Search Results (1,699)

Artificial intelligence (AI) has become an indispensable tool in orthopedic surgery. It provides new methods to increase surgical precision, improve patient safety, and support personalized treatment plans. This review presents a comprehensive analysis of AI-assisted orthopedic surgery across three core domains. Based on 89 recent studies, this review organizes findings around a perception–decision–execution framework. It groups diverse AI applications into certain categories while highlighting the mutuality across domains. Perception systems have progressed from basic CNN-based segmentation models to advanced transformer architectures. They support multi-modal data fusion and enable uncertainty quantification. Decision systems have moved far beyond rigid rule-based methods and evolve into data-driven models that support surgical planning, accurate risk prediction and continuous outcome optimization. And execution systems have advanced from passive navigation tools to active robotic assistance systems with real-time adaptive capabilities. Beyond mapping technological advances, this review also identifies pivotal challenges that hinder clinical translation and concludes with a clear roadmap for future research, which marks closed-loop surgical assistance systems as the next key development direction. Building on these findings, this review illuminates the potential of AI-assisted orthopedic surgery and guides future research toward innovations that can be translated into clinical practice. Full article

Background/Objectives: Distal cholangiocarcinoma is a rare biliary tract cancer typically treated with pancreaticoduodenectomy. Comparative evidence specifically addressing minimally invasive versus open pancreaticoduodenectomy for this disease remains scarce. Methods: We conducted an updated systematic review and pairwise meta-analysis of comparative studies limited to distal cholangiocarcinoma. Binary outcomes were summarized as odds ratios, continuous outcomes as mean differences, and overall survival as hazard ratios. The primary survival analysis included only directly reported hazard ratios from prespecified matched or weighted cohorts; hazard ratios reconstructed from Kaplan–Meier curves were examined only in sensitivity analyses. Results: Six retrospective comparative studies involving 1623 patients met the inclusion criteria. Minimally invasive surgery was associated with lower blood loss (mean difference, −104.93 mL; 95% CI, −145.30 to −64.57; I² = 16.3%). No clear differences were found in clinically relevant postoperative pancreatic fistula (odds ratio, 1.03; 95% CI, 0.85 to 1.25), major morbidity (odds ratio, 0.96; 95% CI, 0.64 to 1.43), or R0 resection (odds ratio, 1.22; 95% CI, 0.96 to 1.56). In the primary overall survival analysis based on directly reported hazard ratios, the pooled hazard ratio was 0.93 (95% CI, 0.57 to 1.52; I² = 1.3%). In the sensitivity analysis incorporating eligible reconstructed hazard ratios, the pooled hazard ratio was 0.88 (95% CI, 0.73 to 1.05). In an exploratory recurrence-related survival family analysis based on directly reported estimates, the pooled hazard ratio was 0.95 (95% CI, 0.83 to 1.07; I² = 0.0%). Conclusions: Minimally invasive pancreaticoduodenectomy may reduce blood loss without clear evidence of worse major postoperative or oncologic outcomes in distal cholangiocarcinoma. However, the available evidence is entirely observational and should be interpreted with caution. Full article

Minimally invasive surgery (MIS) has transformed modern surgical operations by reducing pain, trauma, scarring and recovery time for the patient. However, precision, stability and accuracy continue to limit surgical performance. Robots can exhibit better precision and stability than humans and have the potential to improve MIS results. This work presents the design and development of a patented 3R1T parallel robot for MIS. The mechanism incorporates a coaxial spherical parallel architecture enabling three rotational degrees of freedom, combined with a remotely actuated translational fourth degree of freedom, therefore reducing the weight of the moving structure, decreasing inertial forces and increasing the system accuracy. The kinematic design is analyzed to achieve the required workspace, motor torque requirements are calculated, and a control system with integrated inverse kinematics is developed. A prototype was manufactured, and preliminary experiments were conducted to evaluate the orientation repeatability of the robot. Results demonstrated a repeatability of ±22.86 μm, commensurate with typical MIS constraints. This suggests that the proposed robot offers potential improvements in precision and control for minimally invasive surgical procedures, over traditional manual methods. Full article

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

Background/objectives: Open right hemicolectomy (ORH) remains the standard approach for locally advanced right-sided colon cancer. Minimally invasive techniques are increasingly applied in earlier disease stages; however, evidence regarding long-term oncologic outcomes in advanced tumors remains limited. This study aimed to compare the perioperative and oncologic outcomes of ORH versus robotic right hemicolectomy (RRH). Methods: In this single-center study, a prospectively maintained database of consecutive right hemicolectomy patients (2010–2020) was analyzed. The primary endpoint was overall survival (OS). Secondary endpoints included disease-free survival (DFS), perioperative outcomes, and histopathological quality. Additionally, a subgroup analysis was performed for T4 tumors. Results: A total of 198 patients was included, comprising 77 that underwent ORH and 121 that underwent RRH. RRH achieved oncologic outcomes comparable with ORH, with similar R0 resection rates (96% vs. 97.5%, p = 0.547) and lymph node yields (median of 18 nodes in both groups, p = 0.828). OS did not differ significantly (ORH, 45.3 months vs. RRH, 49.9 months, p = 0.130). DFS was longer in RRH (ORH, 42.2 months vs. RRH, 49.1 months, p = 0.029; HR = 0.575, 95% CI 0.349–0.947); however, this difference disappeared after adjustment for tumor stage. No survival advantage was observed in the T4 subgroup. Conclusions: RRH provides oncologic outcomes comparable to open surgery while offering perioperative advantages, even in locally advanced colon cancer. When performed in experienced high-volume centers, RRH represents a safe and oncologically sound alternative to ORH and may contribute to expanding MIC beyond early-stage disease. Full article

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

Background/Objectives: Urology residency training widely varies across countries, and evidence comparing residents’ experiences at an international level is limited. This study reports the results of an international survey of urology residents from different countries worldwide, aiming to characterize training environments, educational exposure, and trainee expectations across diverse healthcare systems. Methods: A 39-item online survey was administered to urology residents during the Société Internationale d’Urologie (SIU) Regional Meeting (Florence, November 2024), assessing demographics, training exposure, educational resources, workload, satisfaction, and career perspectives. The results were compared between trainees at different postgraduate years (PGYs) to explore associations for key outcomes. Results: Overall, 208 urology residents from 21 countries completed the survey. Most residents were actively involved in research (76.4%), although confidence in independent scientific production was moderate (significantly lower among junior trainees). Surgical exposure increased with PGY, with good experience in endoscopy but limited hands-on exposure and expected autonomy in laparoscopic, robotic, and major open surgery. Despite high overall satisfaction with urology, residents described heavy workloads, inconsistent access to structured teaching and international fellowships, and a long-term shift in career expectations toward private practice. Conclusions: Urology residents worldwide report high engagement in research, strong satisfaction with their specialty choice, and interest in international mobility. Nonetheless, persistent disparities in surgical exposure, research confidence, workload, and gender representation highlight the need for competency-based curricula, structured mentorship, and improved training organization to promote equitable and high-quality urology education globally. Full article

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

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

Renal surgery for localized renal cell carcinoma carries substantial risk of acute kidney injury (AKI) regardless of surgical approach. This prospective study evaluated early biohumoral markers for AKI detection after robotic renal surgery and assessed their prognostic value for 12-month functional outcomes. Adults undergoing robotic renal tumor surgery with a healthy contralateral kidney were enrolled; AKI followed KDIGO 2012 criteria. Biomarkers measured at baseline and 2/24/72 h were serum β2-microglobulin (sβ2) serum IL-6, as well as urinary β2-microglobulin (uβ2), cystatin C (uC), and α2-macroglobulin (uα2M). Kidney function at 12 months was staged according to KDOQI criteria. Among 170 patients (35 radical nephrectomy, RN; 135 partial nephrectomy, PN), 33 developed AKI, more frequently after RN (p < 0.001); baseline biomarkers levels were similar. sβ2 was significantly higher at 2/24/72 h, and at 2 h, it achieved an AUC of 0.78 (cut-off 0.17: sensitivity 82%, specificity 60%), remaining the earliest independent predictor of AKI (p = 0.015). IL-6 differed at 24 h (AUC 0.80), uC at 72 h (AUC 0.73) and uβ2 at 72 h (AUC 0.66). Clinical AKI predicted KDOQI stage progression at 12 months (p < 0.001). Bulldog clamps (mean ischemia time 17.2 ± 6.9 min) were not associated with AKI (p = 0.99) or with KDOQI stage progression (p = 0.54). RN confers a higher AKI risk than PN. sβ2 at 2 h is the earliest actionable marker, complemented by IL-6 (24 h) and uC (72 h); short warm ischemia during robotic PN appears safe. Sequential multimarker assessment may improve recognition of AKI and support timely nephroprotective strategies. Full article

Introduction: Nerve-sparing (NS) during robot-assisted radical prostatectomy (RARP) plays a critical role in postoperative functional recovery, particularly urinary continence and erectile function. Despite the importance of precise neurovascular bundle (NVB) preservation, intraoperative assessment of NS quality remains largely subjective and lacks standardized evaluation tools. The aim of this study was to develop and preliminarily evaluate a structured intraoperative scoring system designed specifically for assessing NS quality during RARP. Methods: A novel 10-point intraoperative NS scoring system (NSQ Score) based on five domains was developed: dissection plane, bleeding control, bundle manipulation, continuity of dissection, and symmetry. Each parameter was rated on a 0–2 scale. Thirty robot-assisted radical prostatectomy (RARP) procedures performed in 2024 were randomly selected from a prospectively maintained institutional surgical video archive. Cases were not pre-filtered based on tumor stage, surgical difficulty, or intraoperative complexity. High-definition video recordings of the nerve-sparing phase were anonymized and independently evaluated by three experienced observers blinded to patient outcomes and to each other’s assessments. Inter-rater agreement was analyzed using weighted Cohen’s kappa statistics with quadratic weights, complemented by exact and near-agreement proportions. Cluster bootstrap resampling was applied to account for bilateral observations. Results: A total of 48 evaluable observations were analyzed. The overall inter-rater agreement demonstrated a weighted kappa of 0.41 (95% CI 0.36–0.48), indicating fair-to-moderate agreement among reviewers. Exact agreement occurred in 43% of observations, while near-agreement (allowing one ordinal level difference) reached 98%. Among individual parameters, symmetry demonstrated the highest reliability with substantial agreement (κ = 0.70; 95% CI 0.58–0.81). Other domains showed fair agreement, including intraoperative bleeding (κ = 0.36), continuity of dissection (κ = 0.39), bundle manipulation (κ = 0.34), and dissection plane (κ = 0.27). Agreement levels were comparable between left- and right-sided dissections. Conclusions: We propose a novel structured intraoperative scoring system for evaluating nerve-sparing quality during RARP. The scale is simple, procedure-specific, and feasible for structured postoperative or video-based assessment. Preliminary results demonstrate fair-to-moderate inter-rater reliability with very high near-agreement, supporting the feasibility of this tool for clinical use. The proposed scoring system may facilitate standardized training, objective performance assessment, and future studies correlating intraoperative NS quality with functional outcomes. Full article

Reconstruction in head and neck surgery requires restoration of complex functions, including speech, swallowing, and breathing, while preserving as much facial form and patient identity as possible. Over the past decade, advances in preoperative digital planning, intraoperative technologies, and robotic platforms have reshaped reconstructive strategies, giving rise to the concept of hybrid reconstruction. Hybrid approaches integrate free tissue transfer with computer-aided design and manufacturing (CAD/CAM), virtual surgical planning, intraoperative navigation, and robot-assisted microsurgery to enhance precision, reproducibility, and functional outcomes. This narrative review examines the principles and applications of hybrid reconstruction in head and neck surgery with particular emphasis on osseous reconstruction of the mandible, maxilla, and midface. The roles of intraoperative navigation and robotic assistance as enabling tools are discussed, along with their potential benefits and current limitations. Functional and morphologic outcomes, patient-reported quality of life, and challenges related to cost, access, training, and evidence heterogeneity are critically reviewed. Hybrid reconstruction represents an advancement toward outcomes-driven, patient-centered care; however, thoughtful integration of emerging technologies and continued emphasis on rigorous outcome assessment are essential to guide responsible adoption in contemporary head and neck reconstructive surgery. Full article

Background/Objectives: Adult spinal deformity (ASD) correction is a complex surgery to restore spinal alignment and relieve patients’ symptoms. Modern techniques and technologies allow for aggressive surgical correction in tissue-friendly ways that preserve anatomy and may enable faster recovery. Robotic-assisted posterior spinal stabilization may be used as an adjunct to complex ASD reconstruction to facilitate a minimally invasive approach, reduce perioperative morbidity and physiological insult, and allow for the performance of procedures traditionally reserved for large academic centers to be effectively performed by qualified surgeons in optimized patients at smaller hospitals with fewer resources. The objective of this study is to assess realignment, perioperative complications, and patient-reported outcomes of complex, minimally invasive, robotic-assisted adult spinal deformity correction in a surgical specialty hospital. Methods: Demographic, surgical, and perioperative data were collected from the medical record. The Oswestry Disability Index (ODI) and Numeric Rating Scale (NRS) for pain scores were collected preoperatively and at regular post-op visits. X-rays were captured preoperatively before hospital discharge and at follow-up visits. Results: Fifty consecutive deformity patients were corrected with a two-stage approach (anterior column reconstruction followed by posterior stabilization with robotic-assisted screw placement on the next day) at a 48-bed (eight operating rooms), surgeon-owned, subspecialty hospital. The average patient age was 70 years, and 64% were female. The average estimated blood loss (EBL) values for the first and second stages were 62 mL and 205 mL, respectively. The average operative time was 172 min during the first stage and 210 min for the second stage. Three interbody spacers (first stage) and 16 screws (second stage) were inserted on average in each procedure. The average length of stay (LOS) in the hospital was 5 days, and the average follow-up period was 10.6 months. No patients required a transfer to another facility with intensive care unit (ICU) capabilities, and none required a revision of hardware placement. There was an average reduction in the lumbar coronal scoliotic curve of 14.5° and an increase in lumbar lordosis of 14.8° at the latest follow-up (p < 0.01). The average mismatch between pelvic incidence and lumbar lordosis (PI-LL) preoperatively was 17.6°, which was reduced to 9.6° at the latest postoperative follow-up (p < 0.01). Mean ODI (%) and NRS scores were significantly improved by 33.8% (46.7 ± 13.3 to 30.9 ± 19.8; p < 0.01) and 55% (6.0 ± 2.2 to 2.7 ± 2.6; p < 0.01), respectively, at last follow-up. Conclusions: This study demonstrates the feasibility of performing complex, robotic-assisted ASD corrective surgery in a surgical specialty hospital, achieving significant correction of sagittal and coronal deformities, relieving patients’ symptoms, and offering efficiency and consistency to pedicle screw placement. This study demonstrates that a minimally invasive approach to complex deformity reconstruction reduces perioperative morbidity with decreased operative times, EBL, and LOS when compared to historic controls. This approach allows for the democratization of deformity care in that procedures typically reserved for large academic centers can be successfully accomplished at smaller institutions in optimized patients by qualified surgeons with appropriate perioperative support staff. Full article

Purpose: The posterior tibial plateau offset (PTPO) is a parameter of sagittal plane bony tibia morphology with high variability and clinical relevance, particularly in cases involving stemmed tibial implants, where posterior tibial cortex interference may occur. However, its change during total knee arthroplasty (TKA), and its relationship to tibial component positioning remain unknown. Methods: Pre- and postoperative sagittal radiographs of 98 patients undergoing primary, mechanically aligned TKA using a single implant system were retrospectively analyzed. PTPO was measured as the distance between the tibial anatomical axis and the center of the tibial plateau or tibial component. Tibial component placement (TCP) was assessed anteriorly and posteriorly and categorized as anatomical (0–1 mm), mild (1–3 mm), or moderate (>3 mm) underhang (TCU) or overhang (TCO). Pre- and postoperative changes in PTPO were analyzed, preoperative PTPO was compared across TCP categories. Correlations with absolute anterior and posterior deviation from anatomical component placements were calculated. Results: PTPO showed high preoperative variability (mean 6.89 ± 3.69 mm) and was significantly reduced after TKA (5.89 ± 3.44 mm; mean change −1.06 ± 3.44 mm; p < 0.001). Higher preoperative PTPO was associated with anterior (p = 0.01) and posterior TCU (p = 0.02). PTPO showed a moderate correlation with anterior (r = 0.53, p < 0.01) and a strong correlation with posterior implant deviation (r = 0.68, p < 0.01). Conclusions: PTPO shows high variability among patients undergoing TKA, is significantly altered through surgery and correlates with tibial component malposition, particularly TCU. Surgeons should consider PTPO during preoperative planning to optimize tibial component positioning and reduce the risk of implant-to-bone conflict, especially when using stemmed implants. In patients with a high preoperative PTPO, accuracy-enhancing techniques such as computer navigation or robotic assistance may be considered. Full article

Patellar maltracking is among the most common causes of anterior knee pain after total knee arthroplasty (TKA), underscoring the need for accurate prevention and treatment. Therefore, the purpose of this narrative review is to provide a comprehensive overview of current evidence on post-TKA tracking, focusing on component alignment, preoperative patient assessment, and revision treatment options. A PubMed database search was performed, leveraging the literature from the last 20 years, and the results were qualitatively synthesized. According to current studies, several precautions should be taken to prevent patellofemoral stress and, consequently, patellar maltracking, such as avoiding internal rotation, valgus alignment, and excessive flexion of the femoral component and internal rotation of the tibial component. Regarding alignment strategies, kinematic alignment appears to offer potential benefits over mechanical alignment in certain functional outcomes and patient satisfaction scores. However, these differences should be interpreted cautiously as they may not always exceed the minimal clinically important difference. Furthermore, recent evidence indicates that quadriceps biomechanics influence TKA outcomes, potentially suggesting that conventional surgical approaches may need to be individualized, though these preliminary findings require prospective validation. Currently, robotic-assisted surgery represents a developmental direction for patient-tailored interventions and offers great promise for better prosthesis customization to the individual patient. Integration of imaging data with dynamic soft-tissue assessment enables more predictable reconstruction of joint kinematics. Regarding surgical treatment, the selection of specific methods requires a prior clinical and radiographic assessment. Indications range from patellar maltracking direction and component malrotation to patient preferences and rehabilitation potential. Ultimately, the future of TKA relies on personalized interventions to prevent complications and improve patient outcomes. This evolution is driven by the shift from mechanical alignment to kinematic alignment, alongside quadriceps tendon assessment and intraoperative robotic-assisted measurement, all aimed at optimizing the accuracy of implant positioning. Full article