Eleftherios Zachariou, Christos Vrysis, Dimitrios Papageorgiou, Ioakeim Sapantzoglou, Ioannis Prokopakis, Pantelis Aggelidis, Nikolaos Kiposoglou, Anastasia Analyti, Konstantinos Tsimidakis, Emmanouil M Xydias, Elias Tsakos, Nikolaos Plevris
{"title":"Surgical efficiency for gynecological surgery with a single robotic console: the value of the surgical team and robotic technology in maximizing efficiency on intensive surgical days: a comprehensive analysis.","authors":"Eleftherios Zachariou, Christos Vrysis, Dimitrios Papageorgiou, Ioakeim Sapantzoglou, Ioannis Prokopakis, Pantelis Aggelidis, Nikolaos Kiposoglou, Anastasia Analyti, Konstantinos Tsimidakis, Emmanouil M Xydias, Elias Tsakos, Nikolaos Plevris","doi":"10.1007/s11701-025-02575-z","DOIUrl":"https://doi.org/10.1007/s11701-025-02575-z","url":null,"abstract":"<p><p>To evaluate the surgical efficiency based on the number of daily procedures by analyzing various time components of the surgical process. This retrospective study examined 108 robot-assisted gynecologic surgeries conducted using the Da Vinci Xi surgical system in a private hospital in Greece from 2021 to 2024. The data were categorized into five case-day groups according to the number of surgeries performed each day, and the timing of several different steps was recorded. Statistical analyses, including ANOVA and correlation heatmaps, were employed. A significant difference was found in the time required for undocking, lavage, and hemostasis (F = 4.0, p < 0.01), with the six-case group experiencing the longest duration (21.9 ± 9.5 min). No significant differences were observed in total case duration across different case volume groups; however, a trend indicated a decrease in duration from the dual-case group (16.6 ± 2.8 min) to the six-case volume group (13.7 ± 2.7 min). The four-case group demonstrated the highest efficiency ratio (0.81), while the six-case group showed a slightly lower ratio (0.76). Additionally, there was a strong positive correlation (Pearson's r = 0.99) between surgery duration and patient docked time. The first surgery of the day (S1) had the longest duration, whereas procedures performed in the middle of the day were more consistent. Robotic surgery is feasible and efficient, whether the day is intensive or relatively easy. We can greatly increase efficiency by standardizing the preparation processes and improving the time taken to dock and undock.</p>","PeriodicalId":47616,"journal":{"name":"Journal of Robotic Surgery","volume":"19 1","pages":"400"},"PeriodicalIF":2.2,"publicationDate":"2025-07-17","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144660785","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":"Mid-term outcomes of robotic assisted versus conventional sternotomy for mitral valve replacement: a nationwide propensity-weighted analysis using Taiwan's National Health Insurance Research Database.","authors":"Yu-San Chien, Ching-Hu Chung, Jiun-Yi Li","doi":"10.1007/s11701-025-02564-2","DOIUrl":"10.1007/s11701-025-02564-2","url":null,"abstract":"<p><strong>Background: </strong>This study aimed to compare survival, complications, and healthcare costs between robotic-assisted and conventional sternotomy mitral valve replacement, using a nationwide population-based dataset from Taiwan.</p><p><strong>Methods: </strong>Patients who underwent isolated surgical MVR between 2016 and 2021 were identified from Taiwan's National Health Insurance Research Database. A total of 5,736 patients met inclusion criteria: 5,547 underwent conventional sternotomy MVR (CSMVR), and 113 received robot-assisted MVR (RAMVR). To reduce confounding, inverse probability of treatment weighting (IPTW) was applied using age, sex, and Charlson Comorbidity Index as covariates, yielding a weighted cohort of 5,660 CSMVR and 5,640 RAMVR cases for outcome analysis.</p><p><strong>Results: </strong>After IPTW adjustment, RAMVR was associated with significantly better survival (hazard ratio: 0.37; 95% confidence interval: 0.33-0.41; p < 0.01), shorter hospital stay (16.5 vs. 22.7 days, p < 0.01), and shorter intensive care unit stay (4.4 vs. 9.1 days, p < 0.01). RAMVR patients also had lower rates of dialysis and stroke. One-year post-discharge medical costs were significantly lower in the RAMVR group (USD 1,640 vs. 4,003, p < 0.01). Although inpatient costs appeared lower for RAMVR, this reflects the exclusion of patient-borne expenses for robotic equipment not reimbursed by insurance.</p><p><strong>Conclusion: </strong>In this national population-based analysis, RAMVR was associated with better mid-term survival, shorter hospital stays, and reduced medical costs compared with conventional sternotomy. These findings support the use of robotic-assisted surgery as a safe and effective alternative in selected patients undergoing mitral valve replacement.</p>","PeriodicalId":47616,"journal":{"name":"Journal of Robotic Surgery","volume":"19 1","pages":"396"},"PeriodicalIF":2.2,"publicationDate":"2025-07-16","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC12267384/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144650895","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 institutional impact of robotic surgery adoption: evidence from prostate and thyroid cancers in South Korea.","authors":"Junsoo Ro, Young Kyung Do","doi":"10.1007/s11701-025-02455-6","DOIUrl":"10.1007/s11701-025-02455-6","url":null,"abstract":"<p><p>The adoption of robotic surgery has significantly impacted various levels of the health system. However, previous studies lack evidence of causality regarding the impact at the institutional level. This study explores the effects of robotic surgery adoption on prostate and thyroid cancer treatments in South Korea, using the National Health Insurance Service (NHIS) data from 2005 to 2017. We applied interrupted time series analysis (ITSA) to examine changes in the number of inpatient admissions and volume of surgery at institutions before and after robotic surgery adoption. For prostate cancer, robotic surgery adoption resulted in an immediate increase of approximately 4.9 surgeries per quarter, with a substantial rise in inpatient admissions. For thyroid cancer, inpatient admissions showed a significant upward trend post-adoption. The increase in service volumes after the adoption of robotic surgery may reflect strategic institutional efforts to expand service delivery, supplier-induced demand to meet performance targets, or the advertising effects of robotic surgery adoption, which likely attracted patients from surrounding areas. This study highlights the broader implications of high-cost medical technologies on healthcare delivery, institutional strategies, and potential increases in healthcare costs. Future research should investigate other conditions treated with robotic surgery to fully understand its system-wide effects.</p>","PeriodicalId":47616,"journal":{"name":"Journal of Robotic Surgery","volume":"19 1","pages":"395"},"PeriodicalIF":2.2,"publicationDate":"2025-07-16","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC12267340/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144643816","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}
Joachim Cheng En Ho, Aryan Raj Goel, Muriel Sirgi, Ayan Bin Rafaih, Ayaz Ahmed Memon, Irshad Shaikh, Muhammad Rafaih Iqbal
{"title":"Robotic Beyond Total Mesorectal Excision (bTME) for locally advanced and recurrent anorectal cancer: a systematic review.","authors":"Joachim Cheng En Ho, Aryan Raj Goel, Muriel Sirgi, Ayan Bin Rafaih, Ayaz Ahmed Memon, Irshad Shaikh, Muhammad Rafaih Iqbal","doi":"10.1007/s11701-025-02573-1","DOIUrl":"10.1007/s11701-025-02573-1","url":null,"abstract":"<p><p>Robotic surgery is increasingly utilized for rectal cancer resection, particularly in cases requiring beyond total mesorectal excision (bTME) to achieve oncological clearance. Despite longer operative times, robotic bTME has been associated with reduced morbidity and blood loss, making it an emerging approach in specialized centers. A systematic review following PRISMA guidelines was conducted in Web of Science, PubMed, and Scopus. Studies reporting robotic bTME for recurrent or locally advanced anorectal cancer were included. Outcomes assessed included study characteristics, demographics, operative outcomes, oncological data, and follow-up. Nineteen studies comprising 1027 patients met the inclusion criteria (13 case series-68% and 6 cohort studies-32%). The median patient age ranged from 51 to 68 years with 73.7% males. Most patients had an ASA score of 2 (53.1%), and BMI ranged from 21.1 to 28.6. Tumor locations were predominantly near the anal verge (median: 3-6 cm), and the most common clinical staging was cT3, cN1, and cM0. Surgical complications included urinary issues (22.6%), anastomotic leakage (11.4%), ileus (10.4%), and bleeding (5.3%). Follow-up data indicated a recurrence rate of 24.9%, and the 1-year survival rate was > 90%. These studies reported an overall complication rate of 49.7%, with a median follow-up of 12-36 months. Oncological outcomes were favorable, although there was significant variability in survival data between studies. The heterogenicity of the studies makes it challenging to conclusively establish robotic bTME as a feasible alternative to the gold standard. Further prospective studies, with measurable outcomes and consistent terminology, are needed to ensure homogeneity.</p>","PeriodicalId":47616,"journal":{"name":"Journal of Robotic Surgery","volume":"19 1","pages":"397"},"PeriodicalIF":2.2,"publicationDate":"2025-07-16","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC12267320/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144650896","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 role of next-generation robotic systems in transforming knee arthroplasty: precision and beyond.","authors":"Ravi Teja Rudraraju, Sanjay Bhalchandra Londhe, Kunal Aneja, Ponnanna Karineravanda Machaiah, Supreet Bajwa, Dolly Singh","doi":"10.1007/s11701-025-02560-6","DOIUrl":"https://doi.org/10.1007/s11701-025-02560-6","url":null,"abstract":"<p><p>Robotic-assisted total knee arthroplasty (RATKA) signifies a paradigm shift in orthopedic surgery, offering enhanced precision, implant alignment, and functional outcomes. Despite extensive research, gaps persist in understanding the clinical advantages, adoption challenges, and cost-effectiveness of RATKA. This review critically examines the evolution of RATKA technologies, focusing on their impact on patient outcomes, learning curves, and cost considerations. It also explores innovative robotic systems, including the MISSO robotic platform, developed in India. While designed to accommodate specific anatomical requirements, MISSO demonstrates the adaptability to cater to global patient demands, addressing the needs of diverse populations worldwide. By integrating advanced algorithms, real-time feedback, and autonomous capabilities, RATKA systems achieve sub-millimeter precision, minimize soft tissue trauma, and expedite recovery. Systems like the fully autonomous CUVIS Joint Robot and surgeon-guided ROSA and CORI Knee platform showcase superior accuracy in implant placement and ligament balancing compared to conventional techniques. This review is not limited to the Indian healthcare system but provides a global perspective for orthopedic surgeons and patients. It highlights the transformative potential of RATKA across various healthcare settings, addressing challenges such as high costs, steep learning curves, and regulatory barriers. Through comprehensive analysis and comparisons, the review bridges critical gaps in the literature and proposes strategies for overcoming limitations, fostering broader adoption of robotic technologies. By offering nuanced insights, this work aims to guide the orthopedic community toward achieving optimal patient outcomes and advancing the global standards of knee arthroplasty.</p>","PeriodicalId":47616,"journal":{"name":"Journal of Robotic Surgery","volume":"19 1","pages":"393"},"PeriodicalIF":2.2,"publicationDate":"2025-07-15","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144643817","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}
M Marije Zwakman, M Miranda Trippenzee, J F M Johan Lange, J P E N Jean-Pierre Pierie, E C J Esther Consten
{"title":"Exploring needs, prevalence and experience with robotic-assisted surgery training among residents: a mixed method study.","authors":"M Marije Zwakman, M Miranda Trippenzee, J F M Johan Lange, J P E N Jean-Pierre Pierie, E C J Esther Consten","doi":"10.1007/s11701-025-02527-7","DOIUrl":"10.1007/s11701-025-02527-7","url":null,"abstract":"<p><p>Robotic-assisted surgery (RAS) is increasingly used in clinical practice, but training opportunities for residents vary widely. This multicenter, mixed-methods study assessed Dutch residents' exposure to RAS, identified their training needs, and explored their perspectives on the future of RAS through a survey (n = 148) and groups interviews (n = 20). Informed consent was obtained. While 69.6% of the residents had RAS experience, only 14.2% had operated as console surgeon. Despite robots being available in 75.7% of hospitals, hands-on training remained limited. Most residents (77.7%) expressed interest in a national RAS curriculum. Qualitative data revealed four major themes: needs and experiences, training requirements, the role of the OR team and industry, and assessment and feedback, with residents advocating for early exposure and holistic feedback. There is a clear need for a formalized RAS training program. Future research should focus on structured curricula, tailored to resident needs, including possible barriers and facilitators.</p>","PeriodicalId":47616,"journal":{"name":"Journal of Robotic Surgery","volume":"19 1","pages":"392"},"PeriodicalIF":2.2,"publicationDate":"2025-07-15","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC12263794/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144638435","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":"Mastering the robot-assisted pyeloplasty learning curve: analysis of operative efficiency, safety, and functional outcomes.","authors":"Mahmoud Farzat, Florian M Wagenlehner","doi":"10.1007/s11701-025-02562-4","DOIUrl":"10.1007/s11701-025-02562-4","url":null,"abstract":"<p><p>Robot-assisted pyeloplasty (RAPY) for ureteropelvic junction obstruction (UPJO) is a technically challenging procedure. This study evaluates the learning curve by analyzing operative time, complications, and renal function recovery across sequential cases. A retrospective study of sixty consecutive patients who underwent RAPY between 2019 and 2024, performed by a single surgeon in a specialized robotic department, was performed. Cases were divided into three phases: early (first 20), middle (21-40), and late (41-60). Outcomes included operative time, complications (as classified by the Clavien-Dindo system), length of hospital stay, and improvement in glomerular filtration rate GFR. Mean age was 56 years, 57% of UPJO was on the left side. 55% of patients were males, 90% presented with symptoms, and the mean lateral distribution of the affected kidneys in renal scintigraphy statistical analysis was 32%. All preoperative parameters showed no significant differences among the study groups. The mean console time was 91 min. The mean hospital stay was 4.8 days, and the mean bladder catheter days were 4.2 days. Operative time decreased significantly from the early to the late phases (118 ± 28 vs. 65 ± 18 min, p < 0.001). The overall complication rate was 16%, minor complications 11%, and major complications 5%. Major complications (Clavien ≥ III) decreased from 25 to 5% (p =0.02) from the early to the late phase. Five patients were readmitted within 90 days after surgery. GFR improvement was consistent across all phases (+ 14.2 mL/min, p =0.25). The RAPY learning curve plateaus at 40 cases, with optimized efficiency and safety and significant improvements in both efficiency and safety until then.</p>","PeriodicalId":47616,"journal":{"name":"Journal of Robotic Surgery","volume":"19 1","pages":"394"},"PeriodicalIF":2.2,"publicationDate":"2025-07-15","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC12263749/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144643815","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":"Comment on: \"Safety and functional outcomes of Versius surgical platform in prostate cancer radical prostatectomy: a single-arm meta-analysis\" by Chen et al.","authors":"Yi Liu, Ninggang Yang, Hongjie Chen","doi":"10.1007/s11701-025-02572-2","DOIUrl":"https://doi.org/10.1007/s11701-025-02572-2","url":null,"abstract":"","PeriodicalId":47616,"journal":{"name":"Journal of Robotic Surgery","volume":"19 1","pages":"388"},"PeriodicalIF":2.2,"publicationDate":"2025-07-14","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144627410","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":"Advances in nanorobotics for gastrointestinal surgery: a new frontier in precision medicine and minimally invasive therapeutics.","authors":"Zixuan Rui, Sepehr Mehdizadeh, Mozhgan Abasi, Younes Pilehvar","doi":"10.1007/s11701-025-02550-8","DOIUrl":"https://doi.org/10.1007/s11701-025-02550-8","url":null,"abstract":"<p><p>Nanorobotics is catalyzing a paradigm shift in GI surgery by synergizing nanoscale engineering, synthetic biology, and intelligent computation to create a novel frontier in precision medicine. This review critically discusses the most recent experimental breakthroughs in surgical nanorobots-from bioinspired actuation to programmable materials to autonomous tumor ablation to closed-looped therapeutic feedback-and charts their development from static constructions to intelligent agents with the ability to navigate the dynamic gastrointestinal (GI) environment. Systematically, we review how nanorobots integrate with artificial intelligence (AI)-fortified platforms, overcome GI-specific obstacles, and can facilitate site-specific intervention with spatiotemporal precision. Based on state-of-the-art preclinical models, organoid studies in humans, and in vivo deployment, we analyze biodegradability, pharmacokinetics, and regulatory readiness in pursuit of first-in-human trials. Aside from technical innovation, this review also addresses grand challenges in autonomy, off-target control, and ethical-legal frameworks, calling for an integrated, cross-specialty format to facilitate clinical translation. In visualizing neural-controlled nanorobots, self-healing machines, and living biosensor networks, we outline the pathway towards intelligent, minimally invasive surgery at the molecular level. This work posits surgical nanorobotics not as an incremental innovation but as a transformative axis for convergent surgical therapeutics in the next generation. It is an academic wake-up call for the strategic coming of age in this field from experimental brilliance to translational inevitability.</p>","PeriodicalId":47616,"journal":{"name":"Journal of Robotic Surgery","volume":"19 1","pages":"390"},"PeriodicalIF":2.2,"publicationDate":"2025-07-14","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144638432","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":"Comment on \"Robotic-assisted kyphoplasty demonstrates superior efficacy, safety, and procedural efficiency compared to fluoroscopy-guided techniques\".","authors":"Nihayat Ullah, Muhammad Tausif, Suliman Khan","doi":"10.1007/s11701-025-02571-3","DOIUrl":"https://doi.org/10.1007/s11701-025-02571-3","url":null,"abstract":"","PeriodicalId":47616,"journal":{"name":"Journal of Robotic Surgery","volume":"19 1","pages":"389"},"PeriodicalIF":2.2,"publicationDate":"2025-07-14","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144638433","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}