Journal of Robotic Surgery最新文献

{"title":"Bridging the gap: feasibility and future directions of robotic surgery in Sub-Saharan Africa-a narrative review.","authors":"Fitsum A Gemechu, Helina K Teklehaimanot, Michael A Negussie, Biruk T Mengistie, Chernet T Mengistie, Mikiyas G Teferi, Liya T Tena, Rodolfo J Oviedo","doi":"10.1007/s11701-025-02860-x","DOIUrl":"https://doi.org/10.1007/s11701-025-02860-x","url":null,"abstract":"<p><p>Robotic surgery (RS) is expanding globally but remains nascent in Sub-Saharan Africa (SSA). Given constrained resources, training gaps, and infrastructure limitations, the feasibility and health-system value of RS in SSA require careful appraisal relative to open and laparoscopic surgery. We conducted a narrative review of RS feasibility, adoption, training, outcomes, and economics with a primary focus on SSA. Sources included PubMed, Embase, Scopus, Google Scholar, and gray literature from January 2010 to May 2025. Evidence was synthesized across themes (infrastructure, workforce, financing, outcomes, and implementation models), incorporating African data where available and using global studies for context. Adoption in SSA is concentrated in a few private centers in South Africa, with Egypt providing continental historical context and Rwanda emerging as a regional training hub. Dominant barriers include high capital and recurrent costs, supply-chain and maintenance needs, reliable power and connectivity requirements, and limited team-based training capacity. While global data consistently show advantages of RS over open surgery (e.g., reduced blood loss, complications, and length of stay), Africa-specific comparative data versus laparoscopy are limited and generally demonstrate longer operative times and greater blood loss without significant differences in conversion, length of stay, or overall morbidity. Promising pathways include centralized high-volume hubs, public-private and NGO partnerships with explicit maintenance and uptime guarantees, regional training pipelines (on-site simulation, fellowships, and telementoring/telesurgery), and staged financing models (shared ownership, refurbishment, and outcome-linked contracts). Emerging, potentially lower-cost platforms may improve affordability, but sustainable case volume and workforce development remain prerequisites. We propose pragmatic metrics to track implementation: procedural volume and mix, system uptime, conversion and complication rates, cost per case, and training outputs. RS is feasible in carefully selected SSA centers when aligned with health-system priorities, robust maintenance, and concentrated training. Given equipoise versus laparoscopy in current African data, early programs should be justified by access, training, and service-delivery goals rather than presumed clinical superiority. Prospective registries, context-specific economic evaluations, and procedure-specific comparative studies are needed to guide equitable and sustainable scale-up.</p>","PeriodicalId":47616,"journal":{"name":"Journal of Robotic Surgery","volume":"19 1","pages":"708"},"PeriodicalIF":3.0,"publicationDate":"2025-10-23","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145349195","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":3,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Maximal anatomic bladder neck preservation at the prostatic origin (MANO) in robotic radical prostatectomy: does prostate size matter?","authors":"Deerush Kannan Sakthivel, Pushan Prabhakar, Mohamed Javid Raja Iyub, Manuel Ozambela, Murugesan Manoharan","doi":"10.1007/s11701-025-02880-7","DOIUrl":"https://doi.org/10.1007/s11701-025-02880-7","url":null,"abstract":"<p><p>Prostate size has traditionally been considered a determinant of surgical difficulty and postoperative outcomes in radical prostatectomy. Larger glands often present challenges in bladder neck dissection, with potential implications for continence and oncological safety. We describe the maximal anatomic bladder neck preservation at the prostatic origin (MANO) technique, designed to enable safe circumferential dissection at the true bladder neck origin irrespective of gland size. This retrospective study analyzed 341 patients undergoing nerve-sparing robotic-assisted radical prostatectomy (RALP) with the MANO technique between 2017 and 2023. Patients were stratified into three groups by MRI-estimated prostate volume: < 30 cc (n = 83), 30-50 cc (n = 147), and > 50 cc (n = 111). Perioperative, pathological, functional, and oncological outcomes were compared. Continence was defined as 0-1 pad/day, assessed at 3, 12, and 24 months. Larger prostates were associated with older age and higher preoperative PSA (p < 0.05). Mean operative time increased with gland size (165.2 vs. 191.5 min, p < 0.001), and hospital stay was longer for > 50 cc prostates (p = 0.003). Blood loss showed a non-significant increase with prostate size. Pathological stage, Gleason grade, and margin status were comparable across groups. Early continence at 3 months was similar (≈71% across cohorts, p = 0.607), with > 85% continent at 12 months in all groups. Biochemical recurrence rates did not differ significantly (p = 0.630). Complications were infrequent, with no ureteric injuries reported. The MANO technique enables safe bladder neck preservation across all prostate sizes. Despite increased operative complexity in larger glands, functional and oncological outcomes remain equivalent. This approach may standardize bladder neck management in RALP and support improved continence recovery irrespective of prostate volume.</p>","PeriodicalId":47616,"journal":{"name":"Journal of Robotic Surgery","volume":"19 1","pages":"707"},"PeriodicalIF":3.0,"publicationDate":"2025-10-22","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145349188","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":3,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Postoperative complication rates of surgeons during the supervised training program in robotic-assisted colorectal surgery.","authors":"Luis Gustavo Capochin Romagnolo, Pedro Costa Moreira, Carlos Augusto Rodrigues Veo, Marcos Vinícius Araújo Denadai, Felipe Daldegan Diniz, Rodrigo Giacomini Bregeiro, Carlos Augusto Real Martinez, Armando Geraldo Franchini Melani","doi":"10.1007/s11701-025-02892-3","DOIUrl":"https://doi.org/10.1007/s11701-025-02892-3","url":null,"abstract":"<p><p>Robotic-assisted surgery (RAS) has established itself as an advanced technique in colorectal surgery, providing better postoperative outcomes due to its greater precision and less invasiveness. However, RAS requires dedicated and supervised training to avoid complications in the initial learning curve. This study evaluated the safety and efficacy of a supervised RAS training program focusing on postoperative complications, and its classification according to the Clavien-Dindo (CD) grade. This is a retrospective, single-center cohort study that included only patients undergoing RAS performed by specialized colorectal surgeons in supervised training. Postoperative complications were evaluated according to the CD classification. A total of 226 patients undergoing different colorectal surgical procedures performed between December 2021 and November 2023 were included. Demographic, clinical, and operative data were collected and compared with the results of previously published studies in order to evaluate the efficacy of supervised training. The median age of patients was 58 years and 58.8% of them were male. The most common surgeries were sigmoidectomy (50%) and rectosigmoidectomy with total mesorectal excision (19%). The overall complication rate was 7.5%, and the most frequent were anastomotic fistulas (2.6%) and intraperitoneal abscesses (1.7%). The mean surgical time was 175 min, and the median hospital stay was three days. According to CD classification 10 patients (4, 4%) developed surgical complications classified as CD III, CD V (0, 4%), CD IV (0.8%), CD I (0.8%), CD II (0, 8%). Patients with complications grade III and IV had significantly longer hospital stay. One patient died (0.4%). The complication rates found were comparable to those reported in the international literature, demonstrating that the risk of complications did not increase during well-structured and supervised training. The risk of perioperative complications during supervised and well-structured training in RAS is similar to those reported in the literature.</p>","PeriodicalId":47616,"journal":{"name":"Journal of Robotic Surgery","volume":"19 1","pages":"706"},"PeriodicalIF":3.0,"publicationDate":"2025-10-22","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145349172","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":3,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Robotic adrenalectomy achieves shorter operative time than laparoscopic approach: a propensity score-matched analysis.","authors":"Atsunari Kawashima, Yoshiyuki Yamamoto, Yu Ishizuya, Takuji Hayashi, Norichika Ueda, Shigeaki Nakazawa, Kentaro Takezawa, Taigo Kato, Koji Hatano, Yoichi Kakuta, Norio Nonomura","doi":"10.1007/s11701-025-02882-5","DOIUrl":"https://doi.org/10.1007/s11701-025-02882-5","url":null,"abstract":"<p><p>Robotic adrenalectomy (RA) offers advantages over conventional laparoscopic adrenalectomy (LA), including enhanced visualization and instrument articulation. However, comparative data on operative efficiency in Japan remain limited, particularly during the early adoption phases. This study aimed to compare the operative times between RA and LA using propensity score-matched analysis while evaluating the feasibility of a reduced-port RA technique. We conducted a single-center retrospective cohort study of 255 patients who underwent adrenalectomies between January 2010 and May 2025. The patients were grouped according to the surgical approach (RA vs. LA). The data collected included demographics, tumor characteristics, operative details, and complications. The primary outcomes were operative time and duration of pneumoperitoneum. Multivariate regression was used to identify predictors of prolonged time. Propensity score matching was controlled for confounders, including age, body mass index (BMI), American Society of Anesthesiologists-Physical Status classification (ASA-PS), tumor size, tumor histology, and surgeon's experience. Patients with RA had slightly larger tumors but experienced significantly shorter operative (median, 131 min vs. 168 min, p < 0.001) and insufflation times (95 min vs. 138 min, p < 0.001) than those with LA. Multivariate analysis confirmed RA as an independent predictor of reduced times (operative: - 22.26 min; insufflation: - 21.82 min; both p < 0.001), while tumor size ≥ 40 mm and pheochromocytoma independently prolonged times. After matching (n = 53 pairs), the RA remained significantly faster. In conclusion, RA achieves significantly shorter operative and insufflation times than LA even during its early adoption phase. A three-port RA approach is feasible without increasing complications, and reduced-port RA may further enhance operative efficiency while maintaining safety.</p>","PeriodicalId":47616,"journal":{"name":"Journal of Robotic Surgery","volume":"19 1","pages":"704"},"PeriodicalIF":3.0,"publicationDate":"2025-10-21","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145337481","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":3,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Team interactions in robotic-assisted surgery: a scoping review.","authors":"Kyi Phyu Nyein, Kyle M Canady, Joshua A Duron, Jessica L Wildman","doi":"10.1007/s11701-025-02850-z","DOIUrl":"10.1007/s11701-025-02850-z","url":null,"abstract":"<p><p>Robotic-assisted surgery (RAS) significantly alters the operating theater team's spatial configuration, necessitating different communication strategies that subsequently affect team dynamics. Despite the growing prevalence of RAS, inconsistencies remain regarding the conceptualization and measurement of team interactions specifically in RAS in the existing literature. This scoping review aims to provide an overview of the empirical research on team interactions within RAS, identify research gaps, and propose future directions. We conducted the scoping review following updated methodological guidelines and Preferred Reporting Items for Systematic reviews and Meta-Analyses extension for Scoping Reviews (PRISMA-ScR) reporting standards. Searches of PsycINFO, CINAHL, PubMed, Cochrane, Embase, MEDLINE, Web of Science, and Scopus databases were performed, including empirical articles published between January 2010 and October 2023 focusing on team interactions in RAS. Fifty-four empirical articles were included for analysis. Findings highlighted four major themes: teamwork and communication, non-technical skills, flow disruptions, and teaching/surgical education. Most included studies used quantitative methods and observational data. Communication was frequently studied but inconsistently defined and measured, whereas non-technical skills were more consistently defined and measured. Flow disruptions significantly impacted surgical outcomes, and studies emphasized the need for education on verbal communication strategies in RAS. This review illustrates the inconsistencies in defining and measuring team-related concepts in the literature, highlighting the need for standardized terminologies and measures. Future research should explore mediators and moderators in team interactions in RAS and integrate non-technical skills into training curricula. Such advancements could enhance surgical training, team effectiveness, patient safety, and outcomes associated with RAS.</p>","PeriodicalId":47616,"journal":{"name":"Journal of Robotic Surgery","volume":"19 1","pages":"703"},"PeriodicalIF":3.0,"publicationDate":"2025-10-21","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC12540599/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145337484","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":3,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Research on traumatic orthopedic surgery robots: a decade bibliometric analysis of research landscapes and evolving frontiers.","authors":"Xin Deng, Yang Wen, Huanyu Lin, Xin Huang, Dong Liu, Lin Chen, Junfeng Wan, Chao Hu, Jiaping Lan, Lei Li","doi":"10.1007/s11701-025-02875-4","DOIUrl":"https://doi.org/10.1007/s11701-025-02875-4","url":null,"abstract":"<p><p>This study employed bibliometric analysis to identify research hotspots and emerging trends in orthopedic trauma surgery robotics. Relevant literature from 2015 to 2025 was sourced from the Web of Science Core Collection (WOSCC) database, and bibliometric and visualization analyses were conducted using VOS viewer, Cite Space, and the Bibliometrix R-package. Overall, the annual publication volume in this field has shown consistent growth. The United States, China, and Italy lead in publication output. Research is primarily concentrated in universities and hospitals, with Shanghai Jiao Tong University, The Chinese University of Hong Kong, and Yonsei University being the top three contributing institutions. Wang Y is the most prolific author. Active researchers in this domain have established several stable collaborative teams, though inter-team cooperation requires further strengthening. \"Surgical Endoscopy and Other Interventional Techniques\" is the leading journal in terms of publications and citations within this area. Key terms currently driving research include surgery, minimally invasive surgery, robotic surgery, and outcomes. Robot-assisted fracture reduction and fixation represent prominent research hotspots. The integration of innovative technologies to enhance the effectiveness and functionality of orthopedic trauma robots, along with fostering high-quality multidisciplinary studies to facilitate clinical advancements, may define the future direction of this field.</p>","PeriodicalId":47616,"journal":{"name":"Journal of Robotic Surgery","volume":"19 1","pages":"705"},"PeriodicalIF":3.0,"publicationDate":"2025-10-21","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145337505","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":3,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Robotic-like maneuverability in endoscopic endonasal surgery: clinical experience with manually operated steerable forceps.","authors":"Masaaki Taniguchi, Hidehito Kimura, Toru Umehara, Toshika Ohkawa-Arita, Katsunori Asai, Ryuichiro Kajikawa, Haruhiko Kishima","doi":"10.1007/s11701-025-02874-5","DOIUrl":"https://doi.org/10.1007/s11701-025-02874-5","url":null,"abstract":"<p><p>Steerable-tip forceps with robotic-like articulation have recently been introduced in endoscopic endonasal surgery to enhance maneuverability in narrow and deep surgical fields. Although manually controlled, these instruments reproduce the multi-degree freedom of robotic forceps. To evaluate their clinical utility and potential relevance as a transitional step toward robotic integration in neurosurgery, we retrospectively reviewed 402 cases of endoscopic endonasal surgery in which steerable-tip forceps were available. Surgical records and videos were analyzed to determine utilization, enabled techniques, effectiveness, adverse events, and resection rates in cases aimed at complete lesion removal. Effectiveness was classified as completely useful, partially useful, or not useful. The forceps were applied in 330 cases, with 203 (61.5%) deemed completely useful, 45 (13.6%) partially useful, and 82 (24.8%) not useful. No adverse events were directly attributable to the instrument. The device facilitated robotic-like techniques such as multidirectional tumor traction, dynamic blunt dissection with tip articulation, and precise positioning of pedicled mucosal flaps, even in peripheral surgical sites. In cases where the forceps were completely useful, the gross total resection rate was 62.5% (115/184), which was significantly higher than in cases where they were only partially or not useful (62.5% vs. 40%, P = 0.0005). These findings suggest that manually controlled steerable-tip forceps can substantially improve maneuverability and access during endoscopic endonasal surgery. By reproducing key functional advantages of robotic instrumentation, these devices provide important translational insights and establish a foundation for the future development and application of robotics in neurosurgery.</p>","PeriodicalId":47616,"journal":{"name":"Journal of Robotic Surgery","volume":"19 1","pages":"702"},"PeriodicalIF":3.0,"publicationDate":"2025-10-20","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145330515","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":3,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Safer fluoroscopy guided femoral access using a passive robotic support with a 3D printed needle and guidewire inserter.","authors":"Muhammad Umair Ahmad Khan, Hahsim Iqbal","doi":"10.1007/s11701-025-02895-0","DOIUrl":"https://doi.org/10.1007/s11701-025-02895-0","url":null,"abstract":"<p><p>Radiation during fluoroscopy guided puncture remains a daily concern for staff. We have designed 11 degree of freedom passive robotic mechanism (7 DOF passive robot and 4 DOF 3D printed needle and guide wire insertion) that keeps manual feel and line of sight while moving hands away from the beam. We tested its effectiveness on operator dose in a controlled swine model. Twelve femoral punctures were completed by one experienced operator. Six were done without the passive robot and six with it. Imaging used a mobile C arm.A diagnostic catheter was used to select both femoral arteries, and the standard Seldinger technique was followed. Real time personal dosimeters recorded per case dose at the fingers, wrist, eyes, left leg, right leg, left arm, and right arm. We also recorded exposure time, access success, and access site events. Navigating hand distance from the source was measured. Dose fell with the robot at every site. Reductions were largest at the fingers and wrist near 80%. Eyes fell by about 42%. The right arm and left leg fell by about 57 and 62%, respectively. The left arm and right leg fell by about 29%. Exposure time averaged 5.1 min without the passive robot and 6.5 min with it. Arterial access success was 100% in both cases. Two access-site complications occurred without the passive robot (one hematoma and one dissection), while one dissection occurred with it. The pattern matches the geometry change created by the passive robot which increases working distance and stabilizes the path while keeping tactile control. The device offers a practical path to safer fluoroscopy guided puncture. Future work will test performance in larger cohorts with multiple operators.</p>","PeriodicalId":47616,"journal":{"name":"Journal of Robotic Surgery","volume":"19 1","pages":"701"},"PeriodicalIF":3.0,"publicationDate":"2025-10-19","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145318782","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":3,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Adnexal mass management by minimally invasive surgery at a comprehensive cancer center.","authors":"Anna Quian, Ann Marie Mercier, Allison Akers, Robert M Wenham, Hye Sook Chon, Mian M Shahzad, Jing-Yi Chern, Rahul Mhaskar, Mitchel Hoffman","doi":"10.1007/s11701-025-02889-y","DOIUrl":"https://doi.org/10.1007/s11701-025-02889-y","url":null,"abstract":"<p><p>This study investigates methods of specimen extraction, pertinent clinical data and pathologic findings associated with minimally invasive surgery (MIS) for adnexal masses. This retrospective cohort study includes patients with an adnexal mass who underwent MIS removal. The association of categorical variables with adverse outcomes was investigated using Pearson chi-square or Fisher's exact test. Four hundred and thirty-eight patients met inclusion criteria. Surgical modalities included laparoscopic (n = 235, 53.7%), robotic (n = 165, 37.7%), and vaginal (n = 1, 0.2%). MIS was converted to laparotomy in 37 cases (8.4%). 203 (46.3%) specimens were removed vaginally, and 235 (53.7%) abdominally. Three hundred and nineteen (72.8%) specimens were removed intact whereas 119 (27.2%) were morcellated or drained 113 contained). Of the 6 uncontained morcellation cases, one was ovarian cancer, and one was a borderline tumor. For malignant histologies, receipt of adjuvant chemotherapy was not associated with specimen integrity (455 intact vs 12 morcellated, p = 0.207), route of specimen removal (31 vaginal vs 36 abdominal, p = 0.217), or use of a specimen bag (46 bag vs 21 no bag, p = 0.105). This study demonstrated that MIS is feasible in the majority of patients referred to our cancer center for an adnexal mass. Perioperative complications were uncommon. Management of the ovarian malignancies encountered in this cohort was not compromised by utilization of MIS.</p>","PeriodicalId":47616,"journal":{"name":"Journal of Robotic Surgery","volume":"19 1","pages":"699"},"PeriodicalIF":3.0,"publicationDate":"2025-10-18","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145313755","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":3,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Systematic review and meta-analysis of comparing open and robotic-assisted intracorporeal radical cystectomy: based on randomized controlled trials.","authors":"Jin-Ming Li, Shi-Mo Liu, Mei-Xia Zhong, Li Wang, Kun Chen, Jing He","doi":"10.1007/s11701-025-02890-5","DOIUrl":"https://doi.org/10.1007/s11701-025-02890-5","url":null,"abstract":"<p><p>This study aims to compare perioperative outcomes between robot-assisted radical cystectomy (RARC) and open radical cystectomy (ORC) using totally intracorporeal urinary diversion. We systematically searched PubMed, Web of Science, Cochrane Library, and SpringerLink for randomized controlled trials (RCTs) comparing RARC and ORC until September 2, 2025. Data on operative time, estimated blood loss (EBL), hospital stay length (LOS), lymph node yield, positive surgical margin (PSM) rates, and complication rates at 30 and 90 days were extracted and pooled. A meta-analysis of four RCTs involving 523 patients showed that RARC was associated with a significantly longer operative time (WMD -74.36 min, p < 0.05). However, there were no statistically significant differences between RARC and ORC in EBL, hospital stay, lymph node yield, PSM rates, or the incidence of major and overall complications at both 30-day and 90-day intervals. As the first comparative study focusing exclusively on totally intracorporeal urinary diversion, this analysis demonstrates that RARC, despite longer operative times, achieves perioperative outcomes comparable to ORC. This suggests RARC is a viable surgical alternative in this specific setting. However, these findings are preliminary and require validation through larger, multicenter RCTs with extended follow-up.</p>","PeriodicalId":47616,"journal":{"name":"Journal of Robotic Surgery","volume":"19 1","pages":"700"},"PeriodicalIF":3.0,"publicationDate":"2025-10-18","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145313824","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":3,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}