Search Results (906)

Background: The utilization of robot-assisted surgery in pediatric patients is increasing, with particularly notable advantages in complex reconstructive procedures. This study aims to evaluate the safety and efficacy of robotic-assisted resection of choledochal cysts in infants aged less than 3 months. Methods: A total of 73 infants with choledochal cysts who were admitted to the Department of General Surgery, Children’s Hospital of Zhejiang University School of Medicine, between April 2019 and December 2025 were included. The patients were divided into a robotic-assisted surgery (RAS) group (n = 39) and a laparoscopic-assisted surgery (LAS) group (n = 34). Clinical data, including demographic information, laboratory indexes, surgical data, and prognostic data, were retrospectively reviewed, and the Mann–Whitney U test, independent-samples t-test, and Fisher’s exact test were used for statistical analysis. Results: The groups were comparable in terms of age, sex, weight, pre- and postoperative biochemical markers, fasting time, cyst diameter, and operative time. Overall, 80.8% of cases were prenatally detected. The RAS group had a significantly shorter postoperative hospital stay (p = 0.004, Z = −2.864), drainage tube duration (p = 0.002, Z = −3.100), and hepaticojejunostomy time (p < 0.0001, df = 71, 95%CI (−5.70, −3.04)) compared to the LAS group. In the LAS group, three patients developed anastomotic fistulas, all of whom required reoperation, and one patient developed adhesive bowel obstruction, whereas in the RAS group, one patient developed incision infection, one developed cholangitis, one developed adhesive bowel obstruction, and one presented with postoperative liver function abnormalities. The hospitalization cost in the LAS group was significantly lower than that in the RAS group (p < 0.0001, Z = −5.468). Conclusions: In experienced pediatric centers, robotic-assisted resection of choledochal cysts is safe and effective for infants aged less than 3 months and deserves further exploration. Full article

Background/Objectives: Following the LACC trial, the role of minimally invasive radical surgery for early-stage cervical cancer remains controversial. Robotic-assisted approaches have been proposed as a potential strategy to preserve the benefits of minimally invasive surgery while incorporating contemporary oncologic precautions. This study compared perioperative, pathological, and early oncologic outcomes between robotic and open radical surgical management in patients with FIGO 2018 stage IA2–IIA1 cervical cancer. Methods: Patients underwent robotic surgery (n = 20; da Vinci Xi), including robotic radical hysterectomy, compartment-based procedures, and fertility-sparing surgery when clinically indicated, or open abdominal radical hysterectomy (n = 22). Perioperative outcomes, histopathological parameters (including lymphovascular space invasion [LVSI], lymph node status, and margin status), and early oncologic outcomes were evaluated. Exploratory multivariable regression analyses were performed to adjust for baseline differences, including age and tumor size. Results: Patients in the open-surgery cohort were older (56.23 ± 15.87 vs. 45.67 ± 9.31 years; p = 0.012) and had significantly larger tumors (3.07 ± 1.10 vs. 1.4 ± 0.7 cm; p = 0.003). Robotic surgery was associated with longer operative time (178 ± 42 vs. 150 ± 38 min; p = 0.028), lower blood loss (112 ± 61 vs. 518 ± 98 mL; p < 0.001), and shorter hospital stay (4.2 ± 1.6 vs. 6.2 ± 1.4 days; p < 0.001). The robotic cohort also demonstrated a higher lymph node yield (median 18 vs. 9; p < 0.001). No statistically significant differences were observed between groups in lymph node metastasis (20.0% vs. 22.7%; p = 1.000), LVSI (33.3% vs. 63.6%; p = 0.121), or R0 resection rate (100% vs. 95.5%; p = 1.000). In exploratory adjusted analyses, surgical approach was not associated with adverse pathological features, whereas tumor size emerged as an independent predictor of both lymph node metastasis and LVSI. No recurrences were observed in the robotic cohort during the available follow-up period. Conclusions: In this exploratory comparative cohort study, robotic radical surgical management in carefully selected patients with predominantly small-volume disease was associated with favorable perioperative outcomes and no statistically significant differences in pathological parameters compared with open surgery. Tumor size, rather than surgical approach, emerged as the principal predictor of adverse pathological features. Given the limited sample size, baseline imbalances between cohorts, heterogeneous robotic procedures, and absence of mature survival data, these findings should not be interpreted as evidence of oncologic equivalence and require confirmation in larger prospective studies. Full article

Background: Minimally invasive surgery has become the standard of care in colorectal cancer management, with laparoscopic techniques widely adopted due to their established short-term benefits and comparable oncological outcomes to open surgery. More recently, robotic-assisted surgery has emerged as an advanced minimally invasive alternative, offering enhanced visualization, improved instrument dexterity, and superior ergonomics. However, the extent to which these technical advantages translate into clinically meaningful improvements remains a subject of ongoing debate. Methods: A systematic review of the literature was conducted using PubMed, Scopus, and Web of Science databases, including studies published between 2005 and 2025. Eligible studies comprised randomized controlled trials, observational studies, cohort studies, and meta-analyses comparing laparoscopic and robotic colectomy for colon cancer. Outcomes of interest included intraoperative parameters (operative time, blood loss, conversion rate), postoperative outcomes (length of hospital stay, complications, mortality), and oncological endpoints (lymph node yield, resection margins, survival). The review was performed in accordance with PRISMA 2020 guidelines. Results: A total of 150 studies met the inclusion criteria. Robotic colectomy was consistently associated with reduced intraoperative blood loss, lower conversion rates to open surgery, and shorter length of hospital stay, albeit at the expense of longer operative times, particularly during the learning phase. Oncological outcomes, including lymph node harvest and margin status, were comparable between approaches, with some studies reporting a modest increase in lymph node yield in robotic procedures. The adoption of intracorporeal anastomosis was significantly higher in robotic surgery, contributing to improved postoperative recovery and reduced wound-related complications. Composite quality metrics, such as textbook outcome (TO), were more frequently achieved in robotic cohorts, largely driven by shorter hospitalization and lower complication rates. However, evidence from randomized controlled trials remains limited, and heterogeneity among studies persists. Conclusions: Robotic colectomy and rectal resection represent a safe and effective alternative to laparoscopic surgery in the treatment of colon cancer, offering potential advantages in perioperative outcomes and surgical precision. Its benefits appear particularly relevant in technically demanding cases, such as deep pelvic dissection and obese patients. Nevertheless, higher costs, longer operative times during the initial learning curve, and limited high-quality randomized evidence warrant cautious adoption. Future large-scale randomized studies are needed to clarify long-term oncological outcomes, cost-effectiveness, and the optimal integration of robotic platforms into standard colorectal surgical practice. Full article

The rapid expansion of video-assisted thoracoscopic surgery (VATS) and robotic-assisted thoracic surgery (RATS) has reshaped thoracic surgical practice over the last two decades, offering reduced perioperative morbidity, shorter hospital stay, and oncological outcomes comparable to conventional thoracotomy in appropriately selected patients. Minimally invasive techniques now account for the majority of anatomical pulmonary resections in many high-volume centers and are being explored, in selected patients at experienced institutions, for increasingly complex procedures. This shift, however, raises a question that has received comparatively little attention: whether reduced trainee exposure to open thoracotomy may, over time, erode open thoracic surgical competence. As minimally invasive approaches become the institutional default, exposure to open surgery is declining, and the skills required to perform complex open resections or to manage intraoperative emergencies may become confined to a diminishing cohort of senior surgeons. In this narrative review, we examine the current boundaries of minimally invasive thoracic surgery, define the clinical scenarios in which open surgery remains indispensable—including bronchoplastic and angioplastic resections, post-induction hostile surgical fields, and unplanned conversion—and consider the implications of the ongoing paradigm shift for training, taking into account the substantial variability of thoracic surgical practice across different regions. We argue that open thoracic surgery is not an obsolete discipline but a foundational competence whose preservation may warrant deliberate attention through structured exposure, simulation, mentorship, and dedicated competence assessment. Throughout, we have sought to distinguish documented trends from reasonable concern and from speculative future risk, and we frame the central issue explicitly as a credible and foreseeable risk rather than a demonstrated decline. Full article

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

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

Background/Objectives: The rising global prevalence of obesity presents an increasing challenge in gynecologic surgery. Although robotic-assisted hysterectomy is widely used, comparative data on perioperative outcomes across body mass index (BMI) categories remain limited. We evaluated whether higher BMI is associated with longer operative duration and increased perioperative complications in robotic-assisted total hysterectomy performed for benign indications. Methods: This retrospective cohort study analyzed 179 patients who underwent robotic-assisted hysterectomy at a German academic medical center between January 2018 and December 2024. Patients were stratified by World Health Organization criteria into normal weight (BMI < 25 kg/m²; n = 51), overweight (BMI 25.0–29.9 kg/m²; n = 59), and obese (BMI ≥ 30 kg/m²; n = 69) groups. The primary outcome was operative time; secondary outcomes included estimated blood loss (EBL), Clavien–Dindo complications, hospital stay, transfusion, and readmission within six weeks. Multivariable regression adjusted for uterine weight, surgeon volume, ASA class, year of surgery, and prior abdominal operations. Results: Operative time increased significantly with BMI (normal: 136.3 ± 68.7 vs. obese: 174.4 ± 74.3 min; p = 0.009). On multivariable analysis, BMI remained an independent predictor of operative time (β = 2.49 min per kg/m², 95% CI 1.01–3.96, p = 0.001) and EBL (β = 15.0 mL per kg/m², 95% CI 1.5–28.5, p = 0.029). Postoperative hemoglobin and transfusion rates did not differ between groups. No significant differences were detected in major complication rates (Clavien–Dindo ≥ III: 4/51 [7.8%], 1/59 [1.7%], 7/69 [10.1%]; p = 0.15), hospital stay, or readmission. High-volume surgeon status (≥30 cases) was independently associated with reduced major complications (OR = 0.16, 95% CI 0.03–0.75, p = 0.020). Conclusions: Robotic-assisted hysterectomy appears clinically feasible across all BMI categories without a detectable increase in major morbidity, although obesity was associated with moderately longer operative times and higher calculated EBL. The study was not powered to detect differences in rare events. Surgeon experience was independently associated with lower complication rates and may help offset the additional technical demands of obesity. Full article

Background/Objectives: Postoperative pain after robot-assisted gynecologic surgery delays recovery and prolongs hospitalization, yet evidence on the role of ultrasound-guided rectus sheath block (RSB) in this setting is limited. We investigated whether preoperative ultrasound-guided RSB was associated with a shorter length of hospital stay (LOS) after robot-assisted gynecologic surgery. Methods: This single-center retrospective cohort study included 266 consecutive female patients who underwent robot-assisted gynecologic surgery between November 2023 and April 2024. RSB was introduced in January 2024; 113 patients from the RSB-eligible era who received the block and 153 patients before RSB introduction served as the RSB and comparator groups, respectively. The primary outcome was LOS. Secondary outcomes included rescue intravenous fentanyl and rescue antiemetic use in the post-anesthesia care unit (PACU) and rescue analgesic administration on the general ward through postoperative day (POD) 2. Multivariable quasi-Poisson regression was used to adjust for potential confounders. Results: LOS was significantly shorter in the RSB group (median 3 [IQR 3–3] vs. 4 [³,⁴,⁵] days; p < 0.001; adjusted IRR 0.78, 95% CI 0.72–0.85). The RSB group also required less PACU rescue fentanyl (0.86 [0.68–1.38] vs. 1.17 [0.85–1.69] μg/kg; p < 0.001), fewer rescue antiemetics (3.5% vs. 11.8%; p = 0.029), and fewer ward rescue analgesics on POD 0 (52.2% vs. 68.6%; p = 0.009) and POD 1 (13.3% vs. 34.2%; p < 0.001). Conclusions: Preoperative ultrasound-guided RSB was associated with shorter LOS, reduced PACU opioid and antiemetic requirements, and fewer early ward rescue analgesics. Randomized trials are warranted to confirm these benefits. Full article

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

Background/Objectives: The clinical management of uterine fibroids in the context of infertility is characterized by significant heterogeneity. The aim of our study was to record the participants’ views and clinical practices regarding minimally invasive, fertility-sparing management of fibroids, focusing on fertility outcomes. Methods: An online survey was distributed to members of the European Society of Gynecology (ESG), using a questionnaire comprising 27 questions. Questions 1 to 5 related to the participants’ background, while questions 6 to 27 related to the clinical management of fibroids. Results: A total of 98 participants completed the survey, of whom 83% (n = 82) practiced in European countries and 43% (n = 42) had completed specialist training in minimally invasive gynecological surgery. For FIGO 0–II fibroids, hysteroscopic removal was recommended by 94% (n = 92) of participants, although only 27% (n = 26) would do so in all cases, irrespective of the size and submucosal proportion. Anti-adhesion agents were used at least occasionally after the hysteroscopic removal of FIGO 0–II fibroids by 51% (n = 50) of participants. A clinically significant fibroid size was recognized by 57% (n = 56) of participants for FIGO III fibroids and by 51% (n = 50) for FIGO IV fibroids. The opinion was almost evenly divided on whether the distance between an intramural, non-cavity-distorting fibroid and the junctional zone affected the decision for removal: 49% (n = 48) considered that it did not, whereas 51% (n = 50) considered that it did, citing variable cut-off values. Most participants favored minimal-access approaches over laparotomy, whereas the use of robot-assisted laparoscopy was limited. Conclusions: Our results confirm the significant variation in clinical practice associated with fibroid management and underline the need for standardized care, based on high-quality evidence. Full article

Background/Objectives: Iatrogenic nerve injury is a significant challenge in urologic surgery, with radical prostatectomy posing a high risk due to complex pelvic neural anatomy. Despite advances in robotic-assisted and nerve-sparing techniques, postoperative urinary incontinence and erectile dysfunction remain prevalent, adversely affecting patients’ quality of life and imposing substantial healthcare costs. Methods: A narrative review was conducted using PubMed, MEDLINE, and the Cochrane Library (searches through February 2026) for studies on radical prostatectomy epidemiology, mechanisms of nerve injury, functional outcomes, and economic burden. Emerging intraoperative fluorescence imaging technologies, surgical strategies to mitigate iatrogenic nerve injuries, and the financial costs of post-prostatectomy complications were assessed. Results: Robotic-assisted radical prostatectomy now accounts for >80% of procedures in the United States, and has been associated in observational studies with improved early recovery of erectile function compared with open and laparoscopic approaches. However, the lack of real-time nerve visualization remains a limiting factor. Recent milestones (January 2026) include the Food and Drug Administration Investigational New Drug clearance for the nerve-specific fluorophore LGW16-03 (NerveTrace), which enables real-time identification of sub-millimeter nerve branches, and the 510(k) premarket clearance of Dendrite imaging (November 2025). Conclusions: Enhanced intraoperative nerve discrimination via molecularly targeted imaging has the potential to reduce iatrogenic complications and improve long-term functional and economic outcomes in prostate cancer surgery, although these benefits have yet to be demonstrated in prospective clinical and health-economic studies. Full article

Apical pelvic organ prolapse (POP) is characterized by descent of the uterus or post-hysterectomy vaginal vault resulting from failure of level I pelvic support and represents a major contributor to pelvic floor dysfunction and recurrent prolapse surgery. Loss of apical support is frequently associated with anterior and posterior compartment defects, leading to vaginal bulge symptoms, pelvic pressure, urinary and bowel dysfunction, sexual dysfunction, and reduced quality of life. This narrative review summarizes current knowledge on POP, from molecular mechanisms and emerging biomarkers to contemporary surgical management, with particular emphasis on sacrocolpopexy and robotic-assisted approaches. A literature search of PubMed, Scopus, Google Scholar, and Consensus identified peer-reviewed studies published up to February 2026. Evidence demonstrates that POP has a multifactorial and polygenic background involving extracellular matrix remodeling, connective tissue integrity, smooth muscle dysfunction, and altered level of protein expression. Several candidate biomarkers, including single-nucleotide polymorphisms, circulating proteins, metabolites, and imaging-based parameters, show potential for risk prediction and earlier diagnosis, although routine clinical implementation remains limited. Sacrocolpopexy remains the gold standard for apical prolapse repair because of superior anatomical outcomes, low recurrence, and significant quality-of-life improvement. Laparoscopic and robotic-assisted sacrocolpopexy provide comparable efficacy with reduced blood loss, shorter hospitalization, and faster recovery. The objective success rate is usually over 90%. Complications are very rare and typically include mesh erosion in 2–4% of cases and the need for reoperation in 6% of cases. Our own experience shows that, for a group of surgeons, the learning curve for the laparoscopic approach reached a plateau after a total of 30 operations. Robotic platforms may facilitate complex pelvic dissection and shorten the learning curve, although higher procedural costs remain a major limitation. Full article

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

Objective: Minimally invasive surgery in Hirschsprung disease (HSCR) management was introduced in the mid-1990s. Despite decades of clinical application of various laparoscopic approaches, there remains a paucity of high-powered prospective studies and comprehensive systematic reviews in the literature. This study aimed to systematically review and summarize published techniques and outcomes of laparoscopic- and robotic-assisted surgery in HSCR. Methods: A systematic literature review was conducted using PubMed and the Cochrane Library. Studies reporting technical and outcome data of laparoscopic- or robotic-assisted surgery for HSCR were included. Data extraction and analysis were performed in accordance with the PRISMA 2020 guidelines. Parameters of interest included surgical technique, age at primary pull-through (PT), operative time, and functional outcomes. Outcomes of laparoscopic- versus robotic-assisted Yancey–Soave PT were compared. Results: A total of 700 publications were screened, of which seven studies met the inclusion criteria. Data from 556 patients were analyzed. A total of 338 underwent laparoscopic-assisted, and 218 underwent robotic-assisted pull-through. Large variability of the reported transanal resection technique (modified Yancey–Soave PT) was reported. Four studies reported functional outcomes in patients aged over four years. Three studies directly compared laparoscopic- and robotic-assisted PT; two reported no difference in the incidence of postoperative Hirschsprung-associated enterocolitis (HAEC). Functional outcomes were assessed using the Krickenbeck classification in three studies and the bowel function score in one study, with no significant differences reported in patients aged >4 years. Conclusions: Laparoscopic- and robotic-assisted Yancey–Soave PT appears to be safe for HSCR. Large variability in the applied surgical technique—despite being commonly classified as modified Yancey–Soave PT—as well as heterogeneity in the bowel function assessment, limit direct comparability between studies. To date, no single minimally invasive approach has demonstrated clear superiority over others. Prospective, randomized controlled studies are required to enable robust comparative evaluation of techniques, overall costs, and outcomes. Full article

Objective: The aim of this study was to evaluate the safety and efficacy of robot-assisted laparoscopic ureteroureterostomy (RALUU) and laparoscopic ureteroureterostomy (LUU) for duplicated kidney malformations in infants. Methods: This retrospective comparative cohort included infants with duplicated kidney malformations who underwent RALUU or LUU between May 2021 and April 2025. Perioperative variables assessed included operative duration, blood loss, oral feeding time, FLACC pain score, hospital stay, and complications. Follow-up outcomes included changes in anteroposterior pelvic diameter (APD), ureteral diameter (UD), and renal function (RF) of the affected upper moiety, assessed using renal ultrasonography and radionuclide imaging, with preoperative measurements serving as the baseline reference. The minimum follow-up duration was 12 months. Surgical success was determined based on fulfillment of all three criteria: resolution or alleviation of clinical symptoms, a reduction in APD and UD, and preserved or improved upper-moiety renal function compared with baseline. Results: The final cohort consisted of 52 infants (RALUU, n = 28; LUU, n = 24). Demographic and clinical profiles were comparable between groups. RALUU was associated with a shorter operative duration than LUU (139.6 ± 16.6 vs. 151.8 ± 21.6 min, p = 0.029). Estimated blood loss, time to oral feeding, FLACC pain score, and hospital stay were comparable. Postoperative complications were observed in 2 RALUU patients and 3 LUU patients. One patient in the LUU group developed urine leakage, which was managed conservatively. Postoperative urinary tract infection occurred in 2 patients in each group. No patient required secondary surgery. At a mean follow-up of 26.8 ± 10.4 and 28.1 ± 11.7 months in the RALUU and LUU groups, both groups showed significant reductions in APD and UD, with preserved RF and a modest postoperative increase. Conclusions: Both RALUU and LUU were safe and effective for duplicated kidney malformations in infants. RALUU was associated with a shorter operative time, while postoperative recovery, complication rates, and follow-up outcomes were comparable. Full article