Search Results (226)

Background and Objectives: Laparoscopic surgery has evolved with the integration of robotic systems, offering enhanced precision and ergonomic benefits. However, conventional robotic systems often lack haptic feedback and are associated with high cost. The Saroa surgical system is a compact, pneumatically driven robot that integrates real-time haptic feedback, potentially addressing the limitations associated with conventional robotic systems. This preliminary study reports the first clinical use of the Saroa system in gynecologic surgery, aiming to assess its feasibility, safety, and usability in robot-assisted hysterectomy. Materials and Methods: Five patients underwent robot-assisted total laparoscopic hysterectomy using the Saroa surgical system. The clinical outcomes, setup and console times, estimated blood loss, and subjective surgeon evaluation were recorded. Results: All surgeries were successfully completed without any intraoperative complications or the need for conversion to conventional surgery. The median setup time was 12 min, the console time was 211 min, and the median blood loss was 80 mL. Surgeons subjectively noted that the system’s real-time haptic feedback substantially improved precision during vaginal cuff tissue manipulation, based on their tactile sensation and real-time force display, thereby reducing the perceived risk of traction-related tissue injuries. Conclusions: This study represents the first clinical application of the Saroa surgical system in gynecologic surgery. The findings suggest that the system is feasible and safe for robot-assisted hysterectomy. Despite limitations such as small sample size and the absence of objective force data, the favorable surgeon-reported experience highlights the potential value of haptic feedback in improving surgical performance. These results support further investigation through larger, controlled studies and quantitative performance evaluation. Full article

For more than 20 years, after the introduction of the first robotic system, research on prostate cancer (PCa) surgery has mainly focused on evaluating outcomes of Robotic-Assisted Radical Prostatectomy (RARP). In the last few years, however, a new generation of innovative techniques, surgical approaches, and expanded indications have emerged. The Single Port (SP) robotic system was the first real hardware innovation in robotic surgery, and has already demonstrated advantages in terms of shorter length of stay, better cosmetic results and reduced postoperative pain. Artificial Intelligence (AI)-powered algorithms are being proposed as reliable tools for surgical assistance, aiding in standardization and mass implementation of robotic training. New surgical indications are emerging on the basis of patient and tumor characteristics. The extensive adoption of PCa screening and the precision of diagnostic tools have increased the rate of PCa diagnoses in a localized stage. Partial prostatectomy, despite needing further validation, has emerged as a safe and minimally invasive treatment option for confined tumors, able to minimize the side effects of prostate surgery. For locally advanced PCa, radioguided surgery has not only enhanced the oncological effectiveness of lymphadenectomy by enabling the precise identification and extraction of pathological lymph nodes, but has also contributed to minimizing the side effects associated with unnecessarily extensive dissections. Finally, in light of the increased efficacy of modern systemic therapies and the longer life expectancy, RP is currently being evaluated for primary tumor management in the metastatic phase. Despite the novelty of the aforementioned treatment options, they are already set to shape the future evolution of PCa management and international guidelines. Full article

Background: The diagnostic work-up of small peripheral pulmonary nodules (PPNs) is becoming increasingly important, especially in light of the upcoming lung cancer screening programs and recommendations in practice. The systematic clinical introduction of the ION robotic-assisted navigational bronchoscopy (RNB) system represents a significant innovation in Germany, whereas clinical experience in the United States has already yielded promising results. The objective of this study is to present the outcomes of the first 50 patients examined with the ION system at our institutions. Materials and Methods: This is a retrospective, single-center analysis. We included the first 50 consecutive patients who underwent diagnostic evaluation of pulmonary nodules using the ION-RNB system, either in the Department of Thoracic Surgery or the Department of Pulmonology. Results: A total of 50 patients were evaluated, including 24 from the Department of Thoracic Surgery and 26 from the Department of Pulmonology. The pulmonary nodules were found in the peripheral third of the lung in 74% of cases, in the middle third in 18% of cases, and in the central third in 8% of cases. The mean lesion size was 1.64 cm (±0.91 cm). In all, 84% of the nodules were solid, 4% were subsolid, and 12% presented as ground-glass opacities (GGOs). Cone beam computed tomography (CBCT) was used to confirm tool-in-lesion position in 68% of cases compared to C-arm fluoroscopy in 32%. Additionally, radial endobronchial ultrasound (rEBUS) was applied in 30% of procedures. The overall diagnostic yield, independent of imaging modality or histological processing method, was 78%. When CBCT and formalin-fixed paraffin-embedded (FFPE) histological analysis were utilized, the diagnostic yield exceeded 90%. Conclusions: Initial clinical experience with the ION-RNB system in Germany shows encouraging results. The high diagnostic accuracy underlines the system’s potential for evaluating peripheral pulmonary lesions precisely. The use of advanced imaging techniques, particularly CBCT, and the choice of histopathological processing methods are critical variables in optimizing patient-centered diagnostic pathways. Further prospective studies are warranted to assess the long-term clinical utility of robotic-assisted bronchoscopy in diverse clinical settings. Full article

Urologic oncological surgery increasingly makes use of robotic systems to realize precise and minimally invasive resections, convent to shorter hospital stays and faster recovery times. The dexterity gains enabled through procedures such as robot-assisted (RA) prostatectomy have helped realize significant advancements in recent years. Complementing these effects via the used of hybrid tracers that illuminate surgical targets, i.e., cancerous tissue, has helped advance the surgical decision making via enhanced visualization. A well-known example is Indocyanine green (ICG)-Technetium-99m (^99mTc)-nanocolloid, a hybrid extension of the radiopharmaceutical ^99mTc-nanocolloid. These hybrid tracers provide a direct link between preoperative imaging roadmaps and intraoperative target identification, and improve efficiency, accuracy, and confidence of the urologist in procedures such as sentinel lymph node biopsy (SLNB). Receptor-targeted hybrid tracer analogues, for e.g., prostate specific membrane antigen (PSMA), are also being explored as an extension of the ongoing efforts that use radiotracers such as ^99mTc-PSMA-I&S. Together, these efforts jointly pave the way for novel techniques in intraoperative lesion localization in other urological malignancies. This narrative review discusses the potential use of hybrid tracers in robotic oncological urology, including different imaging techniques and their applications for tumor localization for prostate, bladder, and kidney cancer. Full article

Background/Objectives: This study aimed to evaluate and compare the perioperative outcomes of robot-assisted partial nephrectomy (RAPN) for complex renal tumors performed using the novel Japanese Hinotori Surgical Robot System (HSRS) and the established Da Vinci Surgical System (DVSS). Methods: Of 484 consecutive patients who underwent RAPN at our institution, 126 with complex renal tumors were included in the DVSS group, and 48 such patients were included in the HSRS group. Complex tumors in this series were defined by the presence of at least one of the following factors: cT1b, completely endophytic, hilar, cystic, or ipsilateral multiple tumors. Results: Following 1:2 propensity score matching, 74 and 37 patients were included in the DVSS and HSRS groups, respectively. Post-matching, most covariates’ absolute standardized mean difference (SMD) was less than 0.1, indicating effective baseline imbalance correction. All RAPN procedures using HSRS were completed without conversion to open surgery, nephrectomy, or Clavien–Dindo ≥3 postoperative complications. No significant differences in major perioperative outcomes were observed between DVSS and HSRS, including operative time (178 vs. 186 min), console time (115 vs. 115 min; encompassing cockpit time for HSRS), warm ischemia time (15 vs. 15 min), and estimated blood loss (51 vs. 30 mL). Positive surgical margin rates (DVSS 1.4% vs. HSRS 5.4%) and Trifecta achievement rates (94.6% vs. 91.9%) were also comparable, with no significant differences. Conclusions: These findings suggest that, even in patients with complex renal tumors, RAPN performed using the HSRS can achieve perioperative outcomes comparable to those obtained with the established DVSS. Full article

Robotic-assisted surgery has gradually established its role in uro-oncological cases that demand a high level of precision, optimising surgeon ergonomics and decreasing fatigue whilst maintaining optimal clinical outcomes. With the novel Hinotori surgical robot (Medicaroid Corporation (Kobe, Hyogo, Japan)) launched in Japan back in 2019, it has now demonstrated its use case across various clinical series of different surgeries. We sought to narratively synthesise the initial feasibility of the Hinotori robotic system in urology. A systematic, comprehensive literature search was conducted across various databases from September 2024 to October 2024. Relevant keywords within the scope of this study were generated for a more accurate search. After exclusion and removal of duplicates, a total of nine articles were included for review. Among the included studies, one study reported data solely on radical prostatectomy for prostate cancer, two studies reported on robotic-assisted nephroureterectomy for renal tumours, two studies reported on partial nephrectomy performed for renal masses, two studies reported on radical nephrectomy carried out for renal malignancies and one study reported on robotic-assisted adrenalectomy for adrenal cancer. Lastly, one study collectively reported on outcomes pertaining to partial nephrectomy, partial nephrectomy, vesicourethral anastomosis and pelvic lymph node dissection in a porcine model, as well as partial nephrectomy, radical prostatectomy and pelvic lymph node dissection in cadavers. The current literature supports its non-inferiority to the well-established Da Vinci system, with no major drawbacks or concerns identified when comparing parameters such as intraoperative time, estimated blood loss (EBL), perioperative events (transfusions, conversion to open surgery), length of hospital stay and major postoperative complications. Future studies involving larger cohorts and more complex surgical cases are essential to further evaluate the efficacy and safety of the Hinotori system. The new Hinotori robotic system offers unique three-dimensional features as a non-inferior robotic platform alternative that has proven clinically safe thus far in its use. Larger scale studies and randomised trials are eagerly awaited to assess and validate more holistically its clinical utility. Full article

Background: This study was designed to evaluate and contrast the surgical outcomes between coaxial robotic single-site myomectomy (RSSM) performed using the da Vinci Xi system and da Vinci SP system. Methods: A retrospective review was conducted on 81 women who underwent coaxial RSSM and 108 women who underwent myomectomy with the da Vinci SP system between October 2020 and January 2024. Propensity score matching was performed based on myoma count, the dominant myoma’s maximum diameter, and the myoma type according to the International Federation of Gynecology and Obstetrics (FIGO) classification. Patient characteristics and surgical outcomes were evaluated and compared between the two groups. Results: Compared to the SP group, the coaxial RSSM group showed significantly lower estimated blood loss (102.33 ± 61.01 vs. 203.98 ± 163.15 mL, p < 0.001), shorter operative time (91.22 ± 18.25 vs. 148.69 ± 45.62 min, p < 0.001), and smaller hemoglobin decrement (1.69 ± 0.93 vs. 2.85 ± 1.30, p < 0.001). However, hospital stay was shorter in the SP group than in the coaxial group (2.06 ± 0.24 vs. 4.07 ± 0.76 days, p < 0.001). There were no statistically significant differences in postoperative complications, including ileus, fever, or wound dehiscence. Additional comparisons using cases performed by four different surgeons yielded results consistent with the one-to-one surgeon comparison. Conclusions: Coaxial RSSM was associated with a shorter operative time and lower blood loss compared to SP myomectomy. A prospective study is warranted to validate and further compare the surgical outcomes of the two techniques. Full article

Background and Objectives: To evaluate the feasibility and clinical outcomes of a novel non-mesh robot-assisted sacrocolpopexy (RSC) using autologous round ligament (ARL) grafts in patients with pelvic organ prolapse (POP). Materials and Methods: This retrospective study included 92 patients who underwent non-mesh RSC with ARL grafts at Kagoshima University Hospital between August 2020 and June 2024. All patients met the inclusion criteria for symptomatic POP-Q stage II or higher and elected to undergo non-mesh RSC. The procedures were performed using the da Vinci^® Xi or the hinotori™ Surgical Robot System. The clinical characteristics, operative data, complications, and recurrence rates were analyzed. Results: ARL harvesting was feasible in all patients, and the non-mesh RSC procedure was completed without conversion to open surgery or any intraoperative complications. The median operative time was 251 min, and the median blood loss was 30 mL. Postoperative complications of Clavien-Dindo grade ≥ 2 occurred in five patients (5%), all of whom developed pelvic infections. De novo stress urinary incontinence was observed in one patient (1%). POP recurrence occurred in seven patients (8%) during a median follow-up of 3 months (range, 3–18 months), all of whom presented with cystocele. Five patients underwent reoperation, and two were managed conservatively. All patients experienced postoperative symptomatic improvement. A higher BMI and advanced POP-Q stage were significant predictors of recurrence. Conclusions: This is the first report of non-mesh RSC using an ARL graft. The procedure is feasible and effective, avoids the use of synthetic mesh, and offers short-term outcomes comparable to those of mesh-based RSC. ARL-based RSC represents a promising alternative, especially for patients at risk of mesh-related complications. Long-term follow-up is required to confirm durability. Full article

Background/Objectives: The potential advantages of robotic assistance in spinal procedures are a growing area of interest, and patient perception plays a key role in its broader acceptance. However, public perception of robotic surgery in spinal operations remains unexplored. This study aims to assess the general public’s perceptions, expectations, and concerns regarding robot-assisted spine surgery. Methods: In the fall of 2024, a questionnaire was distributed to attendees at a public open day at the Neurocenter of Southern Switzerland, where the Globus ExcelsiusGPS™ spine surgery robot was demonstrated live on a mannequin. The 15-item questionnaire assessed demographic data, prior knowledge of medical robots, mental representations of surgical robots, expectations, and emotions after witnessing the demonstration. Data were analyzed using descriptive statistics, chi-square, Wilcoxon, McNemar tests, and logistic regression analysis. Results: A total of 109 questionnaires were collected. Most participants were female (64.4%) and had no direct experience with spinal pathology (79.8%). While 87.2% were aware of robotic surgery in general, only 65.1% specifically knew about its use in spine surgery. After witnessing the live demonstration, 81.9% felt reassured by the robot′s presence in surgery, compared to 61.3% before the demonstration (p = 0.007). Preference for robot-assisted surgery increased from 50.5% to 64.5% (p < 0.001). Notably, individuals with back-related issues showed greater confidence in the robot’s capabilities (p = 0.032). Conclusions: The general public perceives robotic spine surgery positively, viewing it as faster, more precise, and capable of performing tasks not readily performed by humans. The study highlights the importance of live demonstrations in enhancing trust and acceptance of robotic systems. Its findings have economic implications, as patients may be more likely to choose hospitals offering robot-assisted spine surgery. However, it is essential to also acknowledge alternative methods, such as computer-assisted navigation, which has demonstrated efficacy in spine surgery. Full article

Sensorineural hearing loss occurs when cochlear hair cells fail to convert mechanical sound waves into electrical signals transmitted via the auditory nerve. Cochlear implants (CIs) restore hearing by directly stimulating the auditory nerve with electrical impulses, often while preserving residual hearing. Over the past two decades, robotic-assisted techniques in otologic surgery have gained prominence for improving precision and safety. Robotic systems support critical procedures such as mastoidectomy, cochleostomy drilling, and electrode array (EA) insertion. These technologies aim to minimize trauma and enhance hearing preservation. Despite the outpatient nature of most CI surgeries, surgeons still face challenges, including anatomical complexity, imaging demands, and rising costs. Robotic systems help address these issues by streamlining workflows, reducing variability, and improving electrode placement accuracy. This review evaluates robotic systems developed for cochlear implantation, focusing on their design, surgical integration, and clinical outcomes. This review concludes that robotic systems offer low insertion speed, which leads to reduced insertion forces and lower intracochlear pressure. However, their impact on trauma, long-term hearing preservation, and speech outcome remains uncertain. Further research is needed to assess clinical durability, cost-effectiveness, and patient-reported outcomes. Full article

Obesity is a major global health challenge associated with significant metabolic and gastrointestinal comorbidities. While metabolic and bariatric surgery remains the gold standard for durable weight loss, the desire for additional options has fueled the development of endoscopic bariatric therapies (EBTs) as another tool for weight loss. This review examines established EBTs, including endoscopic sleeve gastroplasty (ESG), intragastric balloons (IGBs), and transoral outlet reduction (TORe), alongside emerging therapies such as duodenal mucosal resurfacing (DMR), incisionless anastomosis creation, and fully automated endoscopic gastric remodeling systems. ESG has demonstrated durable weight loss, favorable safety, and superior cost-effectiveness compared to pharmacotherapy alone, while combination strategies using EBTs and anti-obesity medications (AOMs), particularly GLP-1 receptor agonists, have resulted in greater total-body weight loss than either modality alone. Genetic variation, particularly within the leptin–melanocortin pathway, may predict response to endoscopic interventions and guide personalized treatment selection. Novel investigational procedures such as DMR, automated or robotic gastric remodeling, and magnetic or ultrasound-assisted gastric bypass show promising early results. Endoscopic therapies are poised to become increasingly central to the personalized, scalable management of obesity and related metabolic diseases. 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: A surgical therapy for breast cancer, robot-assisted nipple-sparing mastectomy (RANSM) has gained popularity because it may offer better cosmetic results than traditional nipple-sparing mastectomy (CNSM). Data regarding RANSM’s viability and security are still scarce, nevertheless. Comparing the surgical results of RANSM and CNSM in a single-center experience was the goal of this study. Methods: 57 patients who had nipple-sparing mastectomy procedures performed at our facility between January and December 2021 were included in this retrospective research. Of them, 49 patients had CNSM, and 8 patients had RANSM. Analysis was performed on pain scores, length of hospital stay, postoperative complications, patient demographics, and operating time. Results: The mean total operative time was longer for RANSM group was 148 min compared to 117 min for the CNSM group; however, this difference was not statistically significant (p = 0.083). The mean duration of hospital stay was shorter for the RANSM group than for the CNSM group (10.75 days vs. 2.92 days, respectively; p = 0.302). Both groups had similar pain scores on postoperative day 3 (RANSM: 3.50, CNSM: 3.54, p = 0.926). No patient in the RANSM group received adjuvant chemotherapy or radiotherapy, whereas 32.6% of patients in the CNSM group received chemotherapy. The RANSM and CNSM groups experienced complications at rates of 12.5% and 18.4%, respectively (p = 0.571). In contrast to 14.3% in the CNSM group, there were no documented incidences of skin necrosis in the RANSM group. Conclusions: RANSM demonstrated comparable safety to CNSM with potential benefits, including a shorter hospital stay and lower complication rates. These findings support the feasibility of RANSM, particularly in patients prioritizing cosmetic outcomes. To validate these initial findings, more research with larger cohorts and longer follow-up times is necessary. Full article

Background and Clinical Significance: Robotic surgery reduces the need for extensive surgical approaches and lowers perioperative complications. In particular, it offers enhanced dexterity, three-dimensional visualization, and improved precision in confined anatomical spaces. Pelvic masses pose significant challenges due to their close relationship with critical neurovascular structures, making traditional open or laparoscopic approaches more invasive and potentially riskier. Robot-assisted resection, combined with intraoperative neurophysiological monitoring, may therefore offer a safe and effective solution for the management of complex pelvic lesions. Case Presentation: An 18-year-old woman was incidentally diagnosed with an 11 cm asymptomatic pelvic mass located anterior to the sacrum. Initial differential diagnoses included neurofibroma, teratoma, and myelolipoma. Histopathological examination confirmed a ganglioneuroma. Following multidisciplinary discussion, the patient underwent a robot-assisted en bloc resection using the Da Vinci Xi multiport system. Preoperative planning was aided by 3D modeling and intraoperative navigation. Conclusions: Surgery lasted 322 min. Preoperative and postoperative eGFR values were 145.2 mL/min and 144.0 mL/min, respectively. The lesion measured 11 cm × 9 cm × 8 cm. The main intraoperative complication was a controlled breach of the iliac vein due to its close adherence to the mass. No major postoperative complications occurred (Clavien-Dindo Grade I). The drain was removed on postoperative day 3, and the bladder catheter on day 2. The patient was discharged on postoperative day 5 without further complications. Presacral ganglioneuromas are rare neoplasms in a surgically complex area. A multidisciplinary approach using robotic-assisted laparoscopy with nerve monitoring enables safe, minimally invasive resection. This strategy may help avoid open surgery and reduce the risk of neurological and vascular injury. Full article

Craniofacial deformities, particularly craniosynostosis, present significant surgical challenges due to complex anatomy and the need for individualised, high-precision interventions. Augmented reality (AR) has emerged as a promising tool in craniofacial surgery, offering enhanced spatial visualisation, real-time anatomical referencing, and improved surgical accuracy. This review explores the current and emerging applications of AR in preoperative planning, intraoperative navigation, and surgical education within paediatric craniofacial surgery. Through a literature review of peer-reviewed studies, we examine how AR platforms, such as the VOSTARS system and Microsoft HoloLens, facilitate virtual simulations, precise osteotomies, and collaborative remote guidance. Despite demonstrated benefits in feasibility and accuracy, widespread clinical adoption is limited by technical, ergonomic, financial, and training-related challenges. Future directions include the integration of artificial intelligence, haptic feedback, and robotic assistance to further augment surgical precision and training efficacy. AR holds transformative potential for improving outcomes and efficiency in craniofacial deformity correction, warranting continued research and clinical validation. Full article