoneum-related risks.

This Special Issue will explore the multifaceted challenges associated with robotic and laparoscopic surgery and provide evidence-based solutions to optimize clinical outcomes. The scope includes advancements in surgical training methodologies, the incorporation of robotic assistance and artificial intelligence, innovations in technical instrumentation, and strategies for managing intraoperative complications.

By addressing these challenges, this Special Issue will bridge existing gaps in clinical practice, promote skill development, and inspire collaborative research across the surgical community. Through a collection of original research articles and reviews, this Special Issue will serve as a comprehensive resource for surgeons, educators, and researchers striving to overcome barriers and elevate standards in robotic and laparoscopic surgery worldwide.

Dr. Giuseppe Cavallaro
Guest Editor

Dr. Alessia Fassari
Guest Editor Assistant

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

  • laparoscopic surgery
  • minimally invasive surgery
  • surgical challenges
  • clinical practice
  • surgical training
  • robotic-assisted surgery
  • artificial intelligence in surgery
  • laparoscopic instrumentation
  • intraoperative complications
  • surgical innovation
  • skill enhancement
  • surgical outcomes

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Further information on MDPI's Special Issue policies can be found here.

Published Papers (2 papers)

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15 pages, 554 KB  
Article
Interest of the Robotic Approach for Pancreaticoduodenectomy in Elderly Patients in a Setting of Limited Robotic Platform Access: A Propensity Score-Matched Comparison with Open Surgery
by Edouard Wasielewski, Antoine Castel, Hector Prudhomme, Kevin Preault, Salaheddine Abdennebi, Marie Livin, Aude Merdrignac, Fabien Robin and Laurent Sulpice
J. Clin. Med. 2026, 15(4), 1520; https://doi.org/10.3390/jcm15041520 - 14 Feb 2026
Viewed by 488
Abstract
Background: With population aging and the increasing incidence of pancreatic and periampullary malignancies, more elderly patients are being considered for pancreaticoduodenectomy (PD). Although robotic pancreaticoduodenectomy (RPD) is steadily adopted, evidence regarding its safety in patients aged ≥ 75 years remains limited, particularly [...] Read more.
Background: With population aging and the increasing incidence of pancreatic and periampullary malignancies, more elderly patients are being considered for pancreaticoduodenectomy (PD). Although robotic pancreaticoduodenectomy (RPD) is steadily adopted, evidence regarding its safety in patients aged ≥ 75 years remains limited, particularly in centers with restricted access to robotic platforms. Materials and Methods: We conducted a retrospective single-center study including patients who underwent PD between January 2019 and September 2025. Outcomes after RPD were compared between patients aged < 75 and ≥75 years. In addition, elderly patients undergoing RPD were compared with elderly patients undergoing open pancreaticoduodenectomy (OPD) using 1:2 propensity score matching. The primary endpoint was major postoperative morbidity (Clavien–Dindo grade ≥ III). Results: Among 525 PDs, 130 (25%) were performed robotically, including 29 patients aged ≥ 75 years. Within the RPD cohort, age ≥ 75 years was not associated with an increased risk of major complications compared with younger patients (OR 0.68, 95% CI 0.23–1.76; p = 0.45), nor with higher 90-day mortality. In the propensity score-matched elderly cohort, major morbidity was similar between RPD and OPD (10% vs. 7%; p = 0.68). RPD was associated with a significantly lower 30-day readmission rate, despite a higher incidence of delayed gastric emptying, mainly driven by mild (grade A) cases. Conclusions: RPD appears to be safe in carefully selected patients aged ≥ 75 years, with morbidity and mortality comparable to those observed in younger RPD patients and in elderly patients undergoing open surgery. These findings support the selective use of RPD in elderly patients, even in centers with limited access to robotic platforms. Full article
(This article belongs to the Special Issue Minimally Invasive Surgery: Challenges and Solutions in Clinical Practice)
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14 pages, 588 KB  
Systematic Review
Robotic Segmental Resection of the Splenic Flexure and Mid-Transverse Colon for Malignancy Treatment: A Systematic Review of Operative Techniques, Anastomotic Approaches, and Surgical and Oncological Outcomes
by Alessia Fassari, Angelo Iossa, Alessandra Micalizzi, Giulio Lelli, Sara Giovampietro, Edoardo Rosso and Giuseppe Cavallaro
J. Clin. Med. 2025, 14(20), 7236; https://doi.org/10.3390/jcm14207236 - 14 Oct 2025
Cited by 1 | Viewed by 1094
Abstract
Background/Objectives: The potential role of robotic surgery in segmental colectomy for the treatment of splenic flexure and mid-transverse colon cancers remains underexplored. These sites are technically demanding because of the occurrence of vascular variability, the need for dual lymphatic drainage, and the close [...] Read more.
Background/Objectives: The potential role of robotic surgery in segmental colectomy for the treatment of splenic flexure and mid-transverse colon cancers remains underexplored. These sites are technically demanding because of the occurrence of vascular variability, the need for dual lymphatic drainage, and the close anatomical relationship to surrounding organs. This systematic review evaluated surgical strategies, anastomotic techniques, perioperative outcomes, and the oncological adequacy of robotic segmental colectomies in this context. Methods: The review followed the PRISMA guidelines (PROSPERO ID: CRD420251119736). Studies were eligible if they included ≥3 patients who were undergoing a robotic segmental colectomy for malignant tumors of the splenic flexure or mid-transverse colon. Data on patient demographics, operative details, complications, and oncological outcomes were extracted. The risk of bias was assessed using the Newcastle–Ottawa Scale and ROBINS-I. Results: Five retrospective studies reporting on 74 patients were included. All the procedures involved a fully robotic approach. Vascular ligation was uniform for transverse tumors (middle colic vessels point of origin), but varied for splenic flexure lesions. Anastomotic reconstruction was extracorporeal stapled (55.4%), intracorporeal stapled (16.2%), or intracorporeal hand sewn (4.1%). Operative times were in the range of 157.5–268 min; conversion occurred in 4.1% of cases. The overall morbidity was 16.2%, with anastomotic leaks in 5.4% of cases. No 30-day mortality was observed, and one reoperation was required. All patients achieved R0 resection, with a mean lymph node yield of 16.9. Only one recurrence was documented during the follow-up period. Conclusions: Robotic segmental colectomy for splenic flexure and mid-transverse colon malignancies is feasible and safe, achieving consistent perioperative and oncological outcomes. Larger multicenter prospective studies are needed to validate the oncological adequacy, standardize anastomotic strategies, and assess the cost effectiveness of the approach. Full article
(This article belongs to the Special Issue Minimally Invasive Surgery: Challenges and Solutions in Clinical Practice)
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