Search Results (213)

Introduction: Postoperative pulmonary complications, particularly pneumonia, remain frequent after esophagectomy and contribute significantly to morbidity. One-lung ventilation (OLV) is a potential modifiable risk factor, but its impact in minimally invasive (MIE) and robot-assisted Ivor Lewis esophagectomy (RAMIE) within European populations is not well defined. Methods: 619 patients undergoing MIE or RAMIE were analyzed. OLV duration was extracted from operative records. Postoperative pneumonia incidence, overall survival, and perioperative outcomes were assessed. ASA classification and other risk factors were considered. Results: The overall incidence of postoperative pneumonia was 18.6%, with no significant difference between MIE (20.4%) and RAMIE (18.2%). Prolonged OLV duration increased pneumonia risk by 4% per 10 min. Female sex and higher ASA classification were also significant risk factors. Likely reflecting early diagnosis and advanced perioperative management, pneumonia did not affect overall survival, which remained comparable between MIE and RAMIE. Conclusions: Prolonged OLV during MIE and RAMIE increases the risk of postoperative pneumonia without significantly affecting overall survival, reflecting effective complication management. OLV duration may serve as a practical intraoperative indicator to guide risk stratification and optimize postoperative care in minimally invasive and robot-assisted Ivor Lewis esophagectomy. Full article

The advent of robotic surgery has revolutionized multiple medical fields, notably in urology, gynecology, and both general and cardiovascular surgery. This article aims to explore the journey of robotic-assisted surgery (multi/single-port) in abdomen and pelvic surgeries, tracing its historical roots, examining its current landscape, and considering the potential future impact. A comprehensive review of the literature was conducted through PubMed/MEDLINE, utilizing keywords such as “robotic surgical systems,” “robotic surgery devices,” and “robotics AND urology.” Reference lists from selected articles were also explored to ensure a broad scope of understanding. The focus was on robotic systems designed for laparoscopic urological surgeries, all of which have been granted regulatory approval for clinical use. The historical trajectory of robotic surgery is traced back to the late 1980s with early systems like the Probot^®, preceding the transformative introduction of the daVinci^® system in the early 2000s. In addition to daVinci^®, the article introduces newer robotic platforms, including Senhance^®, Revo-I^®, Versius^®, Avatera^®, Hinotori^®, Edge^®, Shurui and HugoTM RAS, which are emerging as serious competitors. While daVinci^® has been the dominant force in robotic surgery for over a decade, these new systems are making significant strides with innovative designs, enhanced precision, and improved cost-efficiency. The growing competition among these platforms promises to expand their potential applications, increase accessibility, and optimize surgical outcomes across various specialties. Furthermore, as new technologies continue to evolve, there is a clear need for more extensive clinical trials and real-world data to assess their long-term impact on surgical practices, healthcare delivery, and patient outcomes. It remains to be seen how these advanced systems will integrate into healthcare infrastructures and their ultimate role in shaping the future of minimally invasive surgery. Full article

Background/Objectives: Colorectal cancer (CRC) is one of the most commonly diagnosed malignancies worldwide and a leading cause of cancer-related mortality. Surgical resection remains the cornerstone of curative treatment. Over the past two decades, robotic-assisted surgery has emerged as an evolution of minimally invasive surgery, aiming to overcome several limitations of conventional laparoscopy. This narrative review summarizes the current state of the art of robotic surgery in CRC. Methods: A narrative review of the literature was conducted using PubMed/MEDLINE and Scopus databases, focusing on publications from 2015 to 2026. The review provides an overview of robotic platforms and summarizes the available clinical evidence. Priority was given to randomized controlled trials, meta-analyses, large observational studies, and clinical practice guidelines. The review focuses on major commercially available robotic systems, including the da Vinci^®, Hugo™ RAS, and Versius^® platforms, as well as emerging robotic technologies. Results: Robotic colorectal surgery showed potentially favorable perioperative and oncological outcomes compared with laparoscopy. In rectal cancer, robotic approaches were associated with improved total mesorectal excision quality, lower conversion rates, and improved postoperative functional outcomes. Emerging evidence also suggested potential improvements in disease-free survival and local disease control following robotic rectal surgery. In colon cancer, robotic colectomy were associated with lower conversion rates, reduced blood loss, and faster postoperative recovery, with comparable long-term oncological outcomes. However, robotic procedures showed longer operative times and higher procedural costs. Conclusions: Robotic colorectal surgery appears to be a safe and effective minimally invasive approach, particularly in rectal cancer surgery. The development of new robotic platforms and increasing market competition may improve cost sustainability and expand its future role in colorectal cancer management. Full article

Background: Prostate cancer (PCa) imposes a substantial global health burden, with robot-assisted radical prostatectomy (RARP) established as the gold standard for localized disease. While da Vinci^® Xi maintains market dominance, Toumai^® MT-1000 offers a potentially cost-competitive alternative lacking prospective validation. Objective: To evaluate perioperative safety, oncologic quality (primary endpoint: positive surgical margins), early functional recovery (continence), and surgeon learning curve between Toumai^® MT-1000 (T-RARP) and da Vinci^® Xi RARP (DV-RARP) performed in high-volume European practice. Materials and Methods: This is a prospective single-center comparative study carried out at Policlinico Gemelli, Rome (May–November 2025), enrolling 80 patients with localized or locally advanced PCa, elected for radical prostatectomy and casually allocated to receive surgery with Toumai or the da Vinci robotic platform. The primary endpoint was the comparison of positive surgical margin (PSM) rates. Secondary endpoints included the comparison of operative time (skin-to-skin), estimated blood loss, length of hospital stay, 45-day postop outcomes, specifically Clavien–Dindo complications, urinary continence recovery (0–1 pad/day), and IIEF-5 scores. Learning curve was evaluated through the cumulative summation (CUSUM) analysis of operative times and linear regression of operative times (n = 80 cases). The analyses used STATA 19 with two-sided tests at p < 0.05 significance. Results: Baseline characteristics showed balance between cohorts (p > 0.05 for most covariates). Perioperative outcomes proved equivalent: median operative time (OT) was 192.5 min (IQR 165–230) for Toumai^® versus 183.5 min (IQR 147–225) for da Vinci^® Xi (p = 0.38); estimated blood loss (EBL) was 150 mL in both groups (p = 0.87); length of hospital stay (LOS) was 2 days in both groups (p = 0.92). PSM rates were identical at 17.5% (p = 0.79). Continence recovery reached 72.5% versus 80% (p = 0.43). Complications (Clavien–Dindo ≥ II) occurred in 7.5% versus 12.5% of cases (p = 0.45). The CUSUM analysis demonstrated operative time proficiency after only four procedures; operative time regression showed no significant trend (p = 0.38). Conclusions: Toumai^® MT-1000 demonstrates similar performance to da Vinci^® Xi across different RARP quality metrics, with no detectable learning curve for surgeons previously experienced with da Vinci. These findings support a safe integration of cost-effective platforms into clinical practice, pending multicenter randomized confirmation. Full article

Background: Robot-assisted surgery has become increasingly used across multiple specialties; however, its integration into aesthetic plastic surgery remains limited. Individualized patient requirements, such as concealed scar placement, superficial soft tissue dissection, and patient-specific docking angles, are major challenges to its adoption, unlike in other specialties. This review aimed to evaluate the current use of robotic systems in plastic surgery, with a particular focus on aesthetic procedures, operative outcomes, and existing technological limitations. Methods: Multiple databases, including PubMed, Scopus, and Google Scholar, were extensively searched to identify studies published between 2011 and 2026. Data on robotic platforms, operative duration, rehabilitation outcomes, and aesthetic indications were extracted and analyzed. Robotic systems such as da Vinci, Symani, MUSA, and ARTAS demonstrated feasibility across reconstructive subspecialties. However, their clinical application remains limited, as purely aesthetic procedures are rare, highlighting a significant lack of standardized docking methods and dedicated instruments. Results: The data show that robotic platforms offer great advantages, such as precision and minimally invasive access; however, their high costs, bulky instrumentation, and limited docking methods represent barriers to their adoption in aesthetic surgery. Conclusions: Robot-assisted aesthetic plastic surgery remains in the early stage of development. Further research is required to establish reproducible docking standards and expand its clinical indications. Advancements in single-port systems, artificial intelligence integration, and surgeon training will facilitate broader clinical implementation. Full article

Robotic colorectal surgery has revolutionized minimally invasive techniques worldwide, offering a more stable operative platform, superior 3D visualization, and wristed instrumentation for challenging pelvic dissections. This narrative review describes the global evolution of robotic colorectal surgery, from the use of multi-port to single-port systems, modular platforms and endoluminal robotic devices. Using Hong Kong’s role as an innovation and research hub, this review demonstrates how integrated innovation, structured training, workflow efficiencies and digital policy frameworks can overcome barriers and inform international implementation of robotic colorectal surgery. Since 2005, The Chinese University of Hong Kong has been pioneering the use of robotic platforms in colorectal surgery, performing first-in-human trials of the da Vinci SP system, the locally developed Sentire C1000 and the EndoMaster EASE for robotic ESD. There is increasing evidence supporting the use of the robotic platform over laparoscopic colorectal surgery, with benefits including reduced open conversions, fewer intraoperative complications, shorter hospital stay, better long-term functional outcomes and improved oncologic outcomes. However, several challenges remain before robotics can be implemented widely on a global scale, such as higher initial capital costs, limited training access, surgeon credentialing and governance for AI-driven data analytics. Full article

Background: Endometrial cancer is one of the most common cancers in women. In recent years, minimally invasive methods such as laparoscopy and robotic surgery have become very popular. Robotic surgery is a rapidly evolving and continuously improving modality. Methods: The main goal of our study was to compare patients operated on with the da Vinci robot with laparoscopy. The study included 300 patients with endometrial cancer who underwent surgery using the da Vinci robotic system and 80 patients with endometrial cancer who underwent laparoscopic surgery. Results: We have demonstrated that robot-assisted surgery is associated with significantly lower blood loss and a reduced risk of complications, whereas operative time remains shorter with laparoscopy. At the same time, we have observed that prolonged robotic operative time occurs particularly in older patients and those with a higher BMI, which should be taken into account when planning surgical procedures. Conclusions: Further research is needed to better define the groups of patients who benefit most and to optimize surgical strategies. Full article

Background/Objectives: An accurate preoperative assessment of prostate cancer malignancy is crucial for risk stratification and selection of the optimal treatment strategy. This study assessed the concordance of Gleason scores between MRI–TRUS fusion biopsy and radical prostatectomy specimens, and identified clinical and histopathological factors associated with post-procedural Gleason score upgrading. Methods: This retrospective analysis involved patients who underwent transperineal MRI–TRUS fusion biopsy followed by radical prostatectomy from 2020 to 2025. Concordance, upgrading, and downgrading of the Gleason score were assessed by comparing biopsy results with the final histopathological examination. Clinical parameters (age, PSA level, prostate volume, and PSA density) and histopathological features of biopsies (Gleason score and percentage of prostate lobes affected by cancer) were analyzed. Multivariate logistic regression models were stratified by PSA level (<10 ng/mL and >10 ng/mL). Results: Gleason score concordance was found in 53.1% of the 603 patients analyzed, upgrading in 29.9%, and downgrading in 17.1%. Higher Gleason scores on biopsy were independently associated with a lower risk of upgrading in the entire cohort and in both PSA subgroups. Larger tumor extent on biopsy was associated with a lower risk of upgrading, with heterogeneous dependencies between prostate lobes. The other clinical parameters showed no independent association with upgrading. Conclusions: Gleason score upgrading remains common after radical prostatectomy. The risk of this progression is primarily related to the histopathological features of the biopsy rather than to baseline clinical parameters, reflecting the limitations of biopsy as a sampling method and the biological heterogeneity of prostate cancer. Full article

Background: Robotic-assisted thoracic surgery is increasingly recognized as an advanced minimally invasive technique for treating non-small cell lung cancer, offering technical advantages such as enhanced precision and visualization. Although numerous studies have been published worldwide, there are no comparable data from Poland. Therefore, evidence on the perioperative safety and oncologic adequacy of robotic-assisted lobectomy during early phase of program implementation within the Polish healthcare system remains limited. Methods: This retrospective, single-institution observational study included 81 consecutive patients who underwent robotic-assisted lobectomy for primary NSCLC between January 2022 and December 2024. All procedures were carried out using the da Vinci Xi system with a standardized four-arm portal approach. Clinical, perioperative, and pathologic parameters were prospectively collected and analyzed descriptively. Postoperative complications were classified according to Clavien-Dindo. Results: The median patient age was 70 years (IQR: 65–74), 52% were male, and 67% had a history of smoking. Adenocarcinoma was the predominant histologic subtype (51%). The median operative time was 176 min (IQR: 149–220). There were no conversions to thoracotomy and no 30-day mortalities. Postoperative complications occurred in 24% of cases, with prolonged air leak being most common (17%). The median hospital stay was 8 days (IQR: 6–10). R0 resection was achieved in 96% of patients, with a median of 14 lymph nodes dissected across 5 nodal stations. Conclusions: Robotic-assisted lobectomy performed during the early implementation phase of a national program demonstrated low morbidity, high rates of complete (R0) resection, and adequate lymph node yields consistent with international benchmarks. These results support the feasibility of robotic lobectomy within the Polish healthcare setting; however, the single-surgeon, single-center design limits generalizability. Further multicenter prospective studies are needed to confirm reproducibility, assess learning curves, and evaluate long-term oncologic outcomes. Full article

Sulfur dioxide is a trace constituent of the upper atmosphere of Venus but plays a dominant role in the photochemistry above the cloud tops. Because SO₂ undergoes indirect dissociation to a relatively long-lived excited state, it has a line-type absorption spectrum in the dissociation region (~190–220 nm). This leads to strong isotopic fractionation under optically thick conditions, a process referred to as self-shielding. Here, I use SO₂ cross-sections, shielding functions, and a simple steady-state photochemical model to estimate sulfur isotope ratios in SO₂. The results indicate that large isotope depletion relative to SO₂ in the deep atmosphere is expected in SO₂ below 70 km altitude, with δ³⁴S ~ −100 to −200 permil. This is readily detectable by the VTLS tunable laser spectrometer planned for the NASA DAVINCI mission. Full article

Introduction: Robotic surgery training requires effective simulation methods to ensure proficiency. Virtual reality (VR) simulators and physical models offer different approaches. Methods: A study was conducted with 30 surgical residents, divided into two groups: one trained on a high-fidelity physical simulator and the other on a VR simulator. Both groups completed standardized exercises, followed by an assessment of their surgical performance using the da Vinci Surgical System simulator. Performance scores were analyzed using statistical methods, including t-tests and multiple linear regression. Results: Residents trained on the physical simulator obtained higher scores compared with those using VR simulation, with a statistically significant difference in overall scores (76 ± 17 vs. 34 ± 29; p < 0.001). The use of the physical simulator was the most influential factor in improved performance, independent of the year of residency. Conclusions: High-fidelity physical simulators enhance robotic surgical training compared to VR simulators. Full article

In clinical practice, the coexistence of Superior Mesenteric Artery (SMA) syndrome (also known as Wilkie’s syndrome) and Celiac Artery Compression Syndrome (also referred to as Dunbar’s syndrome) is extremely rare. This combined pathology is characterized by simultaneous impairment of blood flow in the celiac trunk and compression of the duodenum, which complicates both diagnosis and treatment strategy selection. Traditional open surgical correction is associated with significant invasiveness due to the complexity of the anatomical relationships involved. Minimally invasive approaches, including robot-assisted surgery, allow precise dissection within confined anatomical spaces. This article presents a clinical case of simultaneous robot-assisted decompression of the celiac trunk and duodenum using the da Vinci Xi system. The case demonstrates the technical feasibility of a combined minimally invasive approach for the management of concurrent vascular and duodenal compression. Full article

Background: The da Vinci single-port reduced-port robotic distal gastrectomy (spRRDG) approach shows promise in enhancing surgical recovery while maintaining oncologic safety, but robust multicenter comparative data across diverse robotic platforms are lacking. We aimed to compare clinical outcomes between spRRDG and conventional RRDG (cRRDG) using Korean Laparoendoscopic Gastrointestinal Surgery Study-13 data. Methods: Clinicopathologic variables and perioperative outcomes concerning 820 patients who underwent curative RRDG with D1+ or D2 lymph node dissection (LND) (da Vinci spRRDG, n = 86; cRRDG, n = 734) were analyzed. We compared continuous variables using Student’s t- or Wilcoxon rank-sum tests, as appropriate, and categorical variables using χ² or Fisher’s exact tests. Subgroup analyses were performed according to the extent of LND (D1+ vs. D2). Statistical significance was defined as p < 0.05. Results: spRRDG involved a longer operative time than cRRDG (227.06 ± 6.19 vs. 183.58 ± 2.18 min, p < 0.0001) and fewer retrieved LNs (rLNs) (36.38 ± 1.53 vs. 46.52 ± 0.66, p < 0.0001), but showed superior enhanced recovery after surgery (ERAS)-related outcomes, including shorter hospital stay (4.06 ± 0.23 vs. 5.95 ± 0.13 days), and earlier gas passage (postoperative day [POD] 2.24 ± 0.10 vs. 3.08 ± 0.04) and soft diet initiation (POD 1.59 ± 0.14 vs. 2.89 ± 0.07; all p < 0.0001). In subgroup analyses, the number of rLNs was lower in D1+ spRRDG (34.09 ± 1.58 vs. 44.36 ± 0.72, p < 0.0001), but remained above the oncologic threshold (≥16 LNs). In D2 dissections, no significant difference was observed (45.71 ± 3.69 vs. 53.30 ± 1.39, p = 0.1030). Faster postoperative recovery in spRRDG persisted after adjustment. Conclusion: spRRDG exhibited lower rLNs than cRRDG but remained within an oncologically acceptable range. Comparable complication rates and significantly improved ERAS outcomes suggest spRRDG is safe and feasible; however, its clinical application should remain limited to early gastric cancer until robust evidence from prospective studies emerges. Full article

Laparoscopic surgery provides minimally invasive access to the abdominal cavity but poses control challenges for robotic systems due to the fulcrum constraint at the abdominal wall and the simultaneous interaction of the instrument with both the abdominal wall and internal soft tissue. While current clinical platforms (e.g., da Vinci) primarily rely on visual feedback and do not possess force sensors at the instrument tip, the transition to autonomous robotic surgery requires precise force feedback to ensure safety and effective tissue manipulation. Therefore, developing methods to decouple interaction forces using a single force sensor configuration is a critical enabling technology for future instrumented surgical robots. This paper presents a force-decoupling method that estimates, using only one force sensor, the individual forces applied to the abdominal wall and to internal soft tissue through a viscoelastic modeling approach based on Maxwell elements. Two configurations were evaluated, showing that a single-element Maxwell model provides the best trade-off between accuracy and computational complexity, achieving estimation errors of 9% and 13% for abdominal wall forces, with a root mean square error (RMSE) below 0.36 N. The method was implemented and experimentally validated in a force-controlled robotic system, demonstrating its effectiveness in improving force regulation and interaction safety without requiring additional sensors. Full article

Introduction: Since its introduction in 1994, robot-assisted surgery has advanced significantly and has become a widely accepted tool in minimally invasive surgery. Over the past two decades, robotic technology has also been increasingly adopted in pediatric surgery. Currently, only two robotic systems are officially approved for pediatric use: the da Vinci surgical system and the Senhance system, both of which have certain limitations. To address these challenges, new robotic platforms such as the Versius system are being developed. Materials and Methods: Following approval from the institutional bioethics committee, a total of 14 pediatric patients underwent robotic-assisted surgery using the Versius robotic system between 10 June and 21 October 2024. Procedures included pyeloplasty, vascular hitch, and cholecystectomy. Results: Procedures with the Versius system were performed including children as young as six years of age and with body weight as low as 15 kg. All procedures were completed successfully without conversion to conventional laparoscopy or open surgery. No intraoperative complications were recorded. The overall postoperative complication rate was 21.4% (3/14 cases), including one anastomotic leak, one case of postoperative hematuria, and one case of postoperative ascites. Discussion: The Versius system represents a promising robotic platform for pediatric surgery, offering a different approach to robotic surgery through modularity, mobility, and compatibility with 5 mm instruments. However, several challenges remain, including prolonged setup and docking times, cable management issues, arm conflicts, and limited access to advanced instrumentation. Nevertheless, with ongoing technological development, robotic surgery is likely to play an increasingly important role in pediatric surgical care. Full article