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Minimally Invasive Surgery: Challenges and Solutions in Clinical Practice

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Dr. Giuseppe Cavallaro

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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
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Dr. Alessia Fassari

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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

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14 pages, 588 KB

Open AccessSystematic 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 658

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 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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Minimally Invasive Surgery: Challenges and Solutions in Clinical Practice

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