Journal of Robotic Surgery最新文献

{"title":"Robotic hiatus hernia surgery: learning curve and lessons learned.","authors":"Elisenda Garsot, Georgina Company-Se, Arantxa Clavell, Marta Viciano, Christian Herrero, Lexa Nescolarde","doi":"10.1007/s11701-024-02191-3","DOIUrl":"10.1007/s11701-024-02191-3","url":null,"abstract":"<p><p>New procedures like the robotic approach require proficiency to ensure patient safety and satisfactory functional results. Hiatal hernia surgery serves as a suitable training procedure for upper gastrointestinal tract surgeons transitioning to the robotic approach. This study aims to evaluate the outcomes of implementing the robotic approach in hiatal hernia surgery at a tertiary hospital and to assess the associated learning curve. A retrospective review was conducted on 54 patients (58 surgeries) between June 2019 and March 2024, including both primary and revision robotic antireflux surgeries. The study focused on perioperative outcomes, symptom resolution, and the surgical learning curve, assessed using Cumulative Sum analysis. The results showed that global surgical time averaged 124 ± 57 (54-350) min, 127 ± 38 (116-139) for Primary Surgery and 164 ± 84 (115-212) min for Revisional Surgery. There were no conversions to laparoscopic or open approach. The global median of hospital stay was 2 days (2 for Primary Surgery and 3 for Revisional Surgery) and three patients required readmission (2 for Primary Surgery and 1 for Revisional Surgery). Postoperative complications occurred in 3 patients. Symptom resolution was achieved in 90% of Primary Surgery group and 85.7% of Revisional Surgery group. Learning curve described three phases: 1-training (case 1 to 14), 2-plateau (15 to 25) and 3-expertise phase (25 onwards). The robotic approach in hiatal hernia surgery is feasible with minimal morbidity, short hospital stays, and excellent functional results. With previous experience in laparoscopic approach and esophagogastric surgery the learning curve can be reduced to 14 procedures.</p>","PeriodicalId":47616,"journal":{"name":"Journal of Robotic Surgery","volume":"19 1","pages":"51"},"PeriodicalIF":2.2,"publicationDate":"2025-01-17","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC11742325/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143013998","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":"Learning curve analysis of extraperitoneal single-site robotic-assisted radical prostatectomy: a CUSUM-based approach.","authors":"Jianhao Wu, Yubo Wang, Yueting Huang, Xuezhi Long, Jiahui Tang, Di Gu","doi":"10.1007/s11701-024-02202-3","DOIUrl":"10.1007/s11701-024-02202-3","url":null,"abstract":"<p><p>This study applied cumulative sum (CUSUM) analysis to evaluate trends in operative time and blood loss, It aims to identify key milestones in mastering extraperitoneal single-site robotic-assisted radical prostatectomy (ss-RARP). A cohort of 100 patients who underwent ss-RARP, performed by a single surgeon at the First Affiliated Hospital of Guangzhou Medical University between March 2021 and June 2023, was retrospectively analyzed. To evaluate the learning curve, the CUSUM (Cumulative Sum Control Chart) technique was applied, revealing the progression and variability over time. A cubic polynomial model was utilised to fit the non-linear data trends accurately. Key perioperative outcomes, such as operative duration and estimated blood loss, were assessed and compared between distinct learning stages to identify improvements and transitions during the surgeon's proficiency development. A total of 100 patients were included, with a mean age of 71.44 ± 5.46 years. The median operative time was 119.53 min (94, 144), and the best-fit equation for the CUSUM learning curve of operative time was y = 387.0373  - 3.4334x  - 0.2982x² + 0.003x³ (R² = 0.898), reaching its peak at the 11th case. The median blood loss was 49.9 ml (20, 50), and the best-fit equation for the CUSUM learning curve of blood loss was y = 444.9362 + 23.6787x  - 0.7719x² + 0.0049x³ (R² = 0.957), reaching its peak at the 27th case. The learning curve was divided into a learning phase (1-27 cases) and a proficient phase (28 cases onward). Intraoperative blood loss significantly decreased from 75.93 ± 79.19 mL to 40.27 ± 35.27 mL in the proficient phase (P < 0.05), while operative time remained similar between phases (P > 0.05).There were no statistically significant differences in pelvic drainage tube placement time, drainage volume, positive surgical margin rate, hospital stay duration, or postoperative pain scores (P > 0.05). The findings suggest that proficiency in ss-RARP is typically achieved after approximately 27 cases, indicating a manageable and safe learning curve. These insights can inform the design of surgical training programmes, optimising early learning and improving clinical outcomes for novice surgeons.</p>","PeriodicalId":47616,"journal":{"name":"Journal of Robotic Surgery","volume":"19 1","pages":"49"},"PeriodicalIF":2.2,"publicationDate":"2025-01-10","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC11723840/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142956697","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":"Comparative outcomes of Palmer, Umbilical Veress needle, and open entry techniques in robotic-assisted surgery: a propensity-matched analysis of 9482 patients.","authors":"Ahmed Eraky, Mohammed Almoflihi, Modassar Awan, Mohammad Jaabou, Miriam Campistol, Neeraja Tillu, Manish Kumar Choudhary, Arjun Venkatesh, Kaushik P Kolanukuduru, Zachary Dovey, Osama Zaytoun, Maurizio Buscarini","doi":"10.1007/s11701-024-02208-x","DOIUrl":"https://doi.org/10.1007/s11701-024-02208-x","url":null,"abstract":"<p><p>Robotic-assisted surgery offers several advantages over traditional methods, such as reduced blood loss and fewer complications. Establishing pneumoperitoneum is a critical step, with two primary techniques: the Veress needle (closed) and the Hasson (open) technique. Despite extensive studies in laparoscopic surgery, limited data exist regarding their use in robotic surgery. This study compares complication rates and predictors between Palmer, umbilical Veress needle, and open Hasson techniques in robotic surgery. In this retrospective cohort study of 9482 patients undergoing robotic surgery, we compared palmer, umbilical Veress needle, and Open Hasson techniques using propensity score matching. Primary outcomes were complication rates classified by the Clavien-Dindo system. We used logistic regression to analyze predictors of complications, such as needle attempts and adhesions. One thousand sixteen patients were matched between Palmer and umbilical groups and 310 between Veress needle and open groups. Umbilical insertion was associated with more complications than Palmer (OR 2.14, p = 0.033). Patients requiring more than four needle attempts had higher complication rates (OR 15.43, p = 0.002). Severe adhesions significantly increased complications. After adjustment, the choice of entry method was not independently associated with complications. Surgical entry complications in robotic-assisted surgery are more influenced by needle attempts and adhesions than by the choice of entry technique. Tailoring surgical plans based on patient characteristics and minimizing needle attempts can improve outcomes, underscoring the importance of individualized approaches over standardized methods.</p>","PeriodicalId":47616,"journal":{"name":"Journal of Robotic Surgery","volume":"19 1","pages":"48"},"PeriodicalIF":2.2,"publicationDate":"2025-01-08","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142956693","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":"Revolutionizing surgery: AI and robotics for precision, risk reduction, and innovation.","authors":"Jack Ng Kok Wah","doi":"10.1007/s11701-024-02205-0","DOIUrl":"10.1007/s11701-024-02205-0","url":null,"abstract":"<p><p>Artificial intelligence and robotics are revolutionizing surgical practices by enhancing precision, efficiency, and patient outcomes. With global healthcare systems increasingly adopting AI-driven technologies, the integration of robotics in surgery addresses critical challenges such as surgical accuracy, minimally invasive techniques, and healthcare accessibility. However, disparities in access and ethical concerns regarding automation persist globally, necessitating a balanced discourse on these advancements. The primary objective of the review is to explore the intersection of AI and robotic technologies in surgical practices, highlighting key innovations, their impact on precision medicine, and future trajectories. The novelty of the review lies in synthesizing findings across diverse surgical specialties, including urology, plastic surgery, ophthalmology, and pediatric surgery, to provide a comprehensive understanding of AI's transformative role. The systematic review evaluates the integration of AI and robotics in surgery, synthesizing studies published in 2024. It follows PRISMA guidelines for study selection, data extraction, and synthesis. The review assesses surgical specialties, AI technologies, and outcomes like accuracy, recovery, and complications, ensuring methodological rigor and transparency. The findings indicate substantial advancements in AI-driven surgical systems, improving decision-making, reducing surgical errors, and facilitating personalized treatment strategies. Notable breakthroughs include AI-enhanced imaging, real-time data analysis, and automated robotic instruments, which collectively improve procedural efficiency and patient safety. The discussion emphasizes the critical implications of these innovations, particularly in advancing minimally invasive techniques and expanding surgical capabilities in complex procedures. However, challenges such as cost, ethical considerations, and the need for rigorous training protocols are highlighted as barriers to widespread adoption. The review underscores the implications for policymakers, healthcare institutions, and technology developers to address these barriers and promote equitable access to AI-driven surgical solutions. Limitations include the reliance on recent studies, necessitating long-term evaluations of clinical outcomes. Future research should focus on integrating AI with emerging technologies like augmented reality, fostering interdisciplinary collaboration, and addressing socio-ethical dimensions to fully realize the potential of AI in surgical advancements.</p>","PeriodicalId":47616,"journal":{"name":"Journal of Robotic Surgery","volume":"19 1","pages":"47"},"PeriodicalIF":2.2,"publicationDate":"2025-01-07","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142956703","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":"Comparative analysis of disruptive events in robotic and laparoscopic radical prostatectomy.","authors":"Latif Al-Hakim, Ming Wang, Zhewei Zhang, Jiaquan Xiao, Shomik Sengupta","doi":"10.1007/s11701-024-02194-0","DOIUrl":"https://doi.org/10.1007/s11701-024-02194-0","url":null,"abstract":"<p><p>This study compares laparoscopic (LRP) and robotic-assisted (RARP) radical prostatectomy to identify external and internal disruptive events, focusing on tasks that require heightened attention and coordination among the surgical team. Observations conducted across three hospitals in Australia and China. Data collection was rigorously ensured through the analysis of video recordings and consultations with surgeons, followed by statistical analysis using the Wilcoxon Signed Rank test. In a sample of 54 surgeries (27 RARP, 27 LRP), 15 activities were analysed, identifying 23 internal and 38 external disruption types. The findings indicate that RARP significantly reduces both external and internal disruptions compared to LRP, with decreases of around 41% and 33%, respectively. Notably, neurovascular bundle release showed the highest internal disruptions, with 123 events in RARP and 160 in LRP, and minor vessel bleeding led to the most internal disruptions, with 200 in RARP and 251 in LRP. RARP advantages include fewer disruptions due to pre-dissection inspections for visibility, improved blood management, and a skilled assistant, reducing the need for direct eye contact and repeated instructions. This study adds new dimensions to existing research by comparing internal and external disruptions in complex surgeries-specifically radical prostatectomy-performed using two approaches: robotic-assisted and laparoscopic.</p>","PeriodicalId":47616,"journal":{"name":"Journal of Robotic Surgery","volume":"19 1","pages":"44"},"PeriodicalIF":2.2,"publicationDate":"2025-01-06","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142933108","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":"Introducing robot-assisted kidney transplantation in a high-volume centre in Denmark: a pilot and feasibility study.","authors":"Milla Ortved, Julia Dagnæs-Hansen, Hein V Stroomberg, Vladimir Karas, Malene Rohrsted, Søren S Sørensen, Andreas Røder","doi":"10.1007/s11701-024-02190-4","DOIUrl":"10.1007/s11701-024-02190-4","url":null,"abstract":"<p><p>Robot-assisted kidney transplantation (RAKT) may reduce surgical complications compared to open kidney transplantation (OKT), but no randomised trials have explored this to date. The aim of the present study is to explore the feasibility of introducing RAKT at our institution, making it available in deceased donor transplantation and evaluate early surgical outcomes prior to performing a randomised trial comparing RAKT to OKT. RAKT was performed at Department of Urology, Copenhagen University Hospital, Rigshospitalet, Denmark. The patients were included from June 2022 until May 2023. The data were collected through the national electronic health records. The data include recipient, donor and intraoperative characteristics, postoperative complications within 90 days graded according to Clavien-Dindo classification and days alive and out of hospital (DAOH). The functional outcomes include eGFR, plasma creatinine, delayed graft function, and rejection episodes. Sixteen RAKTs were performed. Fourteen cases were transplantations with living donors and two cases were with deceased donors. There were no major intra-operative adverse events and no conversions. The median operative time was 223 min and median blood loss 150 ml. The median length of stay was 7 days and median DAOH was 82. Seven complications occurred in five patients at 90 days postoperatively; however, there were no major surgical complications. This study comprehensively assesses patient morbidity following RAKT in a small cohort with results indicating favourable outcomes. This supported our clinical assumption of reduced complications for a randomised trial comparing OKT and RAKT (the ORAKTx trial) which has been initiated (NCT identifier 05730257).</p>","PeriodicalId":47616,"journal":{"name":"Journal of Robotic Surgery","volume":"19 1","pages":"45"},"PeriodicalIF":2.2,"publicationDate":"2025-01-06","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC11703890/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142933111","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":"The use of laser-assisted cart positioning significantly reduces the docking time of multimodular robotic systems.","authors":"Martin Baunacke, Christopher Hirtsiefer, Roman Herout, Sherif Mehralivand, Susanne Oelkers, Oliver Kaske, Claudia Franz, Christian Thomas","doi":"10.1007/s11701-024-02196-y","DOIUrl":"https://doi.org/10.1007/s11701-024-02196-y","url":null,"abstract":"<p><p>The Hugo RAS system is characterized by its multimodular design, which leads to an increased docking effort. Exact data for docking time and the learning curve is missing. We describe for the first time the use of a laser-guided cart positioning to reduce the docking time. In this prospective monocentric study, the docking time was evalutated for a consecutive series of pelvic surgeries with the Hugo RAS system. In a subgroup, a cross-line laser was adapted at the cart for positioning using fix points at the ceiling. The medical personnel were classified as \"inexperienced\" with ≤ 5 consecutive dockings and as \"experienced\" with > 5 consecutive dockings. From 10/2023 to 08/2024, 82 procedures were performed with the Hugo RAS. For the evaluation 75 procedures could be considered. The mean docking time was 7.6 ± 3.5 min. There was a reduction in docking time from 13.5 ± 3.7 min in the first 5 procedures to 4.4 ± 0.9 min in the last 5 procedures (p < 0.001). Docking with laser (n = 45) was faster than without laser (n = 30) (6.2 ± 2.5 vs. 9.8 ± 3.7 min, p < 0.001). Faster docking time was observed with inexperienced surgical nursing staff with laser than without laser (10.4 ± 3.7 vs. 5.4 ± 1.4 min; p < 0.001). With experienced nursing staff, the laser had no influence (6.6 ± 1.3 vs. 6.7 ± 2.9 min; p = 0.9). As a reference docking time for daVinci Xi procedures was 2.4 ± 1.7 min (n = 5). Laser-guided cart positioning has a significant impact on docking time, especially for unexperienced medical personnel. Especially in the times of experienced staff shortage, laser-guided cart positioning can save operating time.</p>","PeriodicalId":47616,"journal":{"name":"Journal of Robotic Surgery","volume":"19 1","pages":"46"},"PeriodicalIF":2.2,"publicationDate":"2025-01-06","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC11703870/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142956740","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":"TiRobot-assisted versus freehand femoral neck system placement in the treatment of femoral neck fractures: a systematic review and meta-analysis.","authors":"Yupei Dai, Kaiyong Wang, Guohang Shen, Yang Chen, Anneng Hu, Qunhua Jin","doi":"10.1007/s11701-024-02204-1","DOIUrl":"https://doi.org/10.1007/s11701-024-02204-1","url":null,"abstract":"<p><p>The purpose of this study is to assess the safety and effectiveness of TiRobot-assisted treatment for femoral neck fractures, in comparison to traditional freehand treatment methods. Throughout the research process, we conducted an extensive literature search across numerous databases, including PubMed, EMBASE, Cochrane Library, Web of Science, China National Knowledge Infrastructure (CNKI), CQVIP, and Wanfang. Based on the literature screening criteria, we selected six studies, encompassing 358 cases of femoral neck fracture patients, for this meta-analysis. The study evaluated the effectiveness of TiRobot-assisted versus freehand placement of the Femoral Neck System (FNS). The results indicate that the TiRobot-assisted group demonstrated significant advantages in several surgical parameters. Specifically, the robot-assisted group showed superior outcomes regarding the frequency of guide pin insertion, frequency of X-ray fluoroscopy, operative time, invasive fixation time, intraoperative blood loss and incision length (MD < 0, p < 0.05). Furthermore, there was a significant difference in the Harris score, between the TiRobot-assisted group and the traditional freehand group (MD > 0, p < 0.05). However, the two groups had no significant differences concerning postoperative complications, fracture healing time, and fracture healing rate (p > 0.05). In conclusion, the comprehensive analysis suggests that the TiRobot-assisted technique has distinct advantages over the traditional freehand technique in treating femoral neck fractures. TiRobot-assisted technology, owing to its enhanced safety and efficacy, minimizes surgical trauma and expedites postoperative recovery.</p>","PeriodicalId":47616,"journal":{"name":"Journal of Robotic Surgery","volume":"19 1","pages":"43"},"PeriodicalIF":2.2,"publicationDate":"2025-01-05","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142933056","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":"Enhancing bibliometric methods in simulation-based robotic surgery training.","authors":"Si-Cheng Zhou, Li Wang, Xi Chen, Hong-Qiu Xiao, Fan Yu, Jie Tian","doi":"10.1007/s11701-024-02207-y","DOIUrl":"https://doi.org/10.1007/s11701-024-02207-y","url":null,"abstract":"","PeriodicalId":47616,"journal":{"name":"Journal of Robotic Surgery","volume":"19 1","pages":"40"},"PeriodicalIF":2.2,"publicationDate":"2025-01-04","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142928210","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":"Lateral decubitus: its influence on hemodynamic and respiratory function during retroperitoneal robotic assisted laparoscopic pyeloplasty (R-RALP) in children.","authors":"Stefania Franzini, Stefania Querciagrossa, Cristina Lapenta, Myriam Brebion, Dario Consonni, Thomas Blanc, Gilles Orliaguet","doi":"10.1007/s11701-024-02198-w","DOIUrl":"https://doi.org/10.1007/s11701-024-02198-w","url":null,"abstract":"<p><p>Retroperitoneal robotic-assisted laparoscopic pyeloplasty (R-RALP) is the commonest urologic procedure performed in children, entailing retroperitoneal CO2 insufflation and lateral decubitus, whose effects on cardiopulmonary variables are poorly known. We, therefore, studied hemodynamic and respiratory changes due to CO2 insufflation and lateral decubitus in children undergoing R-RALP and their effects on regional tissue oxygenation. Between 1/2021 and 7/2024, children affected by ureteropelvic joint obstruction (UPJO) underwent a pyeloplasty by R-RALP at Necker Enfants Malades Hospital (Paris, France), using a standardized surgical technique and a lung-protecting anesthetic protocol aimed to prevent hypercarbia. Cerebral and renal Near InfraRed Spectroscopy (NIRS) were added to standard monitoring. Mean monitoring parameters and NIRS values were derived from the prospectively kept continuous reading at eight preset points and analyzed. 37 patients were prospectively included (21 males), with a mean age of 6.0 ± 3.9 years, and mean body weight of 22.5 ± 11.3 kg; 15 patients were operated on in Left Lateral Decubitus (LLD) and 22  in Right Lateral Decubitus (RLD). No different LLD/RLD time trends were observed for standard monitoring parameters and NIRS measurements. Conversely, EtCO2 was higher in the RLD group at trocars insertion (T4, + 3.3 mmHg), beginning of CO2 insufflation (T5, + 2.9), and 45 min after the start of the procedure (T6, + 3.1). At the same time points, Pplat was higher in the LLD group at T4 (+ 3.0 cmH2O); T5, (+ 3.4) and T6 (+ 4.7). During R-RALP, the combination of RLD and CO2 insufflation promotes hypercarbia, while LLD requires increasing Pplat pressures, potentially favoring lung injury and hemodynamic instability during prolonged procedures.</p>","PeriodicalId":47616,"journal":{"name":"Journal of Robotic Surgery","volume":"19 1","pages":"42"},"PeriodicalIF":2.2,"publicationDate":"2025-01-04","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142928219","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}