Intelligent Surgery最新文献

{"title":"Robotic surgery for benign biliary strictures","authors":"Xitao Wang,&nbsp;Jian Tan,&nbsp;Yunfeng Li","doi":"10.1016/j.isurg.2026.03.002","DOIUrl":"10.1016/j.isurg.2026.03.002","url":null,"abstract":"<div><div>Benign biliary strictures (BBS) are ductal narrowings resulting from non-malignant causes, most commonly iatrogenic injuries during cholecystectomy, chronic pancreatitis, and other post-operative complications. While endoscopic and percutaneous interventions are the primary management strategy, surgical reconstruction remains the definitive treatment for refractory cases. This review synthesizes the current understanding of the etiology, diagnosis, and classification of BBS and evaluates the evolving landscape of its management, with a specific focus on the application of robotic surgery for complex biliary reconstruction.</div></div>","PeriodicalId":100683,"journal":{"name":"Intelligent Surgery","volume":"9 ","pages":"Pages 42-48"},"PeriodicalIF":0.0,"publicationDate":"2026-01-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"147709805","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Artificial intelligence in thyroid surgery: From parathyroid identification to functional preservation","authors":"Xiao Xiao,&nbsp;Dianxin Zhou,&nbsp;Wanyu Sun,&nbsp;Zifeng Luo,&nbsp;Song Wang","doi":"10.1016/j.isurg.2026.06.001","DOIUrl":"10.1016/j.isurg.2026.06.001","url":null,"abstract":"<div><div>Postoperative hypoparathyroidism remains a common concern after thyroid surgery, with transient and permanent forms reported in approximately 19%–38% and 0%–3% of patients, respectively. Parathyroid protection therefore requires not only gland identification but also preservation of blood supply and postoperative function. Although near-infrared autofluorescence and indocyanine green angiography improve intraoperative visualization, their interpretation remains influenced by surgical exposure, device settings, background signals, and surgeon experience.</div><div>With the growing availability of intraoperative images and surgical videos, deep learning and computer vision have been introduced into this field. Most available studies focus on structural tasks, including localization on autofluorescence images, detection or segmentation on white-light images, and video-based prompting during endoscopic surgery. These studies show that AI can improve the consistency and timing of parathyroid recognition in selected datasets. A smaller number of studies have attempted ICG-based perfusion analysis or ischemia-related warning. These applications are clinically attractive, but they should not yet be interpreted as validated functional preservation. In many studies, the reference standards are still based on expert annotation, ICG scoring, intraoperative visual assessment, or autotransplantation decisions rather than independent perfusion measurements or postoperative endocrine outcomes.</div><div>This review summarizes current evidence on AI-assisted parathyroid protection in thyroid surgery, with particular attention to the gap between image-based recognition and preservation of postoperative function. At present, the strongest evidence remains at the level of structural recognition. Future work needs to test whether AI-assisted outputs can actually guide surgical decisions and whether they are associated with postoperative PTH recovery, serum calcium stability, calcium or vitamin D supplementation, and temporary or permanent hypoparathyroidism.</div></div>","PeriodicalId":100683,"journal":{"name":"Intelligent Surgery","volume":"9 ","pages":"Pages 50-57"},"PeriodicalIF":0.0,"publicationDate":"2026-01-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148452550","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Feasibility analysis of robotic-assisted proximal gastrectomy with anterior esophagogastrostomy combined with stent-supported Toupet fundoplication (RAFT technique)","authors":"Yuqiang Shan","doi":"10.1016/j.isurg.2026.02.002","DOIUrl":"10.1016/j.isurg.2026.02.002","url":null,"abstract":"<div><h3>Objective</h3><div>To investigate the feasibility and technical points of a novel reconstruction technique following robotic-assisted proximal gastrectomy for gastric cancer, robotic-assisted proximal gastrectomy with anterior esophagogastrostomy combined with stent-supported Toupet fundoplication (RAFT Technique).</div></div><div><h3>Methods</h3><div>A patient diagnosed with esophagogastric junction (EGJ) adenocarcinoma (cT2N0M0) underwent da Vinci robot-assisted proximal gastrectomy. The reconstruction involved an anterior esophagogastric anastomosis combined with a Toupet fundoplication. Postoperative complications and quality of life were monitored and recorded.</div></div><div><h3>Results</h3><div>The procedure was completed successfully. The anastomosis was patent and tension-free, with an estimated intraoperative blood loss of 50 mL. To date, follow-up has revealed no complications such as anastomotic leakage, bleeding, stenosis, or reflux esophagitis, and no tumor recurrence has been observed.</div></div><div><h3>Conclusion</h3><div>The RAFT technique integrates the physiological advantages of anterior esophagogastrostomy with the antireflux efficacy of Toupet fundoplication, while maintaining procedural simplicity by requiring only a single primary anastomosis. Our initial experience confirms its safety and technical feasibility. Further clinical research is warranted to validate these findings.</div></div>","PeriodicalId":100683,"journal":{"name":"Intelligent Surgery","volume":"9 ","pages":"Pages 31-34"},"PeriodicalIF":0.0,"publicationDate":"2026-01-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"147448646","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Current status and advances of robotic hepatectomy for difficult liver segments","authors":"Nan Jiang,&nbsp;Zhuzeng Yin","doi":"10.1016/j.isurg.2026.06.002","DOIUrl":"10.1016/j.isurg.2026.06.002","url":null,"abstract":"<div><div>As a landmark technological breakthrough in 21st-century minimally invasive surgery, robotic surgical systems have been widely adopted for all types of hepatectomy. Difficult liver segments, including Couinaud segments I, IVa, VII and VIII, occupy deep anatomical spaces in immediate proximity to the hepatic veins and inferior vena cava. Conventional laparoscopic techniques suffer from limited working space and suboptimal surgical visualization, thereby substantially raising technical challenges and perioperative risks. Equipped with exclusive merits such as high-definition three-dimensional stereoscopic vision, multi-articulated bionic manipulators and sustained stable field retraction, robotic platforms effectively overcome the inherent limitations of conventional laparoscopy and deliver an innovative technical paradigm for minimally invasive resection of anatomically demanding hepatic segments. In the present study, we summarize the overall application status of robotic hepatectomy. Focusing on the definition and surgical hurdles of difficult hepatic segments, it integrates our institutional clinical experience with data from domestic and international comparative studies to objectively elaborate the core strengths and intrinsic limitations of robotic resection for these lesions. Furthermore, we delineate cutting-edge advances including robotic-specific difficulty scoring metrics, single-port robotic systems, remote robotic surgery and AI-assisted intraoperative navigation, in order to provide theoretical support and clinical references for standardized minimally invasive resection of anatomically intricate complex hepatic segments.</div></div>","PeriodicalId":100683,"journal":{"name":"Intelligent Surgery","volume":"9 ","pages":"Pages 58-62"},"PeriodicalIF":0.0,"publicationDate":"2026-01-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148462986","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Pioneering case: Teleoperated single-port robotic-assisted vNOTES hysterectomy","authors":"Chunhua Zhang,&nbsp;Yunxia Chen,&nbsp;Xiaojie Hu,&nbsp;Xiaowei Dou,&nbsp;Xiaoming Guan","doi":"10.1016/j.isurg.2026.09.001","DOIUrl":"10.1016/j.isurg.2026.09.001","url":null,"abstract":"<div><h3>Objective</h3><div>To evaluate the feasibility and safety of teleoperated single-port robotic-assisted vNOTES hysterectomy using the domestically developed Shurui SR-ENS-600 robotic system for benign gynecological disease and to describe the technical implementation and short-term outcomes.</div></div><div><h3>Methods</h3><div>A 43-year-old woman (BMI 23.0 kg/m²) with complex atypical endometrial hyperplasia underwent teleoperated single-port robotic-assisted vNOTES total hysterectomy with bilateral salpingectomy on June 30, 2026. The procedure was performed using the domestically developed Shurui SR-ENS-600 system, with the surgeon console in Shanghai and the patient-side cart at the Second Affiliated Hospital of Nanjing Medical University, approximately 300 km away, connected via a dedicated low-latency communication network.</div></div><div><h3>Results</h3><div>Total operative time was 60 min (50 min console time and 10 min docking time), with 20 mL blood loss and no intraoperative complications. Network latency was maintained at approximately 10 ms (round-trip), providing uninterrupted 4 K three-dimensional visualization throughout the procedure. The patient was ambulatory at 6 h and discharged on postoperative day 2 without complications. Final pathology demonstrated complex endometrial hyperplasia with atypia, with no evidence of malignancy.</div></div><div><h3>Conclusion</h3><div>As the first reported case using the Shurui SR-ENS-600 platform, this study provides evidence confirming the technical feasibility and safe integration of remote surgery, single-port robotics, and vaginal natural orifice access in gynecological practice. Three factors were essential to the successful outcome: a stable low-latency network, an emergency conversion protocol that allowed local control within 1 min, and a well-prepared on-site backup team. This initial experience addresses a notable gap in the literature on teleoperated gynecologic surgery and offers a practical framework for future adoption. Larger prospective multicenter studies are still needed to confirm its broader applicability and long-term outcomes.</div></div>","PeriodicalId":100683,"journal":{"name":"Intelligent Surgery","volume":"9 ","pages":"Pages 74-78"},"PeriodicalIF":0.0,"publicationDate":"2026-01-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148951674","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Preliminary experience of robot-assisted single-port laparoscopic redo pyeloplasty in children","authors":"Ziqin He ,&nbsp;Chutian Xiao ,&nbsp;Juntao Li ,&nbsp;Yifei Zhang ,&nbsp;Wenwen Zhong ,&nbsp;Jianguang Qiu ,&nbsp;Dejuan Wang","doi":"10.1016/j.isurg.2025.10.002","DOIUrl":"10.1016/j.isurg.2025.10.002","url":null,"abstract":"<div><h3>Objective</h3><div>To describe the surgical technique of robot-assisted single-port laparoscopic redo pyeloplasty (RSLRP) in children and to confirm the feasibility of this technique.</div></div><div><h3>Methods</h3><div>A 12-year-3-month-old boy with recurrent ureteropelvic junction obstruction after robot-assisted laparoscopic surgery underwent RSLRP with da Vinci Xi surgical system. The general clinical characteristics, perioperative variables and follow-up outcomes were summarized.</div></div><div><h3>Results</h3><div>The child was allowed to drink water up to 2 ​h before surgery. The operation was successfully performed without conversion to open surgery or intraoperative complications. The total operative time was 215 ​min, including 170 ​min of console time, with an estimated blood loss of 10 ​mL. Oral intake was initiated postoperatively upon awakening from anesthesia, starting with clear fluids and advancing to a regular diet as tolerated, with no signs of aspiration. The postoperative complication was gross hematuria (Clavien-Dindo grade Ⅱ), which was improved after conservative treatment. The postoperative hospital stay was 7 days, with total hospitalization duration of 11 days. The ureteral stent was removed 35 days after surgery. Follow-up ultrasound showed improvement of hydronephrosis compared with the preoperative assessment.</div></div><div><h3>Conclusion</h3><div>The application of the da Vinci Xi surgical system for pediatric RSLRP is safe and feasible. Further studies with larger cohorts and long-term follow-up are warranted to validate the safety and efficacy of RSLRP in the pediatric population.</div></div>","PeriodicalId":100683,"journal":{"name":"Intelligent Surgery","volume":"8 ","pages":"Pages 125-129"},"PeriodicalIF":0.0,"publicationDate":"2025-01-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145415044","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Successful robotic-assisted liver resection after Yttrium-90 radioembolization in combination with targeted and immunotherapy in unresectable hepatocellular carcinoma:A case report and literature review","authors":"Yewei Zhang ,&nbsp;Zefeng Shen ,&nbsp;Xiao Liang","doi":"10.1016/j.isurg.2025.03.002","DOIUrl":"10.1016/j.isurg.2025.03.002","url":null,"abstract":"<div><h3>Objective</h3><div>To explore the clinical data and review the literature on successful robotic-assisted hepatectomy after yttrium-90 microsphere radioembolization (Y⁹⁰-RE) combined with targeted therapy and immunotherapy for advanced unresectable hepatocellular carcinoma (HCC).</div></div><div><h3>Methods</h3><div>We retrospectively analyzed a case of with advanced HCC patient in our center who successfully underwent robotic-assisted hepatectomy after Y⁹⁰-RE combined with targeted therapy and immunotherapy. Additionally, we reviewed the related treatments and summarized the latest advances in domestic and international literature.</div></div><div><h3>Results</h3><div>The patient was a 65-year-old man, who underwent successful robotic-assisted hepatectomy after Y⁹⁰-RE combined with targeted immunotherapy and was confirmed to achieve pathologically complete remission (pCR). Postoperative pathology showed that the tumor was necrotic, and no tumor residue was observed. The patient was followed up for more than six months, and no tumor recurrence was observed.</div></div><div><h3>Conclusion</h3><div>In this case, Y⁹⁰-RE combined with targeted immunotherapy as a preoperative conversion therapy ​option for advanced unresectable HCC was proven to be safe and feasible in this case.</div></div>","PeriodicalId":100683,"journal":{"name":"Intelligent Surgery","volume":"8 ","pages":"Pages 24-28"},"PeriodicalIF":0.0,"publicationDate":"2025-01-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143759101","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Historical development of the da Vinci robotic surgical system in pancreaticoduodenectomy","authors":"Boyu Diao ,&nbsp;Runxian Wang ,&nbsp;Zhenya Liu ,&nbsp;Hanxiang Zhan","doi":"10.1016/j.isurg.2025.08.002","DOIUrl":"10.1016/j.isurg.2025.08.002","url":null,"abstract":"<div><h3>Objective</h3><div>To examine the historical development of robotic pancreaticoduodenectomy (RPD) and evaluate its clinical applicability and future directions.</div></div><div><h3>Methods</h3><div>This review article synthesizes the evolution of robotic pancreaticoduodenectomy by reviewing key clinical studies and advancements in robotic technology, with a focus on the da Vinci system.</div></div><div><h3>Results</h3><div>Robotic pancreaticoduodenectomy has demonstrated clear advantages in precision, lymph node dissection, and postoperative recovery, although it remains associated with longer operative time and higher costs compared to open pancreaticoduodenectomy.</div></div><div><h3>Discussion</h3><div>The rapid technological advances in robotic surgery have transformed the landscape of pancreatic surgery, but challenges such as high costs, longer operation time, and the lack of haptic feedback remain significant. Emerging trends like AI integration and single-port surgery hold promise for future developments.</div></div><div><h3>Conclusion</h3><div>While RPD provides immediate clinical benefits in terms of recovery and complication rates, further studies on long-term oncologic outcomes and cost-effectiveness are necessary for a comprehensive understanding of its role in pancreatic surgery.</div></div>","PeriodicalId":100683,"journal":{"name":"Intelligent Surgery","volume":"8 ","pages":"Pages 99-105"},"PeriodicalIF":0.0,"publicationDate":"2025-01-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144864386","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Initial experience of single-incision robotic surgery for lateral suspension of patients with pelvic organ prolapse","authors":"Shiyan Wang ,&nbsp;Yuqi Men ,&nbsp;Lei Gao ,&nbsp;Qianqian Ye ,&nbsp;Yiqin Wang ,&nbsp;Hao Deng ,&nbsp;Xiuli Sun","doi":"10.1016/j.isurg.2025.02.001","DOIUrl":"10.1016/j.isurg.2025.02.001","url":null,"abstract":"<div><h3>Objective</h3><div>The aim of this study was to describe technical considerations and short-term outcomes from the first reported eight cases of single-incision robotic operation for lateral suspension of patients with pelvic organ prolapse using the SHURUI robotics surgical system (SR-ENS-600, SHURAI compony, Beijing Daxing Biomedical Base).</div></div><div><h3>Methods</h3><div>Eight patients with a body-mass index vary from 20 to 30 ​kg/m² was treated for anterior vaginal prolapse and apical prolapse by single-incision robot-assisted lateral suspension with the SHURUI robotics surgical system between March 2024 and June 2024 in Peking University People's Hospital.</div></div><div><h3>Results</h3><div>The single-incision SHURUI robot-assisted lateral suspension was successfully performed with eight patients who suffered from anterior vaginal prolapse and apical prolapse. The console time among the operation ranged from 192 ​min to 274 ​min, with intraoperative blood loss ranging from 20 ​mL to 100 ​mL. There was no urinary retention after urinary catheter removal. During the postoperative period, no severe adverse events occurred. There was no prolapse recurrence after one month of postoperative follow-up.</div></div><div><h3>Conclusion</h3><div>Single-incision SHURUI robot-assisted lateral suspension was a safe and feasible surgical method for patients with anterior vaginal prolapse and apical prolapse. The study provided a basis for subsequent research and highlighted the need for further clinical trials to verify its superior operative outcomes.</div></div>","PeriodicalId":100683,"journal":{"name":"Intelligent Surgery","volume":"8 ","pages":"Pages 8-13"},"PeriodicalIF":0.0,"publicationDate":"2025-01-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143464043","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Feasibility and safety evaluation of remote robotic surgery under high latency conditions based on satellite communication","authors":"Gong Zhang ,&nbsp;Lichao Pan ,&nbsp;Xuan Zhang ,&nbsp;Zhaohai Wang ,&nbsp;Zhiqiang Ma ,&nbsp;Chao He ,&nbsp;Zihan Li ,&nbsp;Rong Liu","doi":"10.1016/j.isurg.2025.05.001","DOIUrl":"10.1016/j.isurg.2025.05.001","url":null,"abstract":"<div><h3>Objective</h3><div>To verify the feasibility of geostationary orbit satellite communication in ultra-remote robotic surgery and to construct a remote surgical operation control technology system under high-latency communication conditions.</div></div><div><h3>Methods</h3><div>A large time-delay control method was proposed, including the establishment of the Stability Operation Criteria for Large Time-Delay Remote Robotic Surgery and Generalized-Order Compliant Interaction Control Method. On December 26, 2024, a transregional communication link between Lhasa and Beijing was established via the Asia-Pacific 6D high-throughput satellite (orbital altitude of 36,000 ​km), and two hepatectomies for liver cancer were performed using the Tumai surgical robot system. Core parameters such as end-to-end latency and data packet loss rate were monitored.</div></div><div><h3>Results</h3><div>The Lhasa-Beijing link established through the Asia-Pacific 6D satellite achieved an average end-to-end latency of 632 ​ms (measured uplink 4.2 Mbps/downlink 3 Mbps), with intraoperative robotic arm pose tracking error &lt;0.5 ​mm (n ​= ​2). Both hepatectomies for liver cancer were successfully completed, with surgery durations of 115–124 ​min, blood loss of 20 ​mL, and patients discharged within 24 ​h post-surgery without severe complications (Clavien-Dindo I level).</div></div><div><h3>Conclusion</h3><div>This study is the first to confirm the safety of geostationary orbit satellite support for human surgery and verifies the feasibility of surgical operation control technology under high-latency conditions.</div></div>","PeriodicalId":100683,"journal":{"name":"Intelligent Surgery","volume":"8 ","pages":"Pages 45-52"},"PeriodicalIF":0.0,"publicationDate":"2025-01-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144116887","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}