Search Results (441)

Background and Objectives: Hysterectomy is a common non-obstetric procedure. Minimally invasive techniques, such as laparoscopy and robot-assisted surgery, have replaced open surgery for benign gynecologic conditions. Robotic surgery offers reduced blood loss and shorter hospital stays but is limited by high costs. Articulating laparoscopic instruments aim to replicate robotic dexterity cost-effectively. However, comparative data on these two approaches in hysterectomy are limited. Materials and Methods: This multicenter study analyzed the outcomes of hysterectomies for benign gynecological diseases using articulating laparoscopic instruments (prospectively recruited) and robot-assisted surgery (retrospectively reviewed). The surgeries were performed by minimally invasive gynecological surgeons in South Korea, Japan, and Taiwan. The baseline characteristics, operative details, and outcomes, including operative time, blood loss, complications, and hospital stay, were compared. Statistical significance was set at p < 0.05. Results: A total of 151 patients were analyzed, including 67 in the articulating laparoscopy group and 84 in the robot-assisted group. The operating times were comparable (114.9 vs. 119.9 min, p = 0.22). The articulating group primarily underwent dual-port surgery (79.1%), whereas the robot-assisted group required four or more ports in 71.4% of the cases (p < 0.001). Postoperative complications occurred in both groups, without a significant difference (9.0% vs. 3.6%, p = 0.17). No severe complications or significant differences in the 30-day readmission rates were observed. Conclusions: Articulating laparoscopic instruments provide outcomes comparable to robot-assisted surgery in hysterectomy while reducing the number of ports required. Further studies are needed to explore the learning curve and long-term impact on surgical outcomes. Full article

Background/Objectives: While robot-assisted radical cystectomy (RARC) has shown potential benefits over open radical cystectomy (ORC), such as reduced blood loss and quicker recovery, its adoption has been limited because of its complexity and long learning curve, especially for urinary diversion. We assessed whether a RARC program with fully intracorporeal urinary diversion could be safely implemented in a hospital with no prior experience in RARC, but with expertise in ORC and other robotic surgeries. We also compared perioperative outcomes and complications between RARC and ORC during the implementation phase. Methods: This retrospective comparative study included 50 consecutive patients who underwent RARC between June 2023 and January 2025 and 50 patients previously treated with ORC. All RARC cases were performed with intracorporeal urinary diversion. A structured proctoring program guided two surgeons through a stepwise training approach by an expert RARC surgeon. Perioperative outcomes and 90-day complications were compared. Results: All RARC procedures were completed fully intracorporeally with no conversions to open surgery. Compared with ORC, RARC was associated with significantly shorter operative times (for ileal conduit diversion) and hospital stays, lower estimated blood loss, and fewer postoperative complications. There were no differences in intraoperative complications. Worst single grade ≥ 3 complications were significantly less frequent in the RARC than the ORC group (11 [11%] versus 21 [21%], p = 0.045). On multivariable analysis, the robotic approach independently predicted fewer any-grade complications (odds ratio 0.81, 95% confidence intervals 0.65–0.95, p = 0.01). Conclusions: A RARC program can be safely and effectively implemented in a previously RARC-naïve centre with existing surgical expertise. The robotic approach offers clear perioperative benefits and may represent a favourable alternative to open surgery. Full article

The management of adult spinal deformity (ASD) has evolved dramatically over the past century, transitioning from external bracing and in situ fusion to complex, technology-driven surgical interventions. This review traces the historical development of spinal deformity correction and highlights contemporary enabling technologies that are redefining the surgical landscape. Advances in stereoradiographic imaging now allow for precise, low-dose three-dimensional assessment of spinopelvic parameters and segmental bone density, facilitating individualized surgical planning. Robotic assistance and intraoperative navigation improve the accuracy and safety of instrumentation, while patient-specific rods and interbody implants enhance biomechanical conformity and alignment precision. Machine learning and predictive modeling tools have emerged as valuable adjuncts for risk stratification, surgical planning, and outcome forecasting. Minimally invasive deformity correction strategies, including anterior column realignment and circumferential minimally invasive surgery (cMIS), have demonstrated equivalent clinical and radiographic outcomes to traditional open surgery with reduced perioperative morbidity in select patients. Despite these advancements, complications such as proximal junctional kyphosis and failure remain prevalent. Adjunctive strategies—including ligamentous tethering, modified proximal fixation, and vertebral cement augmentation—offer promising preventive potential. Collectively, these innovations signal a paradigm shift toward precision spine surgery, characterized by data-informed decision-making, individualized construct design, and improved patient-centered outcomes in spinal deformity care. Full article

Total knee arthroplasty is an extensive orthopedic surgery for patients with severe cases of osteoarthritis. This surgery restores the range of motion in the knee joint and allows for pain-free movement. Advancements in medical techniques used in the surgical zone and implant technology, as well as the management of operations and administration for around two decades prior, have hugely improved surgical outcomes for patients. In this study, advancements in TKA were examined through exploring aspects such as robotic surgery, new implants and materials, minimally invasive surgery, and post-surgery rehabilitation. This paper entails a review of the peer-reviewed literature published between 2005 and 2025 in the PubMed and Google Scholar databases. For predictors, we incorporated clinical relevance together with methodological soundness and relation to review questions to select relevant research articles. We used the PRISMA flowchart to illustrate the article selection system in its entirety. Since robotic surgical and navigation systems have been implemented, surgical accuracy has improved, there is an increased possibility of ensuring alignment, and the use of cementless and 3D-printed implants has increased, offering durable long-term fixation features. The trend in the current literature is that minimally invasive knee surgery (MIS) techniques reduce permanent pain after surgery and length of hospital stays for patients, though the long-term impact still needs to be established. There is various evidence outlining that the enhanced recovery after surgery (ERAS) protocols show positive results in terms of functional recovery and patient satisfaction. The integration of these new advancements enhances TKA surgeries and translates them into ‘need of patient’ procedures, ensuring improved results and increases in patient satisfaction. The aim of this study was to perform a comprehensive analysis of the existing literature regarding TKA advancement studies to identify current gaps and problems. Full article

Background/Objectives: Posterior inferior cerebellar artery (PICA) aneurysms are one of the most difficult cerebrovascular lesions to treat and account for 0.5–3% of all intracranial aneurysms. They have deep anatomical locations, broad-neck configurations, high perforator density, and a close association with the brainstem, which creates considerable technical challenges for either microsurgical or endovascular treatment. Despite its acceptance as the standard of care for most posterior circulation aneurysms, PICA aneurysms are often associated with flow diversion using a coil or flow diversion due to incomplete occlusions, parent vessel compromise and high rate of recurrence. This case aims to describe the utility of microsurgical clipping as a durable and definitive option demonstrating the value of tailored surgical planning, preservation of anatomy and ancillary technologies for protecting a genuine outcome in ruptured PICA aneurysms. Methods: A 66-year-old male was evaluated for an acute subarachnoid hemorrhage from a ruptured and broad-necked fusiform left PICA aneurysm at the vertebra–PICA junction. Endovascular therapy was not an option due to morphology and the center of the recurrence; therefore, a microsurgical approach was essential. A far-lateral craniotomy with a partial C1 laminectomy was carried out for proximal vascular control, with careful dissection of the perforating arteries and precise clip application for the complete exclusion of the aneurysm whilst preserving distal PICA flow. Results: Post-operative imaging demonstrated the complete obliteration of the aneurysm with unchanged cerebrovascular flow dynamics. The patient had progressive neurological recovery with no new cranial nerve deficits or ischemic complications. Long-term follow-up demonstrated stable aneurysm exclusion and full functional independence emphasizing the sustainability of microsurgical intervention in challenging PICA aneurysms. Conclusions: This case intends to highlight the current and evolving role of microsurgical practice for treating posterior circulation aneurysms, particularly at a time when endovascular alternatives are limited by anatomy and hemodynamics. Advances in artificial intelligence cerebral aneurysm rupture prediction, high-resolution vessel wall imaging, robotic-assisted microsurgery and new generation flow-modifying implants have the potential to revolutionize treatment paradigms by embedding precision medicine principles into aneurysm management. While the discipline of cerebrovascular surgery is expanding, it can be combined together with microsurgery, endovascular technologies and computational knowledge to ensure individualized, durable, and minimally invasive treatment options for high-risk PICA aneurysms. Full article

Colorectal surgery has undergone significant advances over the past few decades, driven by the evolution of minimally invasive techniques, particularly laparoscopy and robotics. While laparoscopy is widely recognized for its short-term benefits and oncological safety, the increasing adoption of robot-assisted surgery (RAS) has generated considerable debate regarding its clinical benefits, economic implications, and overall impact on patient outcomes. This narrative review synthesizes the existing evidence, highlighting the clinical and economic aspects of RAS in colorectal surgery, while exploring areas for future research. The findings suggest that RAS offers potential technical advantages, including increased precision, three-dimensional visualization, and improved ergonomics, particularly in anatomically complex scenarios such as low rectal resections. Still, its superiority over laparoscopy remains inconclusive and current evidence is mixed. For colon cancer, meta-analyses and analyses of large cohorts suggest lower conversion rates and faster recovery with RAS, although data are mostly retrospective and lack long-term oncological endpoints. In rectal cancer, emerging evidence from randomized controlled trials demonstrates improved short-term outcomes. Additionally, the recently published three-year results of the REAL trial are the first to demonstrate enhanced oncological outcomes following RAS. However, findings remain inconsistent due to methodological heterogeneity, the absence of patient stratification, and limited data on long-term survival and cost-effectiveness. The available evidence indicates that RAS may offer advantages in selected patient populations, particularly for anatomically complex procedures. Yet, its overall utility remains uncertain. Future studies should emphasize high-quality randomized trials, stratified subgroup analyses, and standardized economic evaluations to better define the role of RAS in colorectal surgery. Full article

(1) Minimally invasive techniques are standard in colorectal surgery, though complete mesocolic excision (CME) with central lymphadenectomy remains technically demanding. Robotic systems may address these challenges. While the DaVinci system is well established, the modular Dexter system allows rapid switching between laparoscopy and robotics. (2) This prospective single-surgeon study compared right hemicolectomy with CME and intracorporeal anastomosis using Dexter, DaVinci, and conventional laparoscopy in 75 patients (25 per group) at a German high-volume center. Outcomes assessed included operative time, complications, lymph node yield, and CME quality. (3) Mean operative time was longest with DaVinci (190.5 min) versus Dexter (164.8 min) and laparoscopy (152.6 min). Intracorporeal anastomosis was more frequent in robotic groups. No significant differences were found in lymph node yield, CME quality, postoperative complications, length of stay, or survival. (4) The ability to convert briefly to laparoscopy during Dexter procedures helped manage challenging steps, especially during the learning curve. The results suggest that Dexter is a safe, feasible alternative to established robotic and laparoscopic techniques, with the added benefits of flexibility and integration into existing workflows. Full article

Background: Oncocytoma and angiomyolipoma (AML) are benign renal tumors that may mimic malignant lesions on imaging. With the increasing use of partial nephrectomy (PN) for renal masses, accurate preoperative characterization of these lesions is essential. This study highlights the role of partial nephrectomy as a valuable diagnostic tool in situations where imaging is inconclusive or raises concern for malignancy without definitive confirmation. In the absence of a reliable preoperative diagnosis, partial nephrectomy provides direct histologic verification with minimal perioperative morbidity. Moreover, it offers curative potential when malignancy is present. By achieving both diagnostic certainty and renal preservation, this approach is well-suited for clinical scenarios in which imaging ambiguity might otherwise result in overtreatment through radical surgery or undertreatment Material and methods: in this retrospective study, we reviewed our 5-year experience (2019–2024), 188 partial nephrectomies—including bilateral procedures and operations on solitary kidneys—using robotic and open approaches. All of these 30 tumors were solid renal masses with indeterminate imaging features or suspicious characteristics suggestive of malignancy, further underscoring the limitations of current preoperative diagnostic modalities. Results: Histopathological evaluation confirmed benign renal tumors in 30 cases, with oncocytoma diagnosed in 18 cases (16 robotic, 2 open) and AML in 12 cases (9 robotic, 3 open). Conclusions: Even when imaging raises suspicion of malignancy or remains inconclusive, many small renal masses are ultimately confirmed as benign upon histopathological examination. This study underscores the diagnostic uncertainty associated with small renal tumors and highlights the value of partial nephrectomy as a decisive diagnostic intervention. In situations where non-invasive modalities fail to provide definitive answers, partial nephrectomy offers tissue confirmation with minimal morbidity. Furthermore, when malignancy is present, this approach ensures appropriate oncologic management while preserving renal function. Our findings support the integration of this strategy into routine clinical practice, particularly when diagnostic clarity is essential for guiding safe and effective treatment. Full article

Inguinal hernia repair is one of the most commonly performed surgical procedures worldwide, with over 20 million cases annually. The evolution of hernia surgery has transitioned from tension-based techniques to tension-free approaches, significantly reducing recurrence rates. This review explores the history, advancements, and current trends in minimally invasive inguinal hernia repair, focusing on laparoscopic techniques such as transabdominal preperitoneal (TAPP), totally extraperitoneal (TEP), single-incision laparoscopic surgery (SILS), and robotic-assisted repair. The importance of prosthetic meshes is emphasized, detailing their mechanical properties, pore size, weight classifications, and biocompatibility. Additionally, various mesh fixation methods—including tacks, sutures, and glues—are analyzed, with a discussion on their impact on postoperative complications such as chronic pain, adhesions, and infection risk. The debate between TAPP and TEP techniques is examined, highlighting the ongoing quest to determine the most effective approach. Emerging advancements, including drug-loaded meshes and dual-layered prosthetics, aim to improve integration and reduce complications. Despite significant progress, no universally superior technique or mesh exists, underscoring the need for individualized surgical approaches. Future research should focus on optimizing materials, refining fixation strategies, and enhancing patient outcomes in minimally invasive hernia repair. Full article

Background/Objectives: The aim of this case series is to evaluate the outcomes and safety of video-assisted mastectomy, illustrating the harmonious collaboration of oncologic and plastic surgery. This novel minimally invasive technique allows immediate prosthetic reconstruction and represents a cost-effective alternative to robotic breast surgery. Methods: Video-assisted, single-port nipple-sparing mastectomies were performed in patients with small to medium-sized breasts, followed by immediate direct-to-implant reconstruction with either prepectoral or dual plane implant placement. The patients’ electronic medical records were analyzed, including demographic characteristics, operative times and histopathology reports. Results: A total of 18 patients underwent successful video-assisted mastectomy, without conversion to traditional open procedure. Fifteen of the operations were risk-reducing mastectomies. Twelve patients had complementary procedures performed concurrently on the previously operated contralateral breast (delayed reconstruction/expander-to-implant exchange). Moreover, three patients benefited from additional minimally invasive techniques during the same surgery (prophylactic laparoscopic hysterectomy). Immediate breast reconstruction with polyurethane or microtextured breast implants up to 450 cc was performed, with satisfactory aesthetic outcomes and no cancer recurrences at 6 to 12 months postoperative follow-up. Early complications included transient hypercapnia, areolar congestion and cellulitis. No skin necrosis or implant-related complications were reported. The most frequently encountered late issues were contour irregularities. Conclusions: Video-assisted mastectomy facilitates the safe removal of proven pathologic or healthy breast tissue with minimal damage to the breast’s skin envelope, facilitating single-stage breast reconstruction. Full article

Real-time 3D reconstruction in minimally invasive surgery improves depth perception and supports intraoperative decision-making and navigation. However, endoscopic imaging presents significant challenges, such as specular reflections, low-texture surfaces, and tissue deformation. We present a novel, deterministic and iterative stereo-matching method based on adaptive support weights that is tailored to these constraints. The algorithm is implemented in CUDA and C++ to enable real-time performance. We evaluated our method on the Stereo Correspondence and Reconstruction of Endoscopic Data (SCARED) dataset and a custom synthetic dataset using the mean absolute error (MAE), root mean square error (RMSE), and frame rate as metrics. On SCARED datasets 8 and 9, our method achieves MAEs of 3.79 mm and 3.61 mm, achieving 24.9 FPS on a system with an AMD Ryzen 9 5950X and NVIDIA RTX 3090. To the best of our knowledge, these results are on par with or surpass existing deterministic stereo-matching approaches. On synthetic data, which eliminates real-world imaging errors, the method achieves an MAE of 140.06 μm and an RMSE of 251.9 μm, highlighting its performance ceiling under noise-free, idealized conditions. Our method focuses on single-shot 3D reconstruction as a basis for stereo frame stitching and full-scene modeling. It provides accurate, deterministic, real-time depth estimation under clinically relevant conditions and has the potential to be integrated into surgical navigation, robotic assistance, and augmented reality workflows. Full article

Background and Objectives: After introducing the single-port robotic surgical system (da-Vinci SP), thyroid surgeries using da-Vinci SP are becoming more popular. Although many methods have been designed for thyroidectomy using the da-Vinci SP, there are very few reports on methods that can perform not only thyroidectomy but also lateral cervical lymph node dissection. In this study, we want to report the first clinical experience with SPRA-MRND (Single Port Robotic Areolar-Modified Radical Neck dissection), using right breast access. Materials and Methods: From April 2024 to January 2025, a total of 24 robotic MRNDs were performed, of which 11 were SPRA-MRNDs. The remaining 13 were performed using conventional BABA surgery. The two data sets were compared through retrospective medical record analysis. Results: There were no significant differences regarding patient characteristics, pathologic variables and oncologic outcomes between the two groups. However, SPRA group showed significantly shorter operation time (182.1 ± 27.5 vs. 213.1 ± 31.5 min, p = 0.017), higher immediate postoperative calcium level (calcium: 8.7 ± 0.5 vs. 8.0 ± 0.8 mg/dL, p = 0.014) and lower drainage amount (98.1 ± 33.2 vs. 146.4 ± 43.2 mL, p = 0.005). Conclusions: Our initial experience has shown that SPRA-MRND is performed safely. We propose SPRA-MRND as a good method for minimally invasive robotic surgery. Full article

Background: In recent years, the use of minimally invasive approaches in pancreatic surgery has progressively increased. One of the key components of pancreaticoduodenectomy is the creation of a pancreato-enteric anastomosis, due to the high risk of postoperative complications, particularly the development of postoperative pancreatic fistula. Among the types of anastomoses, the Blumgart technique has gained popularity due to its ease of reproducibility. Methods: In this guide, we summarize and systematize step by step how to perform a feasible, reproductible and safe robotic Blumgart pancreaticojejunostomy, providing some instructions for its successful completion. Results: Despite the heterogeneity of the published data, duct-to-mucosa Blumgart anastomosis seems to be superior in terms of clinically relevant postoperative pancreatic fistula rates compared with other types of pancreato-enteric anastomosis. The advantages of robotic surgery, such as improved precision, greater control, and enhanced visualization, make robotic Blumgart anastomosis a safe, practical, and reproducible technique in the context of robotic pancreaticoduodenectomy. Conclusions: Robotic Blumgart pancreaticojejunostomy is a safe and feasible technique for pancreato-enteric anastomosis following pancreaticoduodenectomy when surgical technique is systematized step by step. Full article

Background: Despite benefits during open pancreatoduodenectomy (PD), the artery-first approach (AFA) during minimally invasive PD (MIPD) has been poorly investigated. Methods: Data of consecutive patients undergoing MIPD (both laparoscopic (LPD) and robotic (RPD)) from 2020 to 2024 for pancreatic cancer (PC) were prospectively collected and retrospectively analyzed, comparing the surgical and oncological outcomes of LPD with right AFA and RPD with posterior AFA. The rate of ineffective AFA (IAFA), defined in the case of excessive resection time, estimated blood loss, or conversion to laparotomy, was also investigated. Results: 71 patients undergoing MIPD were selected (32 LPD and 39 RPD). Baseline patients’ characteristics only differed for a higher rate of neoadjuvant treatment in LPD and RPD groups, respectively (23.1% vs. 0%, p = 0.0036). No patients underwent conversion. R0 resection was obtained in 74.6% of patients. No difference between the groups was found regarding intraoperative, postoperative, and oncological outcomes except for a greater number of lymph nodes harvested in RPD (24 vs. 17, p = 0.023). IAFA was observed in 12.7% of patients, without difference between the groups (9.4 vs. 15.4%, p = 0.499, in LPD and RPD, respectively). Conclusions: MIPD with AFA was feasible and safe in patients affected by PC. RPD using posterior AFA had a higher number of lymph nodes retrieved when compared to LPD using right AFA. RPD has provided subjective advantages for the surgeon in terms of handling, safety, and reproducibility, although these have not translated into better outcomes. Full article

Background and Objectives: The isthmocele is a pouch-shaped defect in the anterior uterine wall, site of a previous cesarean section, due to a scar defect or dehiscence. The prevalence could be underestimated, but the rate of cesarean section is still high in the world. The preferable technique to correct this anomaly is not clearly indicated in the literature. Our objective is to evaluate the literature on the surgical treatment of isthmocele in pre-Cesarean women treated with minimally invasive technique. Our hypothesis is that robotic treatment is more effective than other procedures in women desirous of having children. Materials and Methods: The words “isthmocele”, “laparoscopy”, “robot” and “cesarean scar pregnancy” were searched on the main online scientific search sources (PubMed, Google Scholar, Scopus, WES, and Embase, etc.). We included articles in English and French, chosen for the relevance to the topic. We have decided to include also surgical corrections of isthmocele linked to pregnancies at the site of the defect, with particular attention to video training explanation. Results: We analyzed the literature about the minimally invasive surgery for the repair of an isthmocele, evaluating 20 articles. Comparing several surgical techniques, robotic-assisted laparoscopy could be an effective method to correct the defect, without high risk of intraoperative complications. Conclusions: As indicated in the literature, robotic tailored excision and repair of isthmocele (and of concomitant cesarean scar pregnancy) could be advantageous and safe, and it is necessary to promote video-training about this technique. Full article