Journal of Robotic Surgery最新文献

{"title":"Evaluating the trainee impact on robotic surgery learning curves: a CUSUM analysis of large series pediatric robot-assisted laparoscopic pyeloplasty.","authors":"Jin Kyu Kim, Nikhil V Batra, Konrad M Szymanski, Renee Shavnore, Rosalia Misseri, Martin Kaefer, Mark P Cain, Richard C Rink, Joshua Roth, Pankaj Dangle, Kirstan Meldrum, Benjamin M Whittam","doi":"10.1007/s11701-025-02281-w","DOIUrl":"https://doi.org/10.1007/s11701-025-02281-w","url":null,"abstract":"<p><p>Robot-assisted laparoscopic pyeloplasty (RALP) is a minimally invasive treatment for ureteropelvic junction obstruction (UPJO). The learning curves for RALP have been well-documented, primarily in post-fellowship surgeons, but the impact of trainee involvement during fellowship training remains unclear. This study aims to (1) establish a large series post-fellowship single surgeon learning curve and (2) analyze the impact of annual trainee involvement on surgical proficiency using cumulative sum (CUSUM) analysis. A retrospective review of pediatric RALP cases from July 2012 to June 2023 at a high-volume institution was conducted. Cases performed by a single post-fellowship surgeon were included. Concomitant procedures and redo surgeries were excluded. Operative time (OT) and complication rates (CR) were tracked using CUSUM analysis. The learning curves were categorized into phases: learning, competency, case-mix, and proficiency. The effect of annual fellowship trainees was analyzed by constructing normalized learning curves per academic year. A total of 220 cases were analyzed. The post-fellowship surgeon reached competency after 29 cases, with proficiency achieved after 99 cases. Trainee involvement demonstrated a characteristic \"down-up-down\" pattern in OT and was not associated with increased CR during each of 6 years analyzed, reflecting an initial observation phase, increased operative time during hands-on learning, and eventual improvement. In contrast, the single year without a trainee showed a continuous downward OT trend. The complication rates remained below unacceptable thresholds and case complexity influenced OT trends. CUSUM-based analysis effectively maps the RALP learning curve, revealing distinct phases of surgical proficiency and the impact of trainee involvement. The reproducible trainee learning pattern provides insights into optimizing robotic surgery education while maintaining patient safety.</p>","PeriodicalId":47616,"journal":{"name":"Journal of Robotic Surgery","volume":"19 1","pages":"119"},"PeriodicalIF":2.2,"publicationDate":"2025-03-19","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143664935","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":"Letter to the editor regarding: \"The influence of perioperative enoxaparin on bleeding after TORS oropharyngectomy.\"","authors":"Meghan Turner, John Dewey","doi":"10.1007/s11701-025-02286-5","DOIUrl":"https://doi.org/10.1007/s11701-025-02286-5","url":null,"abstract":"","PeriodicalId":47616,"journal":{"name":"Journal of Robotic Surgery","volume":"19 1","pages":"120"},"PeriodicalIF":2.2,"publicationDate":"2025-03-19","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143665005","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 gastrectomy: can it be implemented without compromising the results?","authors":"Alexis Luna, Noelia Pérez-Romero, Pere Rebasa, Montse Adell, Sandra Montmany, Ariadna Cidoncha, Christian Herrero, Laura Mora","doi":"10.1007/s11701-024-02206-z","DOIUrl":"https://doi.org/10.1007/s11701-024-02206-z","url":null,"abstract":"","PeriodicalId":47616,"journal":{"name":"Journal of Robotic Surgery","volume":"19 1","pages":"118"},"PeriodicalIF":2.2,"publicationDate":"2025-03-18","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143659197","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":"Single-center retrospective study on the clinical application of multi-arm robotic-assisted uniportal video-assisted thoracic surgery.","authors":"Jun Chen, Jianhu Chu, Yunfei Gao, Yueying Yang, Xiaogang Li, Dongbo Luo","doi":"10.1007/s11701-025-02256-x","DOIUrl":"https://doi.org/10.1007/s11701-025-02256-x","url":null,"abstract":"<p><p>This research aims to consolidate clinical experiences with hybrid multi-arm robotic-assisted uniportal thoracoscopic surgery (H-URATS) employing endoscopic staplers and assess its safety and feasibility. A retrospective review was conducted on the clinical records of 128 patients treated with H-URATS at the Department of Thoracic Surgery II, Xinjiang Medical University Affiliated Tumor Hospital, between January and December 2024. The cohort included 52 men and 76 women, with an average age of 57.11 ± 11.61 years. All cases involved multi-arm robotic-assisted uniportal thoracoscopic procedures. Out of 128 cases, 127 were successfully completed, with 1 conversion to thoracotomy due to severe intraoperative hemorrhage. The median operative duration was 160 (115, 232.5) min, including approximately 6 min for docking, and the median intraoperative blood loss was 30 (30-50) mL. The median duration for chest drainage was 4 (3, 5) days, while the median postoperative hospital stay was 5 (4, 6) days. The surgeries included 116 pulmonary resections and 12 resections of mediastinal tumors. There were no perioperative fatalities. Postoperative complications occurred in eight patients, including pulmonary infections, arrhythmias, type I respiratory failure, venous thrombosis, and pulmonary embolism, all of which were effectively managed. All patients were discharged in stable condition, and R0 resection was achieved in all instances. H-URATS represents a safe and practical approach for pulmonary and mediastinal tumor resections, with the potential for broader clinical use.</p>","PeriodicalId":47616,"journal":{"name":"Journal of Robotic Surgery","volume":"19 1","pages":"117"},"PeriodicalIF":2.2,"publicationDate":"2025-03-16","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143639675","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":"Correction: 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/s11701-025-02250-3","DOIUrl":"10.1007/s11701-025-02250-3","url":null,"abstract":"","PeriodicalId":47616,"journal":{"name":"Journal of Robotic Surgery","volume":"19 1","pages":"116"},"PeriodicalIF":2.2,"publicationDate":"2025-03-14","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC11909062/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143630937","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":"Evaluating the impact of a navigation system on the initial cases of robotic gastrectomy for gastric cancer.","authors":"Jae Hun Chung, Dongwon Lim, Si-Hak Lee, Sun-Hwi Hwang","doi":"10.1007/s11701-025-02262-z","DOIUrl":"https://doi.org/10.1007/s11701-025-02262-z","url":null,"abstract":"<p><p>Robotic gastrectomy for gastric cancer presents challenges for novice surgeons owing to the lack of tactile feedback, particularly during complex procedures, such as lymph node dissection. To address these issues, a vascular navigation system was developed to enhance procedural safety and efficiency by providing three-dimensional vascular and anatomical guidance. We retrospectively analyzed 49 patients who underwent robotic distal gastrectomy at Pusan National University Yangsan Hospital. Patients were divided into two groups: those without navigation support (noRUS) and those with a vascular navigation system (RUS). We compared the dissection time, number of lymph nodes (LNs) retrieved, C-reactive protein level on postoperative day 3 (CRPD3), and postoperative recovery status. Univariate and multivariate linear regression analyses were performed. The RUS group demonstrated significantly shorter dissection times (179.85 ± 6.88 vs. 204.87 ± 9.60 min, p = 0.0478) and higher LN retrieval (41.81 ± 2.77 vs. 30.96 ± 2.31, p = 0.0048). The CRPD3, a marker of surgical trauma, was significantly lower in the RUS group (8.27 ± 0.85 vs. 11.68 ± 1.13 mg/dL, p = 0.0184). Moreover, no significant differences were observed in the complication rates or postoperative recovery. The vascular navigation system significantly improved surgical efficiency and LN retrieval and reduced surgical trauma during robotic gastrectomy. This study is the first to evaluate the impact of the navigation system on novice surgeons, highlighting its potential to overcome the learning curve earlier and improve patient outcomes.</p>","PeriodicalId":47616,"journal":{"name":"Journal of Robotic Surgery","volume":"19 1","pages":"115"},"PeriodicalIF":2.2,"publicationDate":"2025-03-13","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143626463","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":"Cystopexy following anterior-approach robot-assisted radical prostatectomy enhances early continence recovery.","authors":"Yu-Hsiang Huang, Jonathan Y J Chen, See-Tong Pang, Kai-Jie Yu, Hung-Cheng Kan, I-Hung Shao, Liang-Kang Huang, Chun-Te Wu, Po-Hung Lin","doi":"10.1007/s11701-025-02253-0","DOIUrl":"https://doi.org/10.1007/s11701-025-02253-0","url":null,"abstract":"<p><p>To evaluate the effect of cystopexy on continence recovery after anterior-approach transperitoneal robot-assisted radical prostatectomy (RaRP). We retrospectively analyzed continence recovery of patients with prostate cancer receiving RaRP in a transperitoneal anterior-approach manner with or without cystopexy. Continence recovery is defined as complete intact continence without safety pad utility. Demographic data, preoperative cancer staging, intraoperative surgical techniques such as neurovascular bundle (NVB) preservation, bladder neck sparing (BNS), cystopexy and postoperative cancer stage, surgical margin status were analyzed via multivariable and univariable regression analysis to evaluate contributing factors associated with continence recovery. We included one hundred and sixty-one consecutive RaRP performed by a single surgeon from 2011 to 2019 without cystopexy and another forty-one consecutive RaRP performed by another single surgeon with cystopexy from 2019 to 2023. Compared to patients without cystopexy, patients receiving cystopexy after anterior-approach RaRP have significant early continence recovery rate at 1-week (p < 0.0001) and 4-weeks (p = 0.0391). In addition, multivariable regression analysis revealed that BNS contributed to better continence recovery at 4 weeks (p = 0.0094). Patients receiving RaRP without NVB preservation had worse continence recovery at 12 weeks (p = 0.0015) and 24 weeks (p = 0.0098). Cystopexy after anterior -approach RaRP may enhance early recovery of continence at 1 week and 4 weeks. The simple technique may be adapted for a better functional outcome of continence.</p>","PeriodicalId":47616,"journal":{"name":"Journal of Robotic Surgery","volume":"19 1","pages":"114"},"PeriodicalIF":2.2,"publicationDate":"2025-03-12","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143617157","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":"Evaluation of perioperative lung ultrasound scores in robotic radical prostatectomy: prospective observational study.","authors":"İrem Vuran Yaz, Emre Sertaç Bingül, Mert Canbaz, Evren Aygün, Mehmet Öner Şanlı, Faruk Özcan, Meltem Savran Karadeniz","doi":"10.1007/s11701-025-02272-x","DOIUrl":"10.1007/s11701-025-02272-x","url":null,"abstract":"<p><p>Robotic major abdominal surgeries are popular worldwide, yet very few clinical studies have investigated the effects of robotic surgery setup on respiratory outcomes. In this prospective observational study, it is aimed to demonstrate the change in ultrasonographic condition of the lungs throughout the robotic surgery and its relation with respiratory outcomes. Robotic radical prostatectomy patients without any preexisting lung or cardiac pathology were enrolled in the study. Lung ultrasound score (LUS) was chosen to evaluate lungs perioperatively in three different time points that is as follows: 5 min after intubation (T1), before extubation (T2), and 30 min after extubation (T3). Blood gas analyses were made at the same time points. Primary outcome was the change of LUS comparing T3 versus T1. Secondary outcomes included intraoperative change of LUS, severe postoperative pulmonary complication incidence, unplanned intensive care unit (ICU) admission incidence, comparison of oxygenation via PaO₂ and PaO₂/FiO₂, and sensitivity/specificity of LUS for determining ICU admission. Total 48 patients were analyzed. T3 LUS was significantly higher than T1 LUS, and T2 was the highest amongst (15.5 [6, 25] vs 8.5 [4, 20] vs 20.5 [13, 30], respectively, p < 0.01). Pre-extubation LUS were significantly higher in patients who were admitted to ICU comparing who were not (23.5 [17, 30] vs 20 [13, 27], p = 0.03). PaO₂/FiO₂ ratio did not change among the groups significantly (p = 0.14). ROC curve of T2LUS showed 67% sensitivity and 85% specificity with a cut-off value of 22.5 for ICU admission (AUC 0.73 [0.516, 0.937], p = 0.04). LUS significantly worsened in robotic prostatectomy throughout the surgery, yet clinical deoxygenation or severe PPC were not observed. On the other hand, pre-extubation LUS may be used to determine possible ICU admission for the patients.Clinical trial registry: This study was prospectively registered at Clinicaltrials.gov (NCT05528159).</p>","PeriodicalId":47616,"journal":{"name":"Journal of Robotic Surgery","volume":"19 1","pages":"112"},"PeriodicalIF":2.2,"publicationDate":"2025-03-11","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC11897065/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143606411","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 environmental impact of multi-specialty robotic-assisted surgery: a waste audit analysis.","authors":"Gerald Tjahyadi, Patrick-Julien Treacy, Kate Alexander, Jacob Bird, Sascha Karunaratne, Scott Leslie, Kate McBride, Daniel Steffens, Ruban Thanigasalam","doi":"10.1007/s11701-025-02278-5","DOIUrl":"10.1007/s11701-025-02278-5","url":null,"abstract":"<p><p>Modern advances in medicine and technology have led to an increase in robotic-assisted surgery (RAS) cases. However, concerns have been raised about the potential environmental impact of RAS. Despite this, only limited quantitative evidence is currently available. Therefore, this study aims to objectively quantify the environmental impact of a multi-specialty RAS caseload at an Australian public tertiary hospital. An analysis was performed to quantify the amount of waste produced on a consecutive multi-specialty RAS caseload performed between August 2016 and March 2023 at a major public hospital. The weight of each instrument and consumable was measured and the total weight of discarded waste was calculated for each RAS case. A total of 671 patients underwent RAS using the da Vinci Xi System, including Urology (n = 341, 50.8%), Cardiothoracic (n = 158, 23.5%), Gynaecology (n = 107, 16.0%), and Colorectal (n = 65, 9.7%). Overall, the amount of waste was 2,948.9 kg, with single-use items contributing the largest volume (93.9%). Cardiothoracic generated the lowest average weight of waste per case (3.04 kg) while Colorectal generated the highest (5.27 kg). Overall, the da Vinci Xi instrument arm drape was the single item with the largest contribution to the total weight of waste (32.9%). RAS generates substantial waste, primarily from single-use items. These findings underscore the need for strategies to mitigate the environmental footprint of RAS as its adoption continues to grow.</p>","PeriodicalId":47616,"journal":{"name":"Journal of Robotic Surgery","volume":"19 1","pages":"113"},"PeriodicalIF":2.2,"publicationDate":"2025-03-11","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC11897078/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143606663","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":"Robotic-assisted retroperitoneal lymph node dissection: defining selection parameters-a B-SAFE approach.","authors":"K Haq, D Chia, U M Haroon, A Oluwole-Ojo, F Reeves, H Verma, R Nair, S Rudman, D Crawley, J Armitage, A Riddick, J Shamash, T S O'Brien, A Fernando, B Challacombe","doi":"10.1007/s11701-025-02273-w","DOIUrl":"https://doi.org/10.1007/s11701-025-02273-w","url":null,"abstract":"<p><p>The objective of the study is to define selection parameters for RRPLND and evaluate the outcomes from cases selected via this method. Patients undergoing RRPLND from 2017 to 2023 (n = 57) were included. Initial criteria for robotic case selection were defined via 'B-SAFE' parameters. Safety was assessed via complication rate and oncological outcome. Analysis of both robotic and open RPLND outcomes including data from across the Anglican Germ Cell Cancer Collaborative Group was done. Mean lesion size was 30 mm (9-72). No cases required open conversion. Positive margin rate was 5.2%. Median length of stay (LOS) was 2 days (1-5). Overall complication rate was 15.7%. One patient required radiological intervention via embolization for a post-operative bleed. No in-field recurrences was observed at a median follow-up of 25 months (1-81). Analysis of parallel open RPLND cohort (n = 57) showed some differences in LOS (2 vs 6 [p =  < 0.05]) and bloods loss (130 vs 865 [p =  < 0.05]) likely explained by case complexity. Nodal yield higher in RRPLND (23 vs 10 [p =  < 0.05]). No significant difference in operation time (4.5 vs 4.6 [p = 0.5]), positive margins (5.2 vs 15.8% [p = 0.06]) or complication rates (15.7 vs 17% [p = 0.85]). This series proposed six parameters that can be used to appropriately select cases for RRPLND which we have defined using the 'B-SAFE' system. Our results using this framework are encouraging, with no instances of open conversion, excellent short-term oncological outcomes and no compromise of peri-operative morbidity with a short LOS. We also demonstrate an evolution in our practice towards more complex cases suggesting that as unit experience grows, initial selection criteria can be expanded to tackle more complex lesions.</p>","PeriodicalId":47616,"journal":{"name":"Journal of Robotic Surgery","volume":"19 1","pages":"111"},"PeriodicalIF":2.2,"publicationDate":"2025-03-11","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143606660","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}