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Clinical Advances in Risk Minimization Through Robot-Assisted Surgery

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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 December 2026 | Viewed by 1524

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Editor

Prof. Dr. Radko Komadina

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Medical Faculty, University of Ljubljana, Ljubljana, Slovenia
Interests: thoracolumbar injuries; spinal surgery; robot-assisted technology; general surgery

Special Issue Information

Dear Colleagues,

We are witnessing the rise of increasingly less invasive surgery. Laparoscopic procedures are being enhanced by robot-assisted technology. This began with interventions in the pelvic region and is now expanding to other anatomical areas. Its application is not limited to surgery within the abdominal cavity, both intra- and extraperitoneal; it also includes, for example, spinal surgery combined with navigation techniques and robotic assistance. In this Special Issue of JCM, we present several professional papers from these fields that herald advances in robotic surgery.

Prof. Dr. Radko Komadina
Guest Editor

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Keywords

robot-assisted technology
robotic surgery
laparoscopic surgery
spinal surgery
robot-assisted gynecological operations
robot-assisted operations in urology
robot-assisted prostatectomy

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Published Papers (4 papers)

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Research

10 pages, 237 KB

Open AccessArticle

Transition from Laparoscopic to Robot-Assisted Partial Nephrectomy: Perioperative Outcomes During an Institutional Transition in a High-Volume European Centre

by Jure Bizjak, Andraž Kondža, Kosta Cerović, Milan Medved and Simon Hawlina

J. Clin. Med. 2026, 15(12), 4746; https://doi.org/10.3390/jcm15124746 - 18 Jun 2026

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Abstract

Background/Objectives: Robot-assisted partial nephrectomy (RAPN) has increasingly replaced laparoscopic partial nephrectomy (LPN) in the management of localized renal tumours. This study aimed to evaluate perioperative, functional and surgical margin outcomes during an institutional transition from LPN to RAPN in a high-volume centre. Methods: We performed a retrospective single-centre analysis of 100 consecutive patients undergoing minimally invasive partial nephrectomy. The last 50 LPN cases (August 2014–May 2018) were compared with the first 50 RAPN cases (June 2018–February 2020). Baseline characteristics, perioperative outcomes, early functional parameters and surgical margin status were analysed. Complications were classified according to the Clavien–Dindo system. Results: Tumours treated in the RAPN group were significantly larger (3.4 vs. 2.5 cm) and more complex (RENAL score of 6 vs. 5; p < 0.001). Operative time was longer in the RAPN group (143 vs. 122 min; p < 0.01), while warm ischaemia time did not differ significantly (16 vs. 15 min; p = 0.37). Estimated blood loss was lower (0 vs. 10 mL; p = 0.049) and the hospital stay was shorter (3 vs. 4 days; p < 0.001) in the RAPN group. Haemoglobin decrease and postoperative creatinine change were comparable between groups. Positive surgical margins were observed less frequently in the RAPN group (2.3% vs. 7.7%), but this difference was not statistically significant (p = 0.34). Complication rates were significantly lower in the RAPN group (4% vs. 22%; p < 0.05), with no major complications observed in the robotic cohort. Conclusions: In this institutional experience, RAPN was associated with favourable perioperative outcomes during the transition period, despite the treatment of larger and more complex renal tumours. The slightly longer operative and warm ischaemia times likely reflect a more comprehensive reconstruction strategy, which may contribute to improved haemostatic control and lower complication rates. Further studies with extended follow-up are required to evaluate oncological and renal functional outcomes. Full article

(This article belongs to the Special Issue Clinical Advances in Risk Minimization Through Robot-Assisted Surgery)

13 pages, 832 KB

Open AccessArticle

Robot-Assisted Radical Prostatectomy as the Institutional Standard: Complete Transition and Contemporary Outcomes from a High-Volume European Center

by Simon Hawlina, Andraž Kondža, Kosta Cerović and Jure Bizjak

J. Clin. Med. 2026, 15(12), 4606; https://doi.org/10.3390/jcm15124606 - 13 Jun 2026

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Abstract

Background: Robot-assisted radical prostatectomy (RARP) is the predominant surgical approach for localized prostate cancer in high-volume centers worldwide. However, comprehensive real-world data describing complete institutional transition from open to robotic surgery remain limited. This study evaluated perioperative and early oncological outcomes of a contemporary RARP cohort and characterized the transition from open radical prostatectomy (ORP) to RARP in a European center. Methods: We analyzed 520 consecutive patients who underwent RARP between January 2023 and December 2025. Perioperative, pathological, and biochemical outcomes were assessed. Biochemical recurrence was defined as prostate-specific antigen ≥0.2 ng/mL. Institutional data from 2011 to 2025 were reviewed to evaluate procedural trends and the transition from ORP to RARP. Surgeon-specific and institutional learning curves were analyzed using operative time and linear regression models. Results: Following the introduction of robotic surgery in 2018, annual RARP volume increased from 37 procedures to 205 in 2025. Since 2023, RARP accounted for more than 99% of all radical prostatectomies. Median operative time decreased from 185 min in 2023 to 165 min in 2025, with consistent downward trends observed across all surgeons. Linear regression confirmed progressive improvement in operative efficiency, with learning rates ranging from −0.22 to −0.92 min per case. Estimated blood loss was minimal, no patients required transfusion, and major complications occurred in four patients (0.8%). Hospital stay decreased from 2 days to predominantly 1 day. During follow-up, 36 patients developed biochemical recurrence or PSA persistence. Biochemical recurrence-free survival differed significantly according to pathological stage (log-rank p < 0.001), with 24-month estimates of 93.7%, 91.5%, and 82.1% for pT2, pT3a, and pT3b disease, respectively. Conclusions: RARP provides favorable perioperative safety, minimal morbidity, and favorable early oncological outcomes in a high-volume setting. The complete institutional transition from ORP to RARP, together with demonstrated surgeon-specific and institutional learning effects, supports the feasibility and safety of implementing RARP as the institutional standard within a structured robotic program. Full article

(This article belongs to the Special Issue Clinical Advances in Risk Minimization Through Robot-Assisted Surgery)

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16 pages, 508 KB

Open AccessArticle

Safe Introduction of Robotic Gastrectomy Facilitated by ICG-Guided Lymphography

by Jure Salobir, Gašper Horvat, Blaž Trotovšek and Primož Sever

J. Clin. Med. 2026, 15(12), 4538; https://doi.org/10.3390/jcm15124538 - 11 Jun 2026

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Abstract

Background/Objectives: Robotic gastrectomy (RG) for gastric cancer requires structured implementation to ensure oncological safety, particularly in Western centers with lower case volumes. Indocyanine green (ICG)-guided near-infrared lymphography may facilitate adequate lymphadenectomy and reliable tumor localization. We report our stepwise institutional introduction of RG and evaluate the perioperative outcomes and diagnostic accuracy of ICG-guided lymphography. Methods: All consecutive patients who underwent curative-intent RG at the University Medical Center Ljubljana between June 2022 and September 2025 were retrospectively analyzed. The implementation followed a structured stepwise approach, beginning with subtotal gastrectomy and progressing to total gastrectomy after formal training at Severance Hospital, Yonsei University Health System, under the mentorship of Prof. Woo Jin Hyung. ICG was administered endoscopically the day before surgery for tumor localization and intraoperative lymphatic mapping. The operative learning curve was assessed by CUSUM analysis, segmented regression, and bootstrapped plateau estimation. Results: Thirty-eight patients underwent RG (17 subtotal and 21 total). R0 resection was achieved in 100% of cases. The conversion rate was 2.6%. Major complications (Clavien–Dindo ≥ IIIb) occurred in six patients (15.8%). The 30-day mortality rate was 0%, and the 90-day mortality rate was 2.6%. Bootstrapped plateau operative times were 321.2 min (95% Bias-corrected and accelerated confidence interval (BCa CI): 278.4–344.1) for subtotal and 413.5 min (95% BCa CI: 378.1–476.1) for total gastrectomy, with the steepest learning phase confined to the first 2–4 cases. ICG was used in 23 patients. In a validation subset of five patients (259 lymph node stations), the sensitivity and negative predictive value were both 100%, with zero false negatives in 57 ICG-negative stations. Conclusions: RG can be safely introduced using a structured, stepwise strategy supported by training at a high-volume expert center. ICG-guided lymphography demonstrated 100% sensitivity for tumor-draining nodal basins in a small validation cohort (n = 5), supporting the feasibility of the technique during program introduction and warranting prospective evaluation in larger series. Full article

(This article belongs to the Special Issue Clinical Advances in Risk Minimization Through Robot-Assisted Surgery)

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10 pages, 403 KB

Open AccessArticle

Safety of Simultaneous Robot-Assisted Resection of Colorectal Malignancy and Synchronous Liver Metastases

by Miha Petrič, Boštjan Plešnik, Jurij Aleš Košir, Blaž Trotovšek and Jan Grosek

J. Clin. Med. 2026, 15(6), 2424; https://doi.org/10.3390/jcm15062424 - 22 Mar 2026

Cited by 1 | Viewed by 482

Abstract

Introduction: Simultaneous resection of primary colorectal malignancies and liver metastases resulted in outcomes comparable to those achieved through a two-stage procedure, while offering the advantage of a single surgical intervention. The role of the robotic approach remains underexplored because of the lack of comprehensive evidence. The objective of our study was to examine the safety of the robotic surgical platform, assess its short-term outcomes, and compare them with those of open procedures. Methods and Material: We retrospectively analyzed data from an initial small series of eight consecutive patients treated at the UMC Ljubljana between March 2023 and December 2025. These patients underwent robot-assisted simultaneous resection of colorectal malignancies and liver metastases. Their outcomes were compared with those of an open cohort of eight patients. Results: The median operative time was 334 min (range, 193–415 min). No conversions or transfusions were required. Three patients experienced severe complications, accounting for 37.5% of the cohort. The median duration of hospitalization was 9.5 days. The median number of lymph nodes retrieved was 22. Complete (R0) resection of the primary tumor was achieved in all cases (100%), whereas resection of the liver was achieved in 87.5% of the cases. Importantly, there were no instances of re-hospitalization within 30 days or mortality within 90 days. Conclusions: Although the rate of severe complications is relatively high, the robotic surgical platform allows for the safe simultaneous resection of colorectal malignancies and liver metastases, achieving short-term outcomes comparable to those of open surgery. Full article

(This article belongs to the Special Issue Clinical Advances in Risk Minimization Through Robot-Assisted Surgery)

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