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Search Results (305)

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Keywords = robotic assistant systems for surgery

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15 pages, 2869 KB  
Article
Design and Validation of an Automatic Instrument Carousel Exchange System (ICES) for Robot-Assisted Laparoscopic Surgery with Modular Instruments
by Roel Horeman, Olaf Aartman, Koen Schouten, Andres Hunt, Sem Frederik Hardon, Micah Prendergast and Tim Horeman-Franse
Actuators 2026, 15(7), 381; https://doi.org/10.3390/act15070381 - 7 Jul 2026
Abstract
Background: Efficient and safe instrument exchange remains an important challenge in robot-assisted laparoscopic surgery (RALS). Current workflows require human assistance, increasing staff workload and contamination risk. The modular design of the AdLap robotic laparoscopic instruments enables automated exchange of instrument shafts. This [...] Read more.
Background: Efficient and safe instrument exchange remains an important challenge in robot-assisted laparoscopic surgery (RALS). Current workflows require human assistance, increasing staff workload and contamination risk. The modular design of the AdLap robotic laparoscopic instruments enables automated exchange of instrument shafts. This study presents the development and validation of the Instrument Carousel Exchange System (ICES). Methods: An automatic ICES was developed for the AdLap robotic surgery platform of the Delft University of Technology. The prototype was designed to hold six Shaft-Actuated Tip-Articulating (SATA) modular instrument shafts (SATA instrument line, SATA Medical, Amsterdam, The Netherlands) and focused on compactness, robustness, modularity, and rapid disassembly for cleaning and sterilization. System performance was evaluated using repeated autonomous instrument exchange cycles without user interaction. Reliability, alignment tolerance, safety, and exchange duration were assessed. Results: The ICES prototype was successfully designed, manufactured, and tested. Repeated functional testing demonstrated reliable autonomous instrument shaft exchange without human intervention. The system tolerated minor alignment deviations while maintaining stable and safe operation. The mean time for a complete instrument shaft exchange was 84 s (SD = 10 s). The modular architecture allowed straightforward disassembly and maintenance while preserving structural integrity and compact design. Conclusions: The developed ICES represents a substantial step toward fully automated modular instrument handling in RALS. Automated instrument exchange may reduce staff workload and minimize contamination risk during procedures. Future work will focus on improving automation speed, alignment efficiency, and autonomous reinsertion of the instrument shaft through the trocar to further enhance clinical applicability. Full article
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8 pages, 1430 KB  
Article
Robotic-Assisted Fixation and Cementation for Sacral Insufficiency Fractures: A Case Series and Technical Note
by Gal Barkay, Maria Auron, Ohad Einav, Ahmad Shahwan and Josh E. Schroeder
J. Clin. Med. 2026, 15(13), 5104; https://doi.org/10.3390/jcm15135104 - 30 Jun 2026
Viewed by 132
Abstract
Background: The prevalence of sacral insufficiency fractures resulting from minor trauma has been on the rise in parallel with the globally aging population. For similar injuries typical to the elderly population, such as hip fractures, surgery and early mobilization have been shown to [...] Read more.
Background: The prevalence of sacral insufficiency fractures resulting from minor trauma has been on the rise in parallel with the globally aging population. For similar injuries typical to the elderly population, such as hip fractures, surgery and early mobilization have been shown to improve postoperative mortality and morbidity rates. As such, there has been a recent increase in the literature in studies advocating for early surgical fixation for sacral insufficiency fractures. However, traditional fluoroscopic techniques are technically demanding and bear an inherent complication risk even in experienced hands. Robotic-assisted surgery has emerged as a promising technological advancement in spinal and pelvic surgery. We share our experience with this surgical technique. Methods: We conducted a retrospective analysis of five consecutive patients with sacral insufficiency fractures who failed non-operative management. Using the Mazor X robotic system, patients underwent CT-planned, guided placement of fenestrated sacroiliac screws followed by cement augmentation. Primary outcomes included surgical time, radiation exposure, complications, and mobilization, with a minimum three-month follow-up. Results: The cohort consisted of five females with a mean age of 78 years. The mean operative time was 36 min (15–47), and the median fluoroscopy count was 13 shots (6–19). All patients reported significant pain relief and achieved successful mobilization on postoperative day 1. No operative or postoperative complications were recorded. Conclusions: This pilot study suggests that robotic-assisted percutaneous sacroiliac fixation with cement augmentation is a safe, efficient, and minimally invasive approach for the treatment of sacral insufficiency fractures. The precision of the robotic system facilitates stable fixation, providing immediate pain relief and early mobilization with a favorable complication profile. Further studies should be performed to verify these findings. Full article
(This article belongs to the Special Issue Spine Surgery and Rehabilitation: Technical Nuances and Outcomes)
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10 pages, 350 KB  
Article
The Effect of a Physical and Psychological Warm-Up on the Demands Experienced by Surgeons Performing Robot-Assisted Laparoscopic Surgery: A Randomized Crossover Trial
by Abdulwarith Shugaba, David Tod, Joel E. Lambert, Theodoros M. Bampouras, Lawrence D. Hayes, Helen E. Nuttall, Daren A. Subar, Nilihan E. M. Sanal-Hayes and Christopher J. Gaffney
Surgeries 2026, 7(3), 78; https://doi.org/10.3390/surgeries7030078 - 30 Jun 2026
Viewed by 174
Abstract
Background/Objectives: Minimally invasive surgery benefits patients but places physical and cognitive demands on surgeons. While robot-assisted laparoscopic surgery (RALS) reduces musculoskeletal strain, it may increase cognitive load. This study examined whether physical and psychological preparatory protocols (warm-ups) influence surgeon strain during RALS. [...] Read more.
Background/Objectives: Minimally invasive surgery benefits patients but places physical and cognitive demands on surgeons. While robot-assisted laparoscopic surgery (RALS) reduces musculoskeletal strain, it may increase cognitive load. This study examined whether physical and psychological preparatory protocols (warm-ups) influence surgeon strain during RALS. Methods: Ten consultant surgeons from East Lancashire Hospitals NHS Trust (UK) participated in a preregistered, randomized study. Each performed RALS under three conditions: control, physical warm-up (10 min simulation tasks on the Da Vinci system), and psychological warm-up (10 min PETTLEP-based mental imagery). Electromyography (EMG) and electroencephalography (EEG) were recorded during key surgical phases. EMG data were normalized to maximal voluntary contractions. Results: The physical warm-up significantly increased EMG activity in the right deltoid and right trapezius (p < 0.05) compared to control, with no differences observed in other muscle groups. EEG alpha power data did not significantly differ between conditions. Conclusions: These findings suggest that brief physical warm-up can enhance muscle activation in key regions involved in RALS, potentially improving motor control and reducing fatigue. Incorporating such strategies may support surgeon performance and well-being. Full article
(This article belongs to the Special Issue Laparoscopic Surgery, 2nd Edition)
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9 pages, 530 KB  
Article
Single-Port Robotic Liver Surgery: A Pilot Feasibility Study of a Standardized Surgical Approach
by Silvio Caringi, Antonella Delvecchio, Annachiara Casella, Valentina Ferraro, Francesca Romano, Matteo Stasi, Nunzio Tralli, Susana Abigail Diaz Menjivar, Henriquez Angel, Riccardo Memeo and Michele Tedeschi
J. Clin. Med. 2026, 15(13), 5028; https://doi.org/10.3390/jcm15135028 - 27 Jun 2026
Viewed by 184
Abstract
Background: Minimally invasive liver surgery has continuously developed with the advent of robotic systems that could present some advantages regarding dexterity and visualization. Single-port robotic devices have been introduced more recently in order to minimize the invasiveness of surgery. Unfortunately, scientific literature [...] Read more.
Background: Minimally invasive liver surgery has continuously developed with the advent of robotic systems that could present some advantages regarding dexterity and visualization. Single-port robotic devices have been introduced more recently in order to minimize the invasiveness of surgery. Unfortunately, scientific literature on this topic is still poor. This pilot feasibility study aimed to assess the technical applicability and short-term outcomes of single-port robotic liver resection. Methods: The study was designed as a retrospective analysis of 11 consecutive patients treated with single-port robotic liver resection. All interventions were performed in order to treat lesions localized in the anterolateral segments of the liver. All preoperative, intraoperative, and postoperative data were collected retrospectively and considered for the analysis. Cirrhotic patients were graded according to the Child–Pugh score. Results: The median age was 67 years (IQR 41–78), and 63.6% of the patients were women. There was cirrhosis in 27.3% of the cases, and all cases were categorized as Child–Pugh class A. Neoadjuvant chemotherapy was not administered in any of the patients. All procedures were considered Tampa grade II. The median operation time was 190 min (IQR 70–320), and the median blood loss was 50 mL (IQR 0–300). Pedicle clamping was done in 36.4% of the cases. An additional assistant trocar was needed in 45.4% of the procedures. In total, two anatomical and nine non-anatomical resections were done. There were no postoperative complications, reinterventions, and 90-day readmissions. The median length of hospitalization was 2 days (IQR 1–3). The postoperative pain was minimal, with a median VAS and NRS score of 0 on postoperative days 0 and 1. Analgesic treatment was ceased on postoperative day 1, and the median time to first flatus was 1 day in all patients. Conclusions: Single-port robotic liver resection seems to be technically possible in selected patients with intermediate-difficulty lesions in anterolateral segments. Additional research is necessary to establish its role in minimally invasive liver surgery. Full article
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40 pages, 1357 KB  
Review
Tumour Localisation Technologies in Colorectal Cancer Surgery: A Scoping Review of Marking and Detection Methods
by Mircea Fulea, Mihaela Mocan, Mircea Murar, Bogdan Mocan and Vasile Bințințan
Diagnostics 2026, 16(13), 1952; https://doi.org/10.3390/diagnostics16131952 - 23 Jun 2026
Viewed by 230
Abstract
Background: Precise intraoperative localisation of small colorectal tumours during laparoscopic surgery remains challenging due to absent tactile feedback and subserosal tumour location. Current standard methods, particularly India ink tattooing, demonstrate 15–30% failure rates for lesions less than 10 mm, leading to prolonged [...] Read more.
Background: Precise intraoperative localisation of small colorectal tumours during laparoscopic surgery remains challenging due to absent tactile feedback and subserosal tumour location. Current standard methods, particularly India ink tattooing, demonstrate 15–30% failure rates for lesions less than 10 mm, leading to prolonged operative times, incomplete resections, and re-operations. Multiple emerging technologies promise improved localisation, yet comparative evidence remains fragmented. Objective: To map and characterise the current landscape of intraoperative marking and identification technologies for small colorectal tumour localisation during laparoscopic surgery, with emphasis on radiofrequency-based methods and alternative approaches, and to identify evidence gaps guiding future research. Methods: Following PRISMA-ScR guidelines, we systematically searched PubMed, Web of Science, and Scopus databases from January 2000 through December 2025 for studies evaluating tumour localisation technologies in colorectal cancer surgery, including primary tumour localisation during laparoscopic colectomy and localisation of colorectal liver metastases during hepatic surgery, or transferable anatomical applications with documented translational potential to colorectal surgery. Two independent reviewers screened all records, with discrepancies resolved through discussion and a third senior reviewer consulted for unresolved disagreements; data were extracted on technical performance, safety, feasibility, cost-effectiveness, usability, innovation potential, and evidence quality. Results: We included 89 studies comprising 18 colorectal-specific articles and 71 transferable/GI-adjacent studies. Detection success rates ranged from 71% to 100% across modalities. Near-infrared fluorescence with indocyanine green demonstrated the strongest clinical evidence with 75–100% detection across eight colorectal studies encompassing 2134 procedures and seamless workflow integration. Radiofrequency identification systems achieved 91.9–99% detection in feasibility studies with promising tissue penetration of 15–35 mm but limited colorectal validation. Electromagnetic navigation excelled in rigid organs with 85–98% success but showed degraded performance in mobile bowel at 71–75%. Critical evidence gaps included absent head-to-head comparative trials, non-standardised outcome metrics limiting cross-study comparability, and limited long-term safety data with only 14 studies providing follow-up exceeding six months. Conclusions: ICG fluorescence represents the most clinically mature technology identified, representing a priority candidate for colorectal-specific validation in challenging localisation scenarios. RFID systems demonstrate promising characteristics justifying prioritised research investment through adequately powered comparative trials. Future research must emphasise consortium-based comparative effectiveness studies, standardised outcome metrics, and integration with robotic and AI-assisted surgical platforms to accelerate clinical translation. Full article
(This article belongs to the Section Clinical Diagnosis and Prognosis)
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17 pages, 3332 KB  
Review
Robotic-Assisted Thoracic Surgery in the Immunotherapy Era: Navigating Altered Anatomy, Oncologic Precision, and the Future of Integrated Platforms
by Dimitrios E. Magouliotis, Vasiliki Androutsopoulou, Ugo Cioffi, Vanesa Brecher, Andrew Xanthopoulos, Fabrizio Minervini and Marco Scarci
J. Clin. Med. 2026, 15(12), 4485; https://doi.org/10.3390/jcm15124485 - 10 Jun 2026
Viewed by 311
Abstract
The adoption of neoadjuvant immune checkpoint inhibitor (ICI)-based chemoimmunotherapy has fundamentally transformed the operative landscape of resectable non-small cell lung cancer (NSCLC). Surgeons are now routinely confronted with ICI-altered tissue planes characterized by hilar fibrosis, vascular friability, and disrupted lymph node architecture. Simultaneously, [...] Read more.
The adoption of neoadjuvant immune checkpoint inhibitor (ICI)-based chemoimmunotherapy has fundamentally transformed the operative landscape of resectable non-small cell lung cancer (NSCLC). Surgeons are now routinely confronted with ICI-altered tissue planes characterized by hilar fibrosis, vascular friability, and disrupted lymph node architecture. Simultaneously, robotic-assisted thoracic surgery (RATS) has consolidated its position as the dominant minimally invasive platform for pulmonary resection, accounting for the majority of lobectomies and segmentectomies performed at high-volume centers in 2023. Whether RATS confers specific technical advantages in this increasingly complex operative context remains incompletely characterized. We conducted a structured narrative review of published evidence, synthesizing data from randomized controlled trials, prospective cohorts, national registry analyses, and emerging technology reports addressing RATS in the setting of neoadjuvant ICI-based therapy for NSCLC. A systematic literature search was conducted across PubMed and EMBASE using predefined search terms. Available evidence, though largely retrospective and limited by small sample sizes, consistently demonstrates that RATS after neoadjuvant chemoimmunotherapy is technically feasible and oncologically sound, with R0 resection achievable in virtually all cases. The enhanced three-dimensional visualization, tremor filtration, and instrument degrees of freedom afforded by robotic platforms appear particularly advantageous in the setting of dense hilar adhesions and fragile pulmonary vasculature. Lymph node yield, a recognized robotic advantage, is preserved or enhanced despite post-ICI fibrosis. Pooled conversion rates to thoracotomy, derived from post hoc surgical analyses of ICI trial populations rather than trials designed to measure conversion, are higher than for upfront resection; available retrospective single-center data, including one direct RATS-versus-VATS comparison, suggest lower conversion rates with RATS in experienced hands, though this conclusion requires prospective validation. Emerging platform integrations, including combined robotic bronchoscopy and thoracoscopic surgery, single-port systems, and artificial intelligence-assisted anatomical navigation, are poised to further extend the reach of minimally invasive surgery in this challenging clinical scenario. In experienced centers, RATS appears to offer a technically favorable minimally invasive platform for pulmonary resection after neoadjuvant ICI-based therapy, with potential advantages over VATS in managing immunotherapy-altered anatomy; however, this conclusion is derived from retrospective series and should be interpreted cautiously pending prospective comparative data. Prospective multicenter trials with standardized surgical endpoints are urgently needed. Full article
(This article belongs to the Special Issue Clinical Research on Robot-Assisted Thoracic Surgery and Lung Surgery)
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13 pages, 815 KB  
Article
Learning Curve of Shape-Sensing Robotic-Assisted Bronchoscopy (ssRAB) for Peripheral Pulmonary Lesions in a Thoracic Surgery Center Using the ION System
by Donatas Zalepugas, Jan Arensmeyer, Philipp Feodorovici, Mark Coburn, Dirk Skowasch, Tatjana Dell, Julian Luetkens, Joachim Schmidt and Hruy Menghesha
J. Clin. Med. 2026, 15(12), 4470; https://doi.org/10.3390/jcm15124470 - 9 Jun 2026
Viewed by 257
Abstract
Background: Robotic-assisted bronchoscopy enables precise navigation to peripheral pulmonary lesions and expands minimally invasive diagnostic options in thoracic surgery. At our institution, the ION™ Endoluminal System (Intuitive Surgical, Sunnyvale, CA, USA) was introduced to improve diagnostic accuracy in challenging peripheral targets. It [...] Read more.
Background: Robotic-assisted bronchoscopy enables precise navigation to peripheral pulmonary lesions and expands minimally invasive diagnostic options in thoracic surgery. At our institution, the ION™ Endoluminal System (Intuitive Surgical, Sunnyvale, CA, USA) was introduced to improve diagnostic accuracy in challenging peripheral targets. It is widely recognized that a defined number of procedures is required to achieve procedural proficiency and optimal clinical outcomes when adopting a novel platform. Therefore, this retrospective single-center study aimed to evaluate the learning curve associated with the implementation of this technology in a thoracic surgery center. Methods: In this retrospective study, all consecutive patients who underwent robotic-assisted bronchoscopies performed using the ION™ Endoluminal System (Intuitive Surgical, Sunnyvale, CA, USA) for the diagnosis of peripheral pulmonary lesions between August 2024 and March 2026 were analyzed. A total of 128 lesions in 89 patients were initially identified. Cases involving marker placement without diagnostic biopsy, as well as procedures not performed by the primary operator, were excluded. After applying exclusion criteria, 109 procedures in 76 patients were included. The mean patient age was 65.4 ± 9.1 years, and 44 patients were female (57.9%). To assess the learning curve, procedures were chronologically divided into three groups: early (cases 1–36), intermediate (37–73), and late (74–109). Outcome measures included procedure time, number of biopsies per lesion, tumor size, and diagnostic yield. Group comparisons were performed using non-parametric and chi-square tests. Procedural learning was assessed by cumulative sum (CUSUM) analysis of procedure time. Results: The overall diagnostic yield was 85.3% (93/109). The diagnostic yield increased over time from 73.0% in the early phase to 83.3% in the intermediate phase and 94.6% in the late phase. The overall comparison was statistically insignificant (χ2 p = 0.117); however, there was a significant linear trend across phases, indicating progressive improvement with exposure to the application of this technology. Procedure time decreased significantly from a median of 49.0 min in the early phase to 31.0 min in the intermediate phase and 30.0 min in the late phase (p < 0.001). At the same time, the number of biopsies per lesion increased significantly (p < 0.001). Tumor size did not differ significantly between groups (p = 0.170). Conclusions: Robotic-assisted bronchoscopy demonstrates a clear learning curve, characterized by increasing diagnostic yield and significantly reduced procedure time during the implementation phase. The technique can be effectively integrated into the thoracic surgical diagnostic workflow and represents a valuable addition to minimally invasive diagnostics for peripheral pulmonary lesions. Full article
(This article belongs to the Section Respiratory Medicine)
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28 pages, 4839 KB  
Article
Design and Implementation of an Autonomous Surgical Robotic Aspirator
by Eva Góngora-Rodríguez, Irene Rivas-Blanco, Álvaro Galán-Cuenca, Carmen López-Casado, Isabel García-Morales and Víctor F. Muñoz
Electronics 2026, 15(12), 2551; https://doi.org/10.3390/electronics15122551 - 9 Jun 2026
Viewed by 251
Abstract
Robotic assistance in minimally invasive surgery has significantly improved precision and dexterity; however, many supportive tasks, such as blood aspiration, still rely on manual operation. This work presents the design and implementation of a supervised autonomous robotic aspirator for detecting and removing bleeding [...] Read more.
Robotic assistance in minimally invasive surgery has significantly improved precision and dexterity; however, many supportive tasks, such as blood aspiration, still rely on manual operation. This work presents the design and implementation of a supervised autonomous robotic aspirator for detecting and removing bleeding in an in vitro experimental model. The proposed system integrates a perception module based on a convolutional neural network for real-time blood segmentation, a task planner for high-level action execution, and a control strategy based on artificial potential fields for autonomous navigation. Additionally, a mixed-reality human–robot interaction interface is incorporated to enable system supervision and seamless transition to teleoperation when required. The system was experimentally validated with a set of in vitro experiments under three representative bleeding scenarios, evaluating four suction strategies based on the computation method for the target selection. Results demonstrate high blood removal rates (above 80% in all cases) and high suction efficiency. The comparative analysis reveals that the performance of the suction strategies is scenario-dependent and highlights a trade-off between suction efficiency and removed area. These findings support the feasibility of autonomous robotic aspiration and provide insights into the design of adaptive strategies for surgical assistance, contributing toward increased task autonomy and reduced need for continuous manual suction control during minimally invasive procedures. Full article
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8 pages, 1037 KB  
Case Report
Primary Lingual Amyloidoma of the Tongue Base Causing Progressive Dysphagia: A Case Report
by Carlos Carazo-Casas, Mar Domínguez-Fernández, Alejandra Véliz-Domínguez and Rafael Barberá-Durban
J. Otorhinolaryngol. Hear. Balance Med. 2026, 7(1), 21; https://doi.org/10.3390/ohbm7010021 - 4 Jun 2026
Viewed by 338
Abstract
Background and Clinical Significance: Localized amyloidoma rarely affects the tongue base, a site far less commonly involved than the larynx. When it does occur at this location, the clinical and radiological presentation can closely mimic oropharyngeal malignancy, making it a genuine diagnostic pitfall [...] Read more.
Background and Clinical Significance: Localized amyloidoma rarely affects the tongue base, a site far less commonly involved than the larynx. When it does occur at this location, the clinical and radiological presentation can closely mimic oropharyngeal malignancy, making it a genuine diagnostic pitfall for head and neck surgeons. Establishing the diagnosis demands histological proof, and ruling out systemic amyloidosis is an essential prerequisite. Case Presentation: An 80-year-old nonsmoking woman was evaluated for progressive dysphagia and globus sensation that had worsened over several years. Endoscopy revealed a firm, lobulated mass at the tongue base, centered on the glossotonsillar sulcus. Incisional biopsy under local anesthesia showed amyloid deposits. MRI demonstrated an avidly enhancing, well-circumscribed lesion without invasion of the deep neck spaces. A comprehensive systemic evaluation—including serum and urine protein electrophoresis with immunofixation, serum free light chains (κ/λ ratio 1.05), echocardiography, and bone marrow biopsy—yielded no evidence of systemic AL amyloidosis or plasma-cell dyscrasia. The mass was excised through transoral robotic surgery (TORS). Histopathology confirmed Congo red-positive, apple-green birefringent amyloid with lambda light-chain restriction; staining for AA amyloid and transthyretin was negative. The patient was diagnosed with primary localized lingual amyloidoma of the AL lambda type and remained symptom-free, with no endoscopic evidence of recurrence, at 12-month follow-up. Discussion: Amyloidoma deserves a place in the differential diagnosis of tongue base masses, particularly when the clinical picture does not fit squamous cell carcinoma. Congo red staining under polarized light, immunohistochemical light-chain typing, and a rigorous systemic workup are the cornerstones of diagnosis. Robotic-assisted transoral excision provides excellent access to the tongue base with low morbidity. Conclusions: This case underscores the need to consider amyloidoma when evaluating tongue base lesions, the central role of Congo red staining and light-chain typing, and the utility of TORS as an effective treatment option for selected symptomatic cases. Full article
(This article belongs to the Section Laryngology and Rhinology)
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19 pages, 17979 KB  
Review
Preoperative and Intraoperative Localization of Small Pulmonary Nodules for Sublobar Resection: Practical Insights into Percutaneous, Bronchoscopic/Robotic, RFID (SuReFInD), and Hybrid-OR CT Workflows
by Kanji Tanaka, Masaru Takenaka, Daikichi Meguro, Nobuyuki Take, Teppei Hashimoto, Yasuhiro Fujita, Takehiko Manabe, Katsuma Yoshimatsu, Hiroki Matsumiya, Masataka Mori, Asahi Nagata and Hidetaka Uramoto
Diseases 2026, 14(6), 195; https://doi.org/10.3390/diseases14060195 - 30 May 2026
Cited by 1 | Viewed by 517
Abstract
Thin-slice high-resolution computed tomography (CT) has improved the detection of small pulmonary nodules, increasing the demand for minimally invasive diagnostic and therapeutic resection. While lobectomy with lymph node dissection remains the standard surgical approach for many patients with resectable non-small cell lung cancer, [...] Read more.
Thin-slice high-resolution computed tomography (CT) has improved the detection of small pulmonary nodules, increasing the demand for minimally invasive diagnostic and therapeutic resection. While lobectomy with lymph node dissection remains the standard surgical approach for many patients with resectable non-small cell lung cancer, accumulating evidence supports sublobar resection for selected small, peripheral, and ground-glass-dominant lesions when sufficient margins are achievable. In thoracoscopic and robotic surgery, localization of nodules ≤10 mm or lesions located >5 mm from the pleural surface can be challenging, and failure to identify the target may lead to conversion, larger resection than intended, or prolonged operative time. Several localization strategies have been developed, including CT-guided percutaneous wire/coil/dye marking, bronchoscopic dye mapping, and virtual-assisted lung mapping (VAL-MAP), robotic-assisted bronchoscopic dye or fiducial localization, radiofrequency identification microtag systems (Surgical Real-Time FInger Navigation and Detection) that provide real-time depth information, and single-stage intraoperative CT-guided marking and resection in hybrid operating rooms. This review synthesizes representative evidence and published outcome ranges, and compares workflows, marker-to-lesion precision metrics, complication profiles, operational burden, and cost structures. We emphasize the practical contrast between two-stage and single-stage workflows, the access-route differences between transthoracic and transbronchial techniques, and the need to report localization-to-incision “time at risk”. We also present an expert-consensus decision algorithm aimed at facilitating tailored selection of localization strategies for modern minimally invasive thoracic surgery. Full article
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16 pages, 357 KB  
Review
Robotic-Assisted Tubal Reanastomosis After Sterilization in the IVF Era: A Narrative Review
by Dimitrios Papageorgiou, Vasilios Pergialiotis, Ioannis K. Papapanagiotou, Eleftherios Zachariou, Nikolaos Plevris, Savvas Petrogiannis, Nikolaos Salakos, Stylianos Kykalos and Konstantinos Kontzoglou
Medicina 2026, 62(6), 1054; https://doi.org/10.3390/medicina62061054 - 29 May 2026
Viewed by 885
Abstract
Background and Objectives: Robotic-assisted tubal reanastomosis (RATR) remains a clinically relevant option for selected women seeking fertility after sterilization. In the era of IVF, surgical reversal continues to be discussed because it may restore the possibility of spontaneous conception rather than offering [...] Read more.
Background and Objectives: Robotic-assisted tubal reanastomosis (RATR) remains a clinically relevant option for selected women seeking fertility after sterilization. In the era of IVF, surgical reversal continues to be discussed because it may restore the possibility of spontaneous conception rather than offering only cycle-dependent treatment. However, the available evidence on RATR is heterogeneous and derives predominantly from observational studies. The aim of this narrative review with a structured literature search was to synthesize the published evidence on the operative, reproductive, and economic outcomes of RATR and to contextualize its role in contemporary fertility counseling. Materials and Methods: A structured literature search of PubMed/MEDLINE, Scopus, and Google Scholar was performed from database inception to 20 December 2025. Data were synthesized descriptively without meta-analysis. Primary robotic clinical studies were interpreted separately from secondary and contextual publications. Results: In total, 16 studies were included in our study. The evidence base comprised predominantly retrospective cohorts and case series; no randomized controlled trials were identified. Reported tubal patency endpoints in robotic cohorts ranged from 81.0% to 94.1%, although denominators differed across studies and were reported either per patient or per tube. Reported pregnancy outcomes ranged from 25% to 80%, reflecting substantial heterogeneity in patient selection, follow-up duration, and outcome definitions. When woman-level delivery or live-birth outcomes were explicitly reported, they were generally encouraging in selected series, although not uniformly defined. Estimated blood loss was usually minimal when reported, and conversion to laparotomy was uncommon. Any comparison with IVF was indirect because no contemporary head-to-head comparative studies were identified. Economic data were sparse, institution-specific, and methodologically heterogeneous. Conclusions: Available observational evidence suggests that RATR is a feasible minimally invasive option for fertility restoration in carefully selected women after sterilization. However, the evidence base remains limited by retrospective design, small cohorts, heterogeneous outcome reporting, variable follow-up, and indirect comparison with IVF. RATR should be considered within individualized fertility counseling rather than as a universal alternative to IVF. Prospective comparative studies with standardized outcome definitions, transparent reporting of prognostic factors, and robust economic evaluation are needed. Full article
(This article belongs to the Special Issue Advances in Reproductive Surgeries)
28 pages, 48166 KB  
Review
Pneumatics in Service Robotics: A Review Across Application Domains and the Impact of Soft Robotics
by Giovanni Colucci, Simone Duretto, Luigi Tagliavini, Andrea Botta, Lorenzo Toccaceli, Francesco Amodio and Giuseppe Quaglia
Actuators 2026, 15(6), 296; https://doi.org/10.3390/act15060296 - 27 May 2026
Viewed by 528
Abstract
Soft robotics is a rapidly evolving field that has attracted significant attention within the scientific community. This review analyzes the main advantages of pneumatic technology in service robots across the different application domains defined by the International Federation of Robotics (IFR). By organizing [...] Read more.
Soft robotics is a rapidly evolving field that has attracted significant attention within the scientific community. This review analyzes the main advantages of pneumatic technology in service robots across the different application domains defined by the International Federation of Robotics (IFR). By organizing the literature according to application domains, this work aims to clarify the specific benefits of pneumatic and soft pneumatic solutions in each context. The proposed approach distinguishes between traditional pneumatic solutions and the subsequent emergence of soft robotics, in order to highlight how and to what extent soft technologies have reshaped the design and application scenarios. Particular attention is devoted to the role of materials and recent manufacturing techniques used by researchers to fabricate soft pneumatic robots. Based on 163 selected papers, the analysis reveals that medical and agricultural applications dominate soft pneumatic research, accounting for 41% and 27% of the soft sample, respectively. Compared to traditional pneumatics, the medical sector has expanded into cardiac assistive devices, wearable monitoring sensors, and minimally invasive surgery; agriculture has grown from 17% to 27% of the soft literature due to precision harvesting grippers. Soft inspection robots have increased thanks to continuum manipulators and bio-inspired locomotion, while search and rescue remains a niche (9%) but promising sector. Unlike previous reviews that focus on single domains or technologies, this work quantifies the uneven transition from rigid to soft pneumatics across IFR sectors and highlights emerging application-specific design paradigms that were not feasible with traditional systems. Full article
(This article belongs to the Special Issue Advanced Technologies in Soft Actuators—2nd Edition)
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17 pages, 1641 KB  
Review
Advancing Genitourinary Cancer Surgery: The Role of Artificial Intelligence and Robotics
by Stamatios Katsimperis, Nikolaos Kostakopoulos, Themistoklis Bellos, Theodoros Spinos, Angelis Peteinaris, Lazaros Tzelves, Athanasios Kostakopoulos and Andreas Skolarikos
J. Clin. Med. 2026, 15(10), 3856; https://doi.org/10.3390/jcm15103856 - 17 May 2026
Cited by 1 | Viewed by 597
Abstract
The convergence of artificial intelligence and robotic surgery is redefining the management of genitourinary cancers by enhancing diagnostic accuracy, surgical precision, and training efficiency. This narrative review explores recent advancements in artificial intelligence applications across the cancer care continuum, with a focus on [...] Read more.
The convergence of artificial intelligence and robotic surgery is redefining the management of genitourinary cancers by enhancing diagnostic accuracy, surgical precision, and training efficiency. This narrative review explores recent advancements in artificial intelligence applications across the cancer care continuum, with a focus on prostate, kidney, and bladder malignancies. Artificial intelligence tools, particularly those based on machine learning and deep learning, have demonstrated strong performance in analyzing imaging data, segmenting tumors, predicting pathological features, and supporting clinical decision-making. Intraoperatively, artificial intelligence enables skill assessment, personalized feedback, and real-time navigation by processing data from surgical videos and robotic system sensors. Augmented reality and intraoperative modeling further enhance visualization and margin control during complex procedures. The review also discusses emerging technologies such as single-port robotic platforms, which offer advantages in confined anatomical spaces and support less invasive approaches. Additionally, the growing field of telesurgery is addressed, highlighting its feasibility for complex urologic operations across vast distances. While many of these innovations are still in early stages of clinical validation, their integration into practice has the potential to improve oncologic and functional outcomes, expand access to expert care, and foster the development of next-generation surgical strategies in urologic oncology. Full article
(This article belongs to the Special Issue Advances in the Clinical Management of Urological Cancers)
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16 pages, 311 KB  
Review
The Evolution and Innovations of Robotic Surgery in Urology: From Early Pioneers to Emerging Competitor
by Loris Cacciatore, Gianluigi Raso, Antonio Minore, Simona Ruggeri, Alberto Ragusa, Francesco Tedesco, Antonio Rosario Iannello, Francesco Esperto and Rocco Papalia
Uro 2026, 6(2), 13; https://doi.org/10.3390/uro6020013 - 15 May 2026
Viewed by 855
Abstract
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 [...] Read more.
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
21 pages, 359 KB  
Review
Robotic-Assisted Surgery for Colorectal Cancer Treatment in 2026: An Updated Narrative Review
by Cammarata Roberto, La Vaccara Vincenzo, Catamerò Alberto, Bani Lucrezia, Castagliuolo Pierpaolo, Giordano Federica, Castagna Vittoria, Coppola Roberto and Caputo Damiano
J. Clin. Med. 2026, 15(10), 3714; https://doi.org/10.3390/jcm15103714 - 12 May 2026
Cited by 1 | Viewed by 1001
Abstract
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 [...] Read more.
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
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