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Advances in Minimally Invasive Surgery: Transformative Technologies, Techniques and Trends
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Advances in Minimally Invasive Surgery: Transformative Technologies, Techniques and Trends

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

Deadline for manuscript submissions: closed (30 January 2026) | Viewed by 4243

Special Issue Editor

Prof. Dr. Michail Pitiakoudis

E-Mail Website
Guest Editor
Second Department of Surgery, University General Hospital of Alexandroupolis, Democritus University of Thrace Medical School, 68100 Alexandroupolis, Greece
Interests: minimally invasive surgery; laparoscopic surgery; robotic surgery; surgical innovation; hernia repair; colorectal surgery; gastrointestinal surgery; hepatopancreatobiliary surgery; surgical simulation; virtual reality; augmented reality; artificial intelligence; surgical training; patient outcomes; surgical oncology
Special Issues, Collections and Topics in MDPI journals

Special Issue Information

Dear Colleagues,

Minimally invasive surgery continues to evolve rapidly, driven by advances in technology, technique, and interdisciplinary innovation. Our Special Issue, "Advances in Minimally Invasive Surgery: Transformative Technologies, Techniques and Trends", aims to highlight cutting-edge developments that are shaping the future of surgical practice.

We welcome original research and review articles focusing on laparoscopic and robotic-assisted procedures with a particular interest in hernia repair, hepatopancreatobiliary and colorectal surgery, and other gastrointestinal interventions. Submissions that explore the integration of artificial intelligence, augmented reality, virtual and mixed reality platforms, and simulation-based training in surgical practice are strongly encouraged.

We also invite contributions on surgical innovation, technique refinement, perioperative outcomes, and novel approaches that enhance patient safety, improve learning curves, and optimize long-term results. Special attention will be given to manuscripts that offer clinical insights into translational applications and multidisciplinary collaboration.

Tentative Table of Contents

  1. Innovations Into Minimally Invasive Approach to Colorectal Surgery.
  2. Artificial Intelligence in Minimally Invasive Surgery: Current Applications and Future Perspectives.
  3. Innovations in Minimally Invasive Hernia Repair.
  4. Minimally Invasive Surgery in Hepatopancreatobiliary Procedures.
  5. Advances and Innovations in Minimally Invasive Gynecologic Surgery: Techniques, Technologies and Future Directions.
  6. Use of Augmented and Virtual Reality in Minimally Invasive Surgery Procedures. 
  7. Simulation-Based Training for Minimally Invasive Surgical Techniques. 
  8. Enhancing Patient Safety and Perioperative Outcomes in Minimally Invasive Surgery.
  9. Translational Innovation in Surgical Oncology Via Minimally Invasive Tools.

We look forward to receiving your valuable contributions to this Special Issue.

Prof. Dr. Michail Pitiakoudis
Guest Editor

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

  • minimally invasive surgery
  • laparoscopic surgery
  • robotic surgery
  • surgical innovation
  • hernia repair
  • colorectal surgery
  • gastrointestinal surgery
  • hepatopancreatobiliary surgery
  • surgical simulation
  • virtual reality
  • augmented reality
  • artificial intelligence
  • surgical training
  • patient outcomes
  • surgical oncology

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Published Papers (4 papers)

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11 pages, 1587 KB  
Article
The Potential Role of an Artificial Intelligence-Driven Tool in Decision-Making for Mitral Valve Repair Surgery
by Serdar Akansel, Martina Dini, Simon H. Sündermann, Emilija Myskinite, Stephan Jacobs, Volkmar Falk, Jörg Kempfert and Markus Kofler
J. Clin. Med. 2026, 15(6), 2300; https://doi.org/10.3390/jcm15062300 - 17 Mar 2026
Viewed by 440
Abstract
Background: Annuloplasty ring sizing is critical for durable outcomes in surgical mitral valve repair (MVr). However, there is no clear consensus on optimal sizing strategies. Artificial intelligence (AI)-based imaging tools may help to reduce uncertainty in preoperative decision-making by providing objective, reproducible and [...] Read more.
Background: Annuloplasty ring sizing is critical for durable outcomes in surgical mitral valve repair (MVr). However, there is no clear consensus on optimal sizing strategies. Artificial intelligence (AI)-based imaging tools may help to reduce uncertainty in preoperative decision-making by providing objective, reproducible and reliable measurements. This study evaluated the predictive capability of a fully automated, computed tomography (CT)-based AI-driven tool for annuloplasty ring sizing in patients undergoing minimally invasive MVr (MI-MVr). Methods: A total of 71 consecutive patients undergoing MI-MVr for Carpentier type II mitral valve insufficiency during the study period were included. Preoperative CT scans were analyzed using a cloud-based, fully automated AI tool to quantify mitral valve geometric parameters. Correlations between AI-derived measurements and implanted ring sizes were assessed using the Pearson correlation test. Univariable and multivariable linear regression analyses were performed to identify independent predictors of ring size selection. Results: Several AI-derived parameters correlated significantly with implanted ring size, with the strongest correlations observed for commissural width (R = 0.693, p < 0.001) and mitral annular area (R = 0.693, p < 0.001). In multivariable regression analysis, these parameters were the strongest predictors of annuloplasty ring size (R2 = 0.504, p < 0.001). Using this model, accurate annuloplasty ring sizing could be predicted in 78.8% of patients. There were no in-hospital mortality and residual mitral regurgitation at discharge. Conclusions: A fully automated, CT-based AI-driven tool demonstrated good accuracy for preoperative annuloplasty ring size prediction in MI-MVr and may have the potential to support surgical decision-making, reduce operator dependence, and improve reproducibility. Full article
(This article belongs to the Special Issue Advances in Minimally Invasive Surgery: Transformative Technologies, Techniques and Trends)
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21 pages, 5402 KB  
Article
Sensorized Vascular High-Fidelity Physical Simulator for Robot-Assisted Surgery Training: A Multisite Pilot Evaluation
by Giulia Gamberini, Alessandro Dario Mazzotta, Angela Durante, Selene Tognarelli, Niccolò Petrucciani, Gianluca Mennini, Gianfranco Silecchia and Arianna Menciassi
J. Clin. Med. 2026, 15(3), 1054; https://doi.org/10.3390/jcm15031054 - 28 Jan 2026
Cited by 1 | Viewed by 507
Abstract
Background/Objectives: Robot-Assisted Surgery poses challenges in skill acquisition due to the lack of haptic feedback, which may lead to adverse intraoperative events. This study focused on a multisite pilot evaluation on the simulator’s ability to discriminate between different levels of expertise and [...] Read more.
Background/Objectives: Robot-Assisted Surgery poses challenges in skill acquisition due to the lack of haptic feedback, which may lead to adverse intraoperative events. This study focused on a multisite pilot evaluation on the simulator’s ability to discriminate between different levels of expertise and the ability to explore potential differences between surgical specialties. Methods: We built a simulator that can replicate anatomies of vascular and adipose tissue. A resistive stretching sensor was integrated into a silicone vessel to objectively measure its deformation. A total of 18 males and 12 females, aged between 26 and 64 years old, participated to the study. In total, there were 30 participants, (21 general surgeons, 2 thoracic surgeons, 4 gynecologists, 3 urologists) and they performed two repetitions of a surgical task and filled in a questionnaire about face- and content validities and a system usability scale. The tests were conducted between February and October 2023. Results: The discriminant validity was positively assessed, considering the maximum deformation value (p-value = 0.0479) and the mean deformation value (p-value = 0.0317). Differences were found between urologists, (i) general surgeons (p-value = 0.0167) and, (ii) gynecologists (p-value = 0.0495). The face- and content validity of the simulator received 80% and 90% of positive answers, respectively. Conclusions: Future works will deal with the evaluation of the simulator abilities in surgical training by comparing surgeons trained on the simulator to those who are not. Full article
(This article belongs to the Special Issue Advances in Minimally Invasive Surgery: Transformative Technologies, Techniques and Trends)
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12 pages, 2738 KB  
Article
Minimally Invasive Nephrectomy for the Management of Polycystic Kidney Disease: The Hilum-First Technique
by Amir Shweiki, Harbi Khalayleh, Michael Rivin, Suha Shabaneh, Abed Khalaileh and Ashraf Imam
J. Clin. Med. 2025, 14(21), 7485; https://doi.org/10.3390/jcm14217485 - 22 Oct 2025
Viewed by 1659
Abstract
Background: Nephrectomy in patients with polycystic kidney disease (PKD) is typically arduous due to the considerable size of the kidneys. The laparoscopic method has arisen as a minimally invasive substitute for open surgery. Nonetheless, conventional laparoscopic methods may be inadequate for tackling the [...] Read more.
Background: Nephrectomy in patients with polycystic kidney disease (PKD) is typically arduous due to the considerable size of the kidneys. The laparoscopic method has arisen as a minimally invasive substitute for open surgery. Nonetheless, conventional laparoscopic methods may be inadequate for tackling the distinct anatomical complexities of a large polycystic kidney. This study presents a unique method, “the hilum first technique”, specifically designed for nephrectomy in patients with PKD, emphasizing its safety and efficacy in addressing this intricate condition. Methods: A retrospective analysis of patients with PKD who underwent minimally invasive nephrectomy using “the hilum first technique” at our hospital between 2020 and 2025. Data on operative time, blood loss, conversion rates, hospital stay, and outcomes were analyzed to evaluate this technique’s safety and efficacy. Results: Minimally invasive nephrectomy using the “hilum first technique” was successfully performed in 16 cases; the mean age of patients was 56.3 years. Two of which were robot-assisted, in which one of them, a bilateral nephrectomy was done, with no conversions to open surgery, even for huge kidneys. The mean operative time was 159.6 min, with an estimated blood loss of 50 mL. Postoperatively, the median duration of hospital stay was 4 days (range: 3–10 days), and 75% of patients experienced no complications. Three patients (18.7%) were readmitted within 30 days due to surgical site infection, subcutaneous hematoma, and pneumonia. Seven patients (43.7%) underwent kidney transplantation within a median duration of 132 days post-nephrectomy. Conclusions: This retrospective study, although limited by a small sample size, demonstrated significant promise as a novel strategy for tackling the challenges of huge polycystic kidneys. The findings suggest its feasibility and safety, although further validation is required. Full article
(This article belongs to the Special Issue Advances in Minimally Invasive Surgery: Transformative Technologies, Techniques and Trends)
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8 pages, 3763 KB  
Case Report
Robotic-Assisted Total Pelvic Exenteration for Rectal Cancer Using the Hugo™ RAS System: First Case Report
by Kosuke Hiramatsu, Shigeo Toda, Shuichiro Matoba, Daisuke Tomita, Yusuke Maeda, Naoto Okazaki, Yudai Fukui, Yutaka Hanaoka, Masashi Ueno, Suguru Oka, Tomoaki Eguchi and Hiroya Kuroyanagi
J. Clin. Med. 2025, 14(18), 6603; https://doi.org/10.3390/jcm14186603 - 19 Sep 2025
Viewed by 1219
Abstract
Introduction: Total pelvic exenteration (TPE) is a radical procedure for advanced pelvic malignancies involving adjacent organs. The Hugo™ RAS System is a novel robotic platform, but its application in TPE has not previously been reported. We describe the first case of robotic-assisted [...] Read more.
Introduction: Total pelvic exenteration (TPE) is a radical procedure for advanced pelvic malignancies involving adjacent organs. The Hugo™ RAS System is a novel robotic platform, but its application in TPE has not previously been reported. We describe the first case of robotic-assisted TPE using Hugo™ RAS in a patient with locally advanced rectal cancer invading the prostate. Methods: A 69-year-old male with mucous and bloody stools was diagnosed with cT4b (prostate, levator ani muscle) N0M0 rectal cancer. After short-course radiotherapy (25 Gy/5 fractions), robotic-assisted TPE was performed. Port placement was planned to coincide with future colostomy and urostomy sites to minimize abdominal wall trauma. En bloc resection was achieved, followed by pelvic reconstruction with a gluteus maximus musculocutaneous flap and fascia lata autograft. Urinary diversion was completed with a robotic intracorporeal Wallace-type ileal conduit. Results: The operation lasted 17 h 56 min, with 175 mL blood loss. Postoperatively, Clavien–Dindo grade IIIa paralytic ileus occurred but was managed conservatively. Pathology revealed pT4b (prostate) N1a M0 disease with negative circumferential margin (11 mm). No recurrence was observed at 9 months. Conclusions: This case highlights the technical feasibility and safety of Hugo™ RAS-assisted TPE. Further clinical experience is needed to confirm reproducibility and oncologic safety. Full article
(This article belongs to the Special Issue Advances in Minimally Invasive Surgery: Transformative Technologies, Techniques and Trends)
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