Intelligent Surgery最新文献

{"title":"Core elements for a smooth transition from laparoscopic to robotic colorectal surgery","authors":"Shuai Ma,&nbsp;Quanbo Zhou,&nbsp;Weitang Yuan,&nbsp;Yugui Lian","doi":"10.1016/j.isurg.2025.05.004","DOIUrl":"10.1016/j.isurg.2025.05.004","url":null,"abstract":"<div><div>With the widespread adoption of da Vinci robotic system, the volume of robotic colorectal surgeries has witnessed an explosive increase. Studies have shown that robotic surgery outperforms traditional laparoscopy in terms of tumor resection quality, intraoperative blood loss, postoperative recovery, and patient prognosis. This article systematically explores the core elements for transitioning from laparoscopic to robotic colorectal surgery, emphasizing learning curve and case selection as pivotal factors. Learning curve analysis indicates that the proficiency process of robotic surgery can be divided into the exploration period, the stabilization period, and the challenge period. Moreover, previous laparoscopic experience has a limited effect on shortening the learning curve, while case selection and training volume are more crucial. Case selection should quantify the surgical difficulty through preoperative clinical parameters and follow the principle of “from simple to complex”. In the future, it is necessary to establish a standardized training system, and develop surgical difficulty prediction tools to optimize clinical decision-making. This article provides a theoretical and practical framework for the safe and efficient transition of surgical approaches.</div></div>","PeriodicalId":100683,"journal":{"name":"Intelligent Surgery","volume":"8 ","pages":"Pages 58-62"},"PeriodicalIF":0.0,"publicationDate":"2025-01-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144203643","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":"Assessment of total mesorectal excision through combined peritoneal and anal approaches in an animal model with Carina™ platform","authors":"Xiang Xia ,&nbsp;Yeqian Zhang ,&nbsp;Jiayi Gu ,&nbsp;Tao Liu ,&nbsp;Chunchao Zhu,&nbsp;Zheng Wang,&nbsp;Zizhen Zhang","doi":"10.1016/j.isurg.2025.03.001","DOIUrl":"10.1016/j.isurg.2025.03.001","url":null,"abstract":"<div><h3>Objective</h3><div>This study assessed the feasibility of performing hybrid transabdominal and transanal total mesorectal excision using the Carina™ platform in an animal model.</div></div><div><h3>Methods</h3><div>The experiment was conducted in a porcine model, where two experienced surgeons performed simultaneous abdominal and transanal portions of the procedure.</div></div><div><h3>Results</h3><div>The procedure was successfully completed in 123 ​min with minimal blood loss of 15 ​mL. Both teams reached the peritoneal reflection without complications or conversion to laparotomy. The Carina™ platform's modular design enabled precise, flexible manipulation and enhanced surgical visibility, facilitating meticulous dissection in the narrow pelvis.</div></div><div><h3>Conclusion</h3><div>The study validated the use of robotic platforms for complex cases and highlighted the advantages of dual-console, modular robotic surgery.</div></div>","PeriodicalId":100683,"journal":{"name":"Intelligent Surgery","volume":"8 ","pages":"Pages 19-23"},"PeriodicalIF":0.0,"publicationDate":"2025-01-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143759182","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":"Da Vinci Xi robot-assisted resection of a large caudate lobe liver tumor: Case report and technical discussion","authors":"Zhichao Yang,&nbsp;Xinyu Ma,&nbsp;Haitao Yang,&nbsp;Zihao Li,&nbsp;Guangchao Yang,&nbsp;Linqiang Li,&nbsp;Yong Ma","doi":"10.1016/j.isurg.2025.02.002","DOIUrl":"10.1016/j.isurg.2025.02.002","url":null,"abstract":"<div><h3>Background</h3><div>This study details the surgical process of using the da Vinci Xi surgical robot to resect a large caudate lobe liver tumor. It aims to share technical experience in robot-assisted resection of large tumors in the caudate lobe of the liver.</div></div><div><h3>Objective</h3><div>To provide evidence supporting the feasibility and safety of robot-assisted liver caudate lobe tumor resection.</div></div><div><h3>Methods</h3><div>On August 5, 2024, the First Affiliated Hospital of Harbin Medical University successfully performed a large caudate lobe tumor resection adjacent to the inferior vena cava using the da Vinci Xi robotic system on a 23-year-old male. Surgical time, techniques, intraoperative blood loss, and postoperative recovery were documented and analyzed.</div></div><div><h3>Results</h3><div>The surgery was successfully completed in 195 ​min with an intraoperative blood loss of 200 ​mL, and no severe postoperative adverse events occurred. The patient recovered well under Enhanced Recovery After Surgery (ERAS) protocols and was discharged. Pathological examination confirmed focal nodular hyperplasia of the liver, with the tumor measuring 8 ​× ​5 ​× ​4.5 ​cm.</div></div><div><h3>Conclusion</h3><div>Robot-assisted liver tumor resection with the da Vinci Xi system is a safe and reliable surgical approach for treating large benign tumors of the liver caudate lobe. This study contributes to the clinical application of such surgeries and further confirms their safety and feasibility.</div></div>","PeriodicalId":100683,"journal":{"name":"Intelligent Surgery","volume":"8 ","pages":"Pages 14-18"},"PeriodicalIF":0.0,"publicationDate":"2025-01-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143534373","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":"Initial experience of pure robotic single incision TME with SST technique for middle-low rectal cancer using the da Vinci SP system","authors":"Choi Nim,&nbsp;Kuok Chi Ian","doi":"10.1016/j.isurg.2025.06.001","DOIUrl":"10.1016/j.isurg.2025.06.001","url":null,"abstract":"<div><h3>Objective</h3><div>To overcome the technique challenge of successful TME and precise distal section of the rectum with free margin for the goal of perfect anastomosis for operations of middle-low rectal cancer. The da Vinci single port SP system is a brand-new platform with its special design, making surgical suture in narrow space feasible.</div></div><div><h3>Methods</h3><div>From June 2024 to October 2024, three male patients with average body-mass index of 22.1 ​kg/m² successfully underwent pure robotic single-incision total mesorectal excision (TME) using the rectal stump transabdominal purse string and single stapled anastomosis technique (SST). The surgical technique considerations and short-term outcomes were reviewed. There was no conversion case.</div></div><div><h3>Results</h3><div>The average robot docking time was 3 ​min (range, 3–5 ​min). The average operative time was 403 ​min (range, 4 h 20mins to 8 ​h 20mins), and the estimated blood loss was 10 ​mL (range, 10 ​mL). There were no postoperative complications. The patients were put on oral diet average 2.6 days after surgery, bowel movements average 3.3 days and discharged on 8 ​± ​4 days post operatively. The final pathology revealed the mean 6.6 ​cm middle-low located rectal cancer with average 3 lymph nodes detected. All the circumferential and distal resection margin were clear.</div></div><div><h3>Conclusion</h3><div>Pure robotic single-incision (TME) with (SST) for middle-low rectal cancer is technically achievable with acceptable short-term outcomes. This approach not only allows for precise resection of rectum with adequate distal margins under direct visualization, but also reduces the need for expensive stapling system and addresses the limitation of da Vinci new SP platform short of its own stapling device. The pathological and short-term clinical outcomes are acceptable. The long-term results still require further careful investigation.</div></div>","PeriodicalId":100683,"journal":{"name":"Intelligent Surgery","volume":"8 ","pages":"Pages 70-75"},"PeriodicalIF":0.0,"publicationDate":"2025-01-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144570022","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":"Multimodal management of stage IVB cervical cancer: Neoadjuvant immunotherapy followed by robotic-assisted radical surgery and maintenance therapy—A case report","authors":"Meng Yang ,&nbsp;Jingjing Wang ,&nbsp;Keyao Chen ,&nbsp;Yanna Liu ,&nbsp;Yi Liu ,&nbsp;Li Sun","doi":"10.1016/j.isurg.2025.09.001","DOIUrl":"10.1016/j.isurg.2025.09.001","url":null,"abstract":"<div><h3>Objective</h3><div>To report a case of FIGO 2018 stage IVB PD-L1-positive cervical squamous cell carcinoma successfully managed with neoadjuvant immunochemotherapy followed by conversion surgery and maintenance systemic therapy, highlighting the feasibility and potential benefit of a multimodal approach in selected patients.</div></div><div><h3>Methods</h3><div>A 61-year-old postmenopausal woman with cervical cancer and distant lymph node metastases (pelvic, para-aortic, and left supraclavicular) was treated with six cycles of neoadjuvant therapy comprising a PD-1 inhibitor, paclitaxel, cisplatin, and bevacizumab. This was followed by two additional cycles of PD-1 inhibitor and bevacizumab alone. Radiologic evaluation identified significant regression of metastatic lesions and shrinkage of the primary cervical tumor. However, mild re-enlargement of the cervical lesion was noted on follow-up imaging. Robotic-assisted radical hysterectomy, pelvic and para-aortic lymphadenectomy, and partial vaginectomy were performed based on multidisciplinary consensus and patient preference. Postoperative adjuvant therapy and maintenance treatment ensued.</div></div><div><h3>Results</h3><div>Neoadjuvant treatment resulted in partial response with significant reduction in both target and non-target lesions. Despite mild re-enlargement of the primary cervical lesion after chemotherapy de-escalation, surgery was pursued. Pathology revealed minimal residual disease confined to the cervical stroma without nodal metastasis. The patient completed four cycles of adjuvant therapy and achieved complete response. She has since remained disease-free on maintenance therapy with bevacizumab and a PD-1 inhibitor, with a follow-up duration of 16 months from the initial diagnosis.</div></div><div><h3>Conclusion</h3><div>This case illustrates that, in selected PD-L1-positive FIGO stage IVB cervical cancer patients with resectable distant metastases and no parametrial invasion, a multimodal approach combining systemic immunochemotherapy with anti-angiogenic agents, followed by robotic-assisted conversion surgery and personalized postoperative management, can achieve complete response and potentially curative outcomes. Robotic surgery also facilitates complex procedures in anatomically constrained spaces, supporting its role in advanced-stage cervical cancer management. This treatment model may offer a viable strategy to prolong progression-free and overall survival in carefully selected patients.</div></div>","PeriodicalId":100683,"journal":{"name":"Intelligent Surgery","volume":"8 ","pages":"Pages 106-111"},"PeriodicalIF":0.0,"publicationDate":"2025-01-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145095172","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":"Robotic surgery for chronic pancreatitis – an update","authors":"Jan Bardenhagen ,&nbsp;Philipp Seeger ,&nbsp;Kongyuan Wei ,&nbsp;Felix Nickel ,&nbsp;Thilo Hackert ,&nbsp;Faik Guntac Uzunoglu","doi":"10.1016/j.isurg.2025.09.002","DOIUrl":"10.1016/j.isurg.2025.09.002","url":null,"abstract":"<div><div>Robotic surgery has been introduced in all fields of general surgery including pancreatic resections in the last decade. While there is growing evidence that this type of minimally-invasive surgery can be used safely for standard procedures including distal pancreatectomy as well as pancreatico-duodenectomy, there is little data on the use of robotic approaches in the indication of chronic pancreatitis (CP) and it's specific drainage or resection procedures such as lateral pancreatico-jejunostomy or duodenum-preserving pancreatic head resection as these procedures may be challenging – especially due to the inflammatory changes. Therefore, patients suffering from CP are rarely chosen for robotic procedures although it may offer similar advantages in this specific patient collective as in other indications.</div><div>This update gives an overview on the current status of robotics in CP surgery with a focus on proper patient selection, technical topics as well as the standards in the authors’ institution and reviews the available literature.</div></div>","PeriodicalId":100683,"journal":{"name":"Intelligent Surgery","volume":"8 ","pages":"Pages 112-117"},"PeriodicalIF":0.0,"publicationDate":"2025-01-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145319548","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":"Short-term outcome analysis of Carina™ platform in gastric and colorectal surgery: A single-group target-value clinical trial","authors":"Penghui He ,&nbsp;Feng Xiao ,&nbsp;Yahang Liang ,&nbsp;Dongning Liu ,&nbsp;Jinyuan Duan ,&nbsp;Shanping Ye ,&nbsp;Bo Tang ,&nbsp;Taiyuan Li","doi":"10.1016/j.isurg.2025.05.003","DOIUrl":"10.1016/j.isurg.2025.05.003","url":null,"abstract":"<div><h3>Objective</h3><div>To systematically evaluate the efficiency and safety of the Carina™ Platform (Ronovo Surgical, Shanghai, China) in the field of general surgery, this study reported our preliminary experience.</div></div><div><h3>Methods</h3><div>Twenty-six consecutive patients were scheduled to undergo Carina robot-assisted laparoscopic surgery in our units from December 2023 to July 2024. The factors analyzed were the time required to prepare the patient and the room, total time of surgery, length of specimens, number of lymph nodes retrieved, blood loss, complications, and post-operative results.</div></div><div><h3>Results</h3><div>This robot-assisted laparoscopic surgery system is safe and mature. All of procedures were completed robotically, and there was no conversion to laparotomy. The median operation time was 172.5 ​min (range, 125–375) and the mean (SD) number of lymph nodes retrieved was 24 (9). The median docking time was 10 ​min (range, 6–15). The incidence of surgical complications was 2 out of 26 cases, including one patient with a rectal anastomotic leak and another patient with a wound infection.</div></div><div><h3>Conclusions</h3><div>The use of the Carina modular robotic system in gastric and colorectal surgery has been demonstrated to be both effective and safe. However, the advantages of modular robotic platforms remain to be explored, and further research is needed to assess long-term outcomes.</div></div>","PeriodicalId":100683,"journal":{"name":"Intelligent Surgery","volume":"8 ","pages":"Pages 53-57"},"PeriodicalIF":0.0,"publicationDate":"2025-01-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144154447","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":"Utility of the da Vinci X robotic system in extramesocolic resections for locally-advanced colon cancer: A video vignette","authors":"Jagannath Dixit ,&nbsp;Joseph Mathew ,&nbsp;Satya Vijay Chigurupati ,&nbsp;Keshav Murthy MR","doi":"10.1016/j.isurg.2025.04.002","DOIUrl":"10.1016/j.isurg.2025.04.002","url":null,"abstract":"&lt;div&gt;&lt;h3&gt;Objective:&lt;/h3&gt;&lt;div&gt;To demonstrate the surgical technique for robotic extramesocolic resection using the da Vinci X platform in locally-advanced colon cancer (LACC), highlighting the challenges associated with this approach when the oncological margins of resection extend beyond the mesocolic fascia.&lt;/div&gt;&lt;/div&gt;&lt;div&gt;&lt;h3&gt;Methods:&lt;/h3&gt;&lt;div&gt;This study, designed as a stepwise demonstration of surgical technique with narrated video footage, was conducted at a tertiary cancer center and teaching hospital in India. The patient was an 86-year-old man with Eastern Cooperative Oncology Group (ECOG) performance score of one, a surgical history of having undergone a laparotomy in the past, a significant family history of colon cancer and no comorbidities, who presented with complaints of bleeding per rectum since 3 months and lower abdominal fullness since 1 month, which on physical examination was determined to be a solitary well-circumscribed fixed mass in the left iliac fossa. On further evaluation, the colonic origin of this mass was confirmed, with colonoscopy revealing a circumferential ulceroproliferative growth extending from 35 to 40 cm of the anal verge, the biopsy of which was reported as a well-differentiated adenocarcinoma. On contrast-enhanced CT of the thorax, abdomen and pelvis, transmural thickening of the distal descending and proximal sigmoid colon causing severe luminal narrowing was evident, with infiltration of the left psoas and abdominal wall musculature, and abutting the left ureter and gonadal vessels, suggestive of LACC. Given the stricturing nature of the primary tumor with features suggestive of impending obstruction, and in the absence of significant locoregional lymphadenopathy or distant metastases, the multidisciplinary tumor board recommended primary surgical resection. A robotic approach was offered, considering the patient’s good performance status, the limited extent of extramesocolic disease, and the anticipated favorable postoperative outcomes.&lt;/div&gt;&lt;/div&gt;&lt;div&gt;&lt;h3&gt;Results:&lt;/h3&gt;&lt;div&gt;The patient underwent a robotic anterior resection with extended complete mesocolic or extramesocolic excision. Before the procedure, a staging laparoscopy was performed to exclude peritoneal surface metastases and confirm operability, following which additional robotic ports were inserted, docking performed and the instruments deployed. Early into surgery, contiguous involvement of the retroperitoneal structures seen to abut the tumor on imaging was ruled out, ensuring disease resectability. Despite the lack of haptic feedback, the surgical margins were estimated and an en bloc resection performed based on compensatory visual cues including tissue color and texture, mobility of fascial planes and peritumoral edema, demonstrating the Reverse Braille phenomenon or faux haptic feedback wherein tactile sensation is perceived when vision is greatly enhanced, primarily considered a function of surgeon experience and the acuity of vision i","PeriodicalId":100683,"journal":{"name":"Intelligent Surgery","volume":"8 ","pages":"Pages 67-69"},"PeriodicalIF":0.0,"publicationDate":"2025-01-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144261828","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":"Robotic remote left lateral hepatectomy: A 2,600 ​km telesurgical case from Yunnan to Beijing","authors":"Xuan Zhang ,&nbsp;H.S. Boo ,&nbsp;Yuyao Song ,&nbsp;Zhaohai Wang ,&nbsp;Rong Liu","doi":"10.1016/j.isurg.2025.05.002","DOIUrl":"10.1016/j.isurg.2025.05.002","url":null,"abstract":"<div><h3>Purpose</h3><div>To report on a successful case of robotic remote left lateral hepatectomy.</div></div><div><h3>Methods</h3><div>A 56-year-old female patient with a liver hemangioma in the left lateral segment underwent robotic remote left lateral hepatectomy at Chinese People's Liberation Army General Hospital (PLAGH).</div></div><div><h3>Results</h3><div>The surgery lasted 1 ​h and 21 ​min with minimal blood loss and was conducted using a 5G network with a one-way delay of 40 ​ms. The patient was discharged in one day post-surgery. There were no complications, including hemorrhage or bile leakage.</div></div><div><h3>Conclusions</h3><div>This case highlights the potential of telesurgery in hepatic surgeries to improve access to specialized surgery while addressing logistical, ethical and technological challenges.</div></div>","PeriodicalId":100683,"journal":{"name":"Intelligent Surgery","volume":"8 ","pages":"Pages 63-66"},"PeriodicalIF":0.0,"publicationDate":"2025-01-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144231504","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":"Advantages and prospects of robotic surgery for colorectal cancer","authors":"Qi Fan,&nbsp;Zhengwei Fu,&nbsp;Dehai Xiong","doi":"10.1016/j.isurg.2025.01.001","DOIUrl":"10.1016/j.isurg.2025.01.001","url":null,"abstract":"<div><div>This paper provides an overview of the development, technical features and current applications of the da Vinci surgical robots in colorectal cancer surgeries and conducts an in-depth analysis of the precision and stability of the da Vinci surgical robots in surgeries, as well as its technical advantages in reducing surgical trauma and accelerating recovery. This paper evaluates the clinical efficacy and safety of da Vinci surgical robotic-assisted surgery through a comparison of partial clinical data with traditional surgical methods, particularly focusing on the economic and social benefits. It fully demonstrates the advantages and application prospects of the da Vinci surgical robots in colorectal surgery, including intelligent precision technology, good clinical outcomes and excellent cost-effectiveness, while also discussing the current challenges and countermeasures.</div></div>","PeriodicalId":100683,"journal":{"name":"Intelligent Surgery","volume":"8 ","pages":"Pages 1-7"},"PeriodicalIF":0.0,"publicationDate":"2025-01-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143387728","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}