Search Results (135)

Background/Objectives: Prostate cancer is one of the most common non-skin solid malignancies among male solid organ transplant recipients (SOTRs), in whom radical prostatectomy is technically demanding. We report the first use of indocyanine green (ICG) fluorescence for simultaneous transplanted-ureter identification and renal graft vascular mapping during robot-assisted radical prostatectomy (RARP), and the first use of the CMR Versius^® platform in a SOTR. Methods: Retrospective case series of four consecutive male SOTRs (two renal [RTRs], two hepatic) undergoing RARP. In both RTRs, a dual-route ICG protocol was used on the da Vinci Xi with Firefly^® imaging: pre-docking intraureteral ICG via a ureteral catheter for ureter identification, plus an intravenous ICG bolus for graft vascular mapping and cortical perfusion. One hepatic recipient was operated with the CMR Versius^® system using an infra-umbilical port configuration to avoid the chevron transplant scar. Results: All four procedures were completed robotically without conversion. Median operative time was 176 min and median estimated blood loss 350 mL. Surgical margins were negative (R0) in all four; final pathology was pT3aN0 in three and pT2N0 in one, although in the renal recipients nodal staging reflected a contralateral-only dissection. PSA was undetectable at three months in all patients. One hepatic recipient later developed biochemical recurrence, managed with salvage radiotherapy and androgen deprivation therapy, with subsequent undetectable PSA. One hepatic recipient had a Clavien–Dindo IIIa complication. No graft dysfunction occurred. Conclusions: ICG-guided RARP and the CMR Versius^® platform appear technically feasible in carefully selected solid organ transplant recipients treated at an experienced multidisciplinary centre, with no graft-related complications observed in this small initial series. These preliminary findings require validation in larger, multicenter studies before general safety and oncological efficacy can be established. Full article

Background: The integration of neoadjuvant and perioperative chemo-immunotherapy (CT-IO) has significantly reshaped the treatment of resectable non-small-cell lung cancer (NSCLC), improving pathological response and survival outcomes. However, its impact on surgical management—particularly robotic-assisted thoracic surgery (RATS)—remains incompletely defined. This review provides a practical overview of current evidence and technical considerations for robotic lung resection following neoadjuvant chemo-immunotherapy. Methods: A narrative review of the literature was performed, focusing on phase III trials, meta-analyses, and surgical series reporting perioperative, oncological, and technical outcomes of minimally invasive—especially robotic—approaches after neoadjuvant or perioperative chemo-immunotherapy. Results: Randomized trials have established CT-IO as a standard treatment option for selected patients with resectable stage II–III NSCLC—although the specific standard varies according to stage, molecular and PD-L1 status, and regulatory approval—significantly improving pathological complete response and event-free survival. However, immune-related fibrosis, nodal scarring, and altered tissue planes increase surgical complexity and intra-postoperative complications. Available evidence, largely retrospective and derived from selected patient populations treated at experienced centers, suggest that RATS is feasible and safe, offering enhanced visualization and dexterity that may facilitate dissection in challenging post-induction settings. Vascular management and lymph node dissection remain critical technical aspects, and early conversion to open surgery, when required, should be regarded as an appropriate safety strategy rather than a complication. Conclusions: RATS after neoadjuvant chemo-immunotherapy appears feasible and promising in selected patients treated at experienced centers, but current evidence does not yet establish it as the preferred approach for all patients. Careful patient selection, adherence to oncological principles, and surgeon experience are essential. Prospective data are needed to define optimal surgical timing and standardize techniques. Full article

Background/Objectives: Intraoperative ultrasound (IOUS) has become an integral component of modern hepatic oncology surgery, providing real-time imaging guidance during liver resections for hepatocellular carcinoma, colorectal liver metastases, and other primary or secondary hepatic malignancies. Despite substantial improvements in preoperative imaging modalities, occult lesions, disappearing metastases after chemotherapy, and complex vascular relationships continue to represent major intraoperative challenges. This structured narrative review aimed to evaluate the contemporary role of IOUS in hepatic oncology surgery, with particular emphasis on contrast-enhanced intraoperative ultrasound (CE-IOUS), minimally invasive liver surgery, navigation-assisted hepatectomy, and emerging artificial intelligence-based technologies. Methods: A structured literature review was conducted using PubMed/MEDLINE, Scopus, Web of Science, and Google Scholar databases. Peer-reviewed studies, international guidelines, consensus statements, systematic reviews, and technological reports addressing IOUS applications in liver surgery were analyzed. Particular focus was placed on studies evaluating lesion detection, intraoperative strategy modification, disappearing colorectal liver metastases, parenchymal-sparing hepatectomy, laparoscopic and robotic liver surgery, navigation systems, augmented reality integration, and AI-assisted imaging technologies. Results: Contemporary evidence demonstrates that IOUS continues to significantly influence intraoperative decision-making despite advances in magnetic resonance imaging and multidetector computed tomography. CE-IOUS improves the detection of occult hepatic lesions and residual disease after systemic chemotherapy, particularly in disappearing colorectal liver metastases. IOUS-guided anatomical and parenchymal-sparing resections contribute to the preservation of functional liver parenchyma while maintaining oncologic radicality. In minimally invasive liver surgery, laparoscopic ultrasound remains essential for lesion localization and vascular mapping. Recent developments integrating navigation systems, augmented reality platforms, and AI-assisted image recognition suggest a progressive transition toward digitally integrated precision liver surgery. Conclusions: IOUS remains a cornerstone of modern hepatic oncology surgery and continues to evolve from a localization tool into a comprehensive platform for precision-guided liver resection. The integration of CE-IOUS, navigation technologies, and artificial intelligence may further enhance intraoperative accuracy, oncologic safety, and individualized surgical planning in the future. Full article

Background & Objectives: Endovascular embolization has matured into a sophisticated, precision-guided discipline that is central to the management of complex neurovascular pathologies. This review synthesizes contemporary treatment strategies, evaluating the advanced material characteristics of conventional inert liquid polymers, specifically non-adhesive ethylene vinyl alcohol (EVOH) copolymers and adhesive cyanoacrylates, alongside their targeted clinical applications in brain arteriovenous malformations (bAVMs), dural arteriovenous fistulas (dAVFs), hypervascular intracranial tumors, and chronic subdural hematomas (CSDHs). Furthermore, it examines the critical material and hemodynamic constraints that limit these agents in cerebral aneurysm repair. Methods: A comprehensive literature synthesis through 3 July 2026 was integrated with peer-reviewed clinical illustrations to evaluate both procedural mechanics and the necessity of post-procedural physiological management. Review Findings: Embolization serves a critical dual role: as a definitive curative therapy and as an essential preoperative or radiosurgical adjunct. As demonstrated by recent clinical validations, technical angiographic success must be closely coupled with vigilant neurocritical oversight to manage profound, localized hemodynamic shifts. While these conventional methods represent established clinical practice, the field is evolving away from inert mechanical occlusion toward a highly integrated approach. The convergence of stimuli-responsive “smart” hydrogels and endovascular robotics is being evaluated for potential roles in transforming these interventions into dynamic, bioactive platforms capable of modulating disease-specific mechanisms, such as Rat Sarcoma-Mitogen-Activated Protein Kinase (RAS-MAPK) and Bone Morphogenetic Protein (BMP) signaling in bAVMs or the Von Hippel-Lindau/Vascular Endothelial Growth Factor (VHL/VEGF) axis in hypervascular tumors. This review further analyzes landmark data, including the Squid Trial For the Embolization of the Middle Meningeal Artery for Treatment of Chronic Subdural Hematoma (STEM) trial for CSDH, providing a synthesis for translating these advanced material sciences into standardized, multidisciplinary neurointerventional care. Full article

Ultrasound is safe, portable, and relatively low cost, and robotic ultrasound research is expanding across many diagnostic applications. Within this context, abdominal aortic aneurysm (AAA) screening remains comparatively unexplored, with few systems reporting end-to-end autonomous scanning and clinician-validated evaluation in volunteers. We present a conditionally autonomous (Level-3) robotic ultrasound system in which the operator defines the region of interest and confirms the target force band, after which the robot performs surface-constrained abdominal sweeps under force control and automatically selects diagnostic frames and estimates aortic diameter without further manual interaction during scanning. The system combines RGB-depth-based patient-to-robot registration, hybrid position–force control with a low-cost force sensor, and a post-acquisition image-analysis pipeline comprising rule-based aorta localisation, a composite image quality assessment (IQA) metric, and a transfer-learned U-Net segmentation baseline. In a feasibility study on ten healthy volunteers spanning BMI 18.6–33 and diverse sex and skin-tone profiles, the robot maintained stable contact within the target force band in all sessions and produced aortic images rated diagnostically acceptable by clinicians in all participants. Automated diameter measurements showed a mean absolute difference of 1.45 mm relative to clinician reference values, with 9/10 cases within 3 mm and all within the 5 mm screening criterion. Volunteer questionnaires indicated high levels of comfort and trust in the system. These results demonstrate the feasibility of operator-supervised, force-aware robotic AAA scanning and highlight the potential of low-cost robotic ultrasound for wider automated vascular imaging. Full article

Artificial intelligence (AI) is reshaping the field of diagnostic radiology; however, its applications in interventional radiology and pediatric interventional radiology (PIR) remain limited despite clear clinical needs and the rich multimodal data environment characteristic of pediatric procedural care. In this narrative review, I summarize the current state of AI technologies relevant to PIR and outline future perspectives for their clinical integration. Peer-reviewed literature and position statements identified through MEDLINE/PubMed, Embase, Scopus, and major society publications up to the first quarter of 2026 are synthesized, focusing on AI applications across the PIR care pathway, including dose-sparing image acquisition and reconstruction, automated image interpretation and computer-aided diagnosis, data-driven procedural planning and navigation, and post-procedural risk prediction and monitoring. After briefly introducing core machine learning and deep learning concepts, pediatric-specific challenges are discussed, including radiation sensitivity, growth-related anatomical variability, regulatory constraints, and the scarcity of large, annotated datasets, as well as existing and emerging applications along the PIR care pathway: AI-assisted dose reduction and image reconstruction, automated image interpretation, segmentation, and computer-aided diagnosis; data-driven procedural planning, including three-dimensional modelling, augmented reality, AI-enabled/AI-adjacent robotics, and AI-directed procedural navigation; and post-procedural risk prediction and outcome monitoring. Finally, emerging paradigms, including explainable AI, federated learning, and multimodal integration, are highlighted, and research priorities, collaborative frameworks, and governance principles required to ensure safe, equitable, and effective AI deployment in PIR are outlined. In doing so, this review delineates the current evidence gaps and priority directions for clinically meaningful AI adoption in PIR. Although AI has the potential to improve patient care, it has not yet been specifically designed, validated, or deployed in children. Existing work demonstrates feasibility across the PIR workflow, but most tools remain weakly linked to pediatric clinical endpoints. Full article

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

Minimally invasive spine surgery (MISS) has progressively transformed the management of spinal disorders by reducing soft-tissue disruption, perioperative morbidity, and recovery time while maintaining clinical outcomes comparable to conventional open techniques. Beyond its technical evolution, MISS has increasingly assumed a central role in the treatment of bone-related spinal conditions, including vertebral fractures, degenerative instability, metastatic disease, and osteoporosis-associated pathology. This narrative review provides a comprehensive overview of the evolution of MISS with a specific focus on its interaction with vertebral bone biology, implant stability, and fusion processes. A structured literature search of the PubMed/MEDLINE database was conducted, including English-language studies published between 1980 and June 2025 addressing MISS techniques, enabling technologies, and bone-related clinical outcomes. Current evidence suggests that MISS may preserve paraspinal vascularization and soft tissue integrity, potentially supporting bone healing and fusion, although high-quality comparative data remain limited. The effectiveness of MISS in osteoporotic and metastatic vertebral disease is closely linked to bone quality, implant anchorage, and biomechanical considerations, particularly in the context of pedicle screw fixation and interbody support. Emerging technologies—including navigation, robotics, and artificial intelligence—may enhance accuracy in implant placement and reduce bone-related complications, but robust evidence of long-term benefit is still lacking. Despite its advantages, MISS presents important limitations, including a steep learning curve, increased costs, and uncertain superiority in terms of fusion rates and long-term biomechanical stability. Future research should prioritize high-quality comparative studies focusing on bone healing, implant integration, and patient-specific factors such as bone density. MISS should therefore be interpreted not only as a surgical paradigm shift but as an evolving strategy for optimizing outcomes in bone-related spinal disorders. Full article

Background/Objectives: Well-leg compartment syndrome is a rare but potentially life-threatening complication associated with the lithotomy position during pelvic or lower abdominal surgery. While previous studies have examined this condition in specific surgical fields, comprehensive studies focusing on minimally invasive surgery, including laparoscopic and robot-assisted surgery, have not been conducted. This scoping review aimed to summarize the latest evidence on this condition, identify risk factors, and evaluate prevention strategies. Methods: This scoping review was conducted according to the PRISMA-ScR guidelines. A comprehensive literature search was performed using MEDLINE, Embase, and CENTRAL. Data were extracted from studies focusing on patients who underwent minimally invasive surgery in the lithotomy position. Results: A total of 25 studies, including cohort studies and case reports, were included. The majority of cases were observed in procedures exceeding 4 h in duration, with a notable prevalence in the left lower extremity during gastrointestinal surgical procedures. Fasciotomy was required in the majority of reported cases. Risk factors included high body mass index, large calf circumference, prolonged operative time, peripheral vascular disease, and specific surgical positions such as head-down or head-down plus right-sided tilting. Preventive measures included intraoperative lower limb pressure monitoring, leg positioning, use of improved support devices, and reduction of operative time in the lithotomy position. Conclusions: This review identified key risk factors and preventive measures for compartment syndrome of the unaffected lower limb in minimally invasive pelvic surgery. However, evidence for minimally invasive surgery is limited, and standardized guidelines do not exist. Further multicenter studies are needed to establish optimal preventive measures and improve patient safety. Full article

Background: Retroperitoneal surgical corridors, particularly in robotic-assisted partial nephrectomy and donor surgery, require precise knowledge of hilar vascular orientation. The typically described Vein–Artery–Pelvis (VAP) anatomy is often assumed, yet its reliability is poorly quantified. Therefore, the purpose of the present study is to provide a comprehensive radioanatomical map of hilar architecture to enhance surgical safety and predictability. Methods: Contrast-enhanced computed tomography (CT) scans of the abdomen from 200 patients (104 males and 96 females) were evaluated. The anterior-to-posterior sequence of hilar structures, the frequency of early vascular branching, and the presence of accessory vessels were documented and stratified by sex and laterality. Results: The conventional VAP sequence was observed in a minority of cases, occurring in only 32.6% (131 sides). The map identified 37 distinct sequence variants. The most common variants included VAPA (9.0%), AVAP (7.8%), and VAAP (7.0%). Adherence to typical VAP anatomy was significantly lower in males (27.9%) than in females (37.7%). Arterial complexity, characterized by early branching or accessory vessels, was present in 43.2% of sides, with a significantly higher occurrence in males and on the right side. Venous mapping revealed a marked lateral disparity; accessory veins were predominantly right-sided (12.5%), whereas early venous branching was predominantly a left-sided feature (30.0%). Conclusions: Renal hilar architecture demonstrates substantial variability, with the classical VAP configuration representing a minority arrangement. These findings highlight the importance of individualized preoperative imaging assessment and may help anticipate anatomical complexity in retroperitoneal surgery. Full article

Background: Splenic flexure cancers represent a small but anatomically complex subset of colorectal malignancies, characterised by variable vascular supply and lymphatic drainage. This has led to ongoing uncertainty regarding the optimal extent of resection and level of vascular ligation. With increasing adoption of robotic surgery, a range of operative approaches has been described, although these remain inconsistently reported and poorly synthesised. Aim: We aimed to map operative heterogeneity in robotic splenic flexure cancer surgery, focusing on resection extent, vascular ligation, reconstruction strategy, and technical configuration. Methods: A structured scoping review was performed in accordance with PRISMA-ScR guidelines. MEDLINE (PubMed) and Embase (Ovid) were searched from inception to January 2026. Studies reporting robotic resection for primary splenic flexure colon cancer with extractable operative detail were included. Data were synthesised descriptively and grouped into three tiers based on study design: comparative cohorts, case series, and technical reports. Results: Sixteen studies comprising 97 robotic resections were included. Three were comparative cohort studies; two were case series, and eleven were single-case technical reports. Comparative studies consistently described a flexure-directed segmental resection with preservation of the inferior mesenteric artery and division of the left colic artery. In contrast, there was greater variability in management of the middle colic branches and inferior mesenteric vein. Reconstruction strategy differed across tiers, with extracorporeal anastomosis more commonly reported in comparative cohorts, while intracorporeal techniques were frequently described in technical series. Anastomotic configuration, specimen extraction, and use of indocyanine green fluorescence varied widely. Terminology relating to complete mesocolic excision and D2/D3 lymphadenectomy was inconsistent and often poorly defined. Conclusions: Robotic splenic flexure surgery shows broad agreement in overall resection strategy but considerable variability in vascular control, reconstruction, and technical execution. This likely reflects differences in reporting rather than clear differences in oncological intent. A more consistent and structured operative description is needed to allow meaningful comparison and to support the development of evidence-based approaches in this technically demanding area. Full article

Background: Endoscopic sacrocolpopexy (ESC) is a widely performed procedure for pelvic organ prolapse, with laparoscopic sacrocolpopexy (LSC) and robotic-assisted sacrocolpopexy (RSC) approaches. However, suturing to the anterior longitudinal ligament at the sacral promontory carries a risk of massive hemorrhage due to presacral vascular injury. This study aimed to determine the frequency of presacral venous variations considered clinically relevant during suturing at the promontory and to explore their association with perioperative outcomes using contrast-enhanced three-dimensional computed tomography (3D-CT). Methods: Among 319 consecutive ESC cases performed between 2014 and 2025, 265 patients who underwent preoperative contrast-enhanced CT were retrospectively analyzed in this single-center cohort study. Two vascular findings were defined as clinically significant: (1) anomalous drainage of the internal iliac vein into the contralateral common iliac vein and (2) a clearly visualized median sacral vein on 3D reconstruction. The clinical impact of vascular abnormalities was evaluated using surgical time, blood loss, and perioperative complication rates as indicators. Student’s t-test was used for comparing continuous variables, and the chi-squared test was used for comparing categorical variables. The data for this study were retrospectively collected from electronic medical records, anonymized, and then analyzed. Results: Anomalous internal iliac vein drainage was observed in 11.3% (30/265), and a visible median sacral vein was observed in 10.2% (27/265). Overall, 17.7% (47/265, CI: 13.2–22.2%) of patients had at least one clinically significant variation. There were no significant differences between the groups in terms of age, parity, BMI, operative time, blood loss, or perioperative complication rates. No cases required transfusion. Conclusions: Clinically significant presacral vein mutations were present in approximately 1 in 6 patients. The main findings of this study are that clinically significant presacral vascular mutations are relatively frequent (17.7%) in ESC and that there was no significant difference in perioperative outcomes between patients with and without vascular mutations. Clinically relevant presacral vascular variations are relatively common in ESC. Preoperative contrast-enhanced 3D-CT may support risk assessment and surgical planning. Full article

Background: Statistics show that the number of patients suffering from stroke and living with disability as a result has increased significantly worldwide between 1990 and 2021. This implies the necessity of continuous improvement of both treatment methods and rehabilitation, which is essential in the treatment process. According to the International Classification of Functioning (ICF), as many as 88% of patients do not regain functionality in their affected upper limbs six months after a vascular incident, which negatively affects their quality of life. Upper limb rehabilitation using robots is a progressive approach to restoring not only lost limb function, but above all, independence in activities of daily living. Aim of the study: The aim of this review is to determine the actual effects of rehabilitation using various robots in patients after cerebrovascular accidents and to compare these effects with those achieved by patients who participated in a non-robotic rehabilitation program. Methods: Studies published between 2019 and 2025 were included in the analysis. The analysis was written according to the Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) checklist. Results: Studies have shown improvement in upper limb function in patients exercising both with and without the use of a robot, but statistical data clearly show better results in patients undergoing therapy with robots. Conclusions: Studies have shown that the use of a rehabilitation program involving robots brings measurable improvements in many different aspects of upper limb function, and evidence confirming the effectiveness of this therapy encourages further research, refinement, and dissemination of this method and technology. Full article

Interventional robots play a crucial role in surgical procedures, where accurate force measurement is essential for enhancing safety. Compliant mechanisms utilize material deformation to achieve millinewton-scale force output and millimeter-level displacement with high repeatability. Motivated by this, we propose a method for measuring the catheter force by integrating a compliant mechanism and a sensor. First, we designed an operating force detection module. It comprises a double-parallelogram structure with four elastic units, a catheter drive module, and a sensor. The sensor connects the compliant mechanism to the base. Second, stiffness and gravity compensation models were established and validated experimentally. Finally, we constructed an experimental platform to evaluate the force measurement accuracy, drive accuracy, and real-time detection capability. Experimental results demonstrate that the proposed method achieves a maximum detection error of 0.1482 N, an average error of 0.0096 N, a resolution of 0.01 N, and an average axial delivery error of 0.8287 mm. Additionally, a master–slave control framework was developed, along with a master controller that manipulates the slave robot to deliver the catheter within a vascular phantom, while simultaneously displaying real-time force information via the human–computer interaction interface. Full article

Lymphedema is a chronic, incurable disease affecting patients who undergo high-risk cancer treatments. Advances in microsurgical techniques have paved the way for the development of techniques that can prevent or treat this unrelenting condition. In this article we discuss microsurgical interventions for the prevention and treatment of lymphedema, as well as the role of robotics in lymphatic surgery. Full article