Journal of Robotic Surgery最新文献

{"title":"Opioid-free versus opioid-based anesthesia for robot-assisted radical prostatectomy: a single-center randomized controlled trial.","authors":"Tomasz Składzień, Aleksandra Żmuda, Michał Cicio, Teresa Kowal, Anna Kwinta, Renata Bugielska, Wojciech Szpunar, Jan Szpor, Katarzyna Maciejewska, Rafał Świstek, Tomasz Lonc, Tomasz Drygalski, Paweł Maciejewski","doi":"10.1007/s11701-026-04028-7","DOIUrl":"10.1007/s11701-026-04028-7","url":null,"abstract":"<p><p>Multimodal, opioid-sparing analgesia is standard in urological surgery, and there is additional interest in eliminating intraoperative opioids in prostate cancer surgery. Randomized evidence for opioid-free anesthesia (OFA) in robot-assisted radical prostatectomy (RARP) is lacking. In this single-center randomized controlled trial, adult men undergoing RARP were allocated 1:1 to OFA (dexmedetomidine plus ketamine, no intraoperative opioids) or a remifentanil-based technique. Both groups received identical multimodal premedication, a bilateral quadratus lumborum block, sevoflurane maintenance and identical oxycodone patient-controlled analgesia (PCA). The primary outcome was cumulative PCA oxycodone consumption over the first 24 postoperative hours. Prespecified secondary outcomes were pain (NRS), postoperative nausea and vomiting (PONV), the demanded-to-delivered PCA bolus ratio, and perioperative changes in serum creatinine and white-cell count. A total of 149 patients were analyzed (OFA n=75, opioid-based n=74). Cumulative 24-h oxycodone consumption was lower with OFA (median 12.0 mg [interquartile range, IQR 6.0-22.0] vs 19.0 mg [10.5-34.0]; p=0.001), with a Hodges-Lehmann location-shift estimate of -6.0 mg (95% confidence interval, CI -10.0 to -2.0). Pain scores did not differ at any time point, and PONV was infrequent, with no significant between-group difference. Intraoperative hemodynamic adverse events (bradycardia, hypotension), perioperative white-cell count and serum creatinine did not differ between groups. In RARP delivered on a standardized multimodal and regional analgesic background, OFA reduced postoperative opioid consumption compared with a remifentanil-based technique, without a detectable difference in pain scores and with a similar safety profile.Trial registration ClinicalTrials.gov NCT06380244, registered 23 April 2024.</p>","PeriodicalId":47616,"journal":{"name":"Journal of Robotic Surgery","volume":"20 1","pages":""},"PeriodicalIF":4.2,"publicationDate":"2026-10-13","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC13661647/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"149184834","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":"From the operating room to the cloud: the evolving continuum from live surgical broadcasting to remote tele-surgery.","authors":"Priyank Yadav, Husam H Balkhy, Mohan S Gundeti","doi":"10.1007/s11701-026-03962-w","DOIUrl":"10.1007/s11701-026-03962-w","url":null,"abstract":"<p><p>In the last four decades, the transmission of a live surgical operation to a remote audience has evolved from closed-circuit educational broadcast into a fully remote, robot-assisted surgery performed across different continents. This review maps that journey systematically, defining a six-rung Digital Surgical Spectrum - from passive live broadcast to artificial-intelligence-augmented autonomous surgery - grounding each stage in published clinical evidence across multiple surgical domains. We demonstrate that each rung of this spectrum is no longer theoretical. Live broadcasts have reached audiences across multiple countries. Tele-proctoring was validated at scale during the COVID-19 pandemic, and tele-mentoring has been shown in systematic review to produce a safety and efficacy profile broadly comparable to on-site supervision. True remote tele-surgery has been accomplished over distances exceeding 8,000 km with latencies well within established procedure specific safety thresholds. We also present a case timeline and an Institutional Readiness Framework specifying the technical, regulatory, and other prerequisites for each rung, organized visually as a Digital Surgical Spectrum. Importantly, nuances such as the performance paradox of observed surgery, consent frameworks, cybersecurity risk, regulatory fragmentation, and the threat of entrenching rather than correcting global surgical inequity are examined. As the field advances, the growth of tele-surgical technologies will depend on international regulatory harmonization and equity-centered deployment, supported by prospective multi-specialty outcome registries.</p>","PeriodicalId":47616,"journal":{"name":"Journal of Robotic Surgery","volume":"20 1","pages":""},"PeriodicalIF":4.2,"publicationDate":"2026-10-13","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC13661728/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"149184820","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":"Robot-assisted buccal graft uretero-pyeloplasty for pediatric recurrent UPJO: a multi-center case-series.","authors":"Nicolas Fernandez, Jennifer Ahn, Maya Gopalan, Thomas S Lendvay, Kyle Rini, Suhaib Abdulfattah, Nicole J Kye, Sanjay Aiyar, Sameer Mittal, Christopher J Long, Arun K Srinivasan, Aseem R Shukla, Chester Koh, Benjamin Whittam, Mohan Gundeti, Andrew Strine, Mickey Daugherty, Andrew Kirsch, Ardavan Akavan, Justin Kim, Justin Roth, Benjamin Press, Maria Rodriguez, Alexandra Siegal, Jorge Arias","doi":"10.1007/s11701-026-04061-6","DOIUrl":"10.1007/s11701-026-04061-6","url":null,"abstract":"<p><p>Redo pyeloplasty is technically more complex due to more significant scar tissue and risk for poor ureteral blood supply affecting outcomes. Use of buccal graft uretero-pyeloplasty was originally reported in the pediatric population back in 2017 as an alternative for complex reoperations. We hypothesize that in highly selected group of pediatric patients undergoing redo pyeloplasty, a buccal graft uretero-pyeloplasty would demonstrate efficacy. A total of 6 institutions identified patients undergoing a robot-assisted buccal uretero-pyeloplasty from 2014 to 2025. Demographic, pre-operative, intraoperative and postoperative variables were aggregated. Success was defined as improvement of hydronephrosis and or resolution of initial presenting symptoms. A total of 12 cases were identified. Median age at the time of initial pyeloplasty was 12 years (IQR 9.75-15.25 years), and buccal graft redo pyeloplasty was at a median of 16 years (IQR11-18 years). Median length of the buccal graft was 4 cm (include SD). Nine cases (75%) had omental wrap and all except one were onlay grafts. The most common reason for failure was persistent pain (6 patients) followed by worsening dilation (3 patients). With a median follow-up of 2 years (IQR11-18 years), nine patients (75%) reported improvement of their symptoms and 6 (50%) improved the hydronephrosis. Two continued with chronic flank pain despite no reports of obstruction or worsening dilation. This is the largest pediatric cohort reporting outcomes after buccal graft uretero-pyeloplasty for recurrent UPJO. In a small sample size of highly selected pediatric patients, buccal graft onlay may be utilized with reasonable efficacy while acknowledging lower success than reported in other recurrent UPJO case series.</p>","PeriodicalId":47616,"journal":{"name":"Journal of Robotic Surgery","volume":"20 1","pages":""},"PeriodicalIF":4.2,"publicationDate":"2026-10-13","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"149184995","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":"Perspectives of robotic surgeons on the strengths, weaknesses, opportunities, and threats of robotic surgery in india: a cross-sectional survey.","authors":"Naveen Sekar, Gomathi Shankar, Sudharsanan Sundaramurthi, N R Vishnu Prasad","doi":"10.1007/s11701-026-04069-y","DOIUrl":"10.1007/s11701-026-04069-y","url":null,"abstract":"<p><p>Robotic surgery is increasingly being adopted in India, but its wider implementation is associated with economic, training, and resource-related challenges. This study assessed the perspectives of surgeons performing robotic surgery in India regarding the perceived strengths, weaknesses, opportunities, and threats (SWOT) associated with robotic surgery. A cross-sectional questionnaire-based survey was conducted from June 2023 to January 2025 among surgeons performing robotic surgery in India. The questionnaire comprised 25 five-point Likert-scale statements addressing different aspects of robotic surgery, together with an open-ended component. Data were collected using KoboToolbox and analysed descriptively using Stata version 14.0. Seventy-five robotic surgeons participated. Participants perceived better three-dimensional visualization (72, 96.0%), improved instrument manipulation and ergonomics (73, 97.3%), greater precision (71, 94.7%), and resistance to tremor and fatigue (71, 94.7%) as important strengths. Perceived limitations included absence of tactile feedback (70, 93.3%), additional operating-room time (51, 68.0%), high procedural costs (49, 65.3%), and frequent instrument replacement (45, 60.0%). Forty-three participants (57.3%) perceived an absence of structured academic robotic training, while 46 (61.3%) felt that increasing robotic surgery could reduce residents' exposure to open and laparoscopic surgery. Perceived opportunities included expansion to additional procedures (72, 96.0%), wider penetration in India (71, 94.7%), medical tourism (66, 88.0%), microsurgical applications (54, 72.0%), and telesurgery (51, 68.0%). Open-ended responses additionally identified artificial intelligence, advanced imaging, cost reduction, and development of new robotic techniques as potential opportunities. Surgeons performing robotic surgery in India perceived substantial technical and ergonomic advantages alongside economic, training, and resource-related challenges. The findings highlight perceived opportunities for expansion into complex and microsurgical procedures and integration with emerging technologies. Structured competency-based training, systematic outcome auditing, and procedure-specific assessment of clinical benefit and resource utilization may help inform the future development of robotic surgery in India.</p>","PeriodicalId":47616,"journal":{"name":"Journal of Robotic Surgery","volume":"20 1","pages":""},"PeriodicalIF":4.2,"publicationDate":"2026-10-13","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"149184946","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 operative performance of three robotic platforms in benign gynecologic surgery: a single-surgeon retrospective cohort study.","authors":"Kim-Seng Law, Ruri Mineda, Tze Swen Looi, Peng-Yu Chen, Yi-Ching Chen, Pei-Jhen Wu","doi":"10.1007/s11701-026-04023-y","DOIUrl":"10.1007/s11701-026-04023-y","url":null,"abstract":"<p><p>This single-surgeon retrospective cohort study compared operative efficiency and perioperative outcomes among the da Vinci Xi, Hugo RAS, and da Vinci SP platforms in 218 women undergoing robotic hysterectomy or myomectomy for benign disease. The primary outcome was console time; secondary outcomes included operative time, estimated blood loss, length of stay, and complications. Hysterectomy models were adjusted for age, obesity, and total specimen weight. Myomectomy models additionally accounted for the number of myomas and maximum myoma diameter. Adjusted hysterectomy console times were 96.3 min (SP), 95.6 min (Hugo), and 136.5 min (Xi); Xi was significantly longer than SP (P = .001). Adjusted myomectomy console times were 107.6, 97.9, and 140.6 min, respectively, with no significant difference between SP and Hugo (P = .86) or between SP and Xi (P = .22). Adjusted estimated blood loss did not differ significantly from SP in hysterectomy. In myomectomy, estimated blood loss was higher with Hugo than with SP (415.8 vs. 191.1 mL; P = .04), whereas Xi did not differ from SP (P = .45). Length of stay and short-term complication rates did not differ significantly, although the study was not designed to establish equivalence. Platform-associated differences were procedure-specific and sensitive to adjustment for case complexity.</p>","PeriodicalId":47616,"journal":{"name":"Journal of Robotic Surgery","volume":"20 1","pages":""},"PeriodicalIF":4.2,"publicationDate":"2026-10-12","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC13654872/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"149167067","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 clinical application value of mixed reality guidance in robot-assisted laparoscopic radical nephrectomy for renal cancer.","authors":"Xin Chang Zou, Yuan Liang Cao, Xiang Da Xu, Hai Chao Chao, Huan Huan Deng, Tao Zeng","doi":"10.1007/s11701-026-04048-3","DOIUrl":"https://doi.org/10.1007/s11701-026-04048-3","url":null,"abstract":"<p><p>Although robot-assisted laparoscopic radical nephrectomy (RAL-RN) has realized the benefits of minimally invasive surgery, it continues to face several key technical limitations, including the lack of integrated patient-specific three-dimensional anatomical navigation and insufficient real-time intraoperative navigation. While mixed reality (MR) technology has shown considerable potential in renal tumor surgery, its clinical application value specifically within the context of radical nephrectomy for renal cancer warrants further systematic evaluation. This study aims to evaluate the clinical efficacy and practical value of MR guidance in RAL-RN. A retrospective analysis was conducted of 74 patients who underwent RAL-RN between September 2021 and March 2024. Participants were categorized into two groups based on preoperative assessment methodology: an MR navigation group (n = 33) and a conventional imaging group (n = 41). All patients received non-contrast and triple-phase contrast-enhanced renal CT scans. The MR group utilized Hololens-based intraoperative anatomical reference with three-dimensional models reconstructed from preoperative CT data during Da Vinci robotic procedures. Perioperative outcomes, including baseline demographic and clinical characteristics, operative time, estimated blood loss, and postoperative complications, were compared between the two groups to assess the potential technical advantages of MR-guided navigation. The two groups showed comparable baseline characteristics (p > 0.05). The MR group exhibited significantly shorter operative time (161.15 ± 10.87 min versus 182.29 ± 12.40 min, p < 0.001), reduced blood loss (150.00 mL [interquartile range 140.00 to 165.00] versus 165.00 mL [150.00 to 165.00], p = 0.008), faster gastrointestinal function recovery (26.82 ± 4.17 h versus 28.93 ± 3.68 h, p = 0.024), earlier tube removal (5.00 days [4.00 to 5.00] versus 6.00 days [6.00 to 7.00], p < 0.001), and shorter postoperative hospitalization (6.00 days [6.00 to 7.00] versus 8.00 days [7.00 to 8.00], p < 0.001). No significant differences were observed in tumor staging, renal function parameters (postoperative and 12-month Scr and GFR), histopathological type, or complication rates (Clavien-Dindo grades 1 and 2) between groups (all p > 0.05). MR guidance was associated with shorter operative time and faster postoperative recovery in RAL-RN. However, given the non-randomized design, these findings should be regarded as preliminary and cannot establish causality. Prospective studies with standardized allocation and adequate follow-up are warranted to confirm the clinical value of MR guidance.</p>","PeriodicalId":47616,"journal":{"name":"Journal of Robotic Surgery","volume":"20 1","pages":""},"PeriodicalIF":4.2,"publicationDate":"2026-10-12","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"149167642","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 colorectal cancer surgery: perioperative and oncological outcomes at a national referral center in Mexico.","authors":"José M Aguilar-Romero, Itzel Vela-Sarmiento, Javier Melchor-Ruan, Hector Martinez-Said, Jorge L Aguilar-Frasco, Leonardo S Lino-Silva, Adrian N Morales Moreno","doi":"10.1007/s11701-026-04052-7","DOIUrl":"https://doi.org/10.1007/s11701-026-04052-7","url":null,"abstract":"<p><p>Robotic colorectal surgery is increasingly used for technically demanding pelvic procedures, but contemporary cancer-specific experience from Latin American public oncology centers remains limited. To describe perioperative and pathological outcomes of a robotic colorectal cancer program at a national oncology referral center in Mexico. We retrospectively analyzed 75 consecutive patients who underwent robotic surgery for colorectal malignancy at the Instituto Nacional de Cancerología between June 2024 and March 2026. Colon and rectal cancer were analyzed as separate descriptive cohorts. Major morbidity was defined as Clavien-Dindo grade III or higher within 30 days. Fifty-seven patients (76.0%) had rectal cancer and 18 (24.0%) had colon cancer. No conversion to open surgery occurred (0/75; exact 95% CI 0-4.8%). Median operative time was 290 min (IQR 220-345), estimated blood loss 50 mL (IQR 30-100), and hospital stay 4 days (IQR 3-6). Major morbidity occurred in 13/75 patients (17.3%), reintervention in 12/75 (16.0%), and 30-day readmission in 12/75 (16.0%). Among rectal patients, 54/57 (94.7%) received total neoadjuvant therapy (TNT) and 11/54 (20.4%) achieved pathological complete response. The circumferential resection margin was < 1 mm in 8/57 (14.0%). Mesorectal quality was complete in 41/57 (71.9%), nearly complete in 7/57 (12.3%), and incomplete in 9/57 (15.8%). Median lymph-node yield was 9 (IQR 6-12) for rectal cancer and 25.5 (IQR 16.25-32.25) for colon cancer. This series describes robotic colorectal cancer surgery within an established national oncology service, with a case mix dominated by low rectal procedures. The findings provide contemporary perioperative and pathological quality data for continued institutional audit; comparative studies and longer follow-up are required before conclusions regarding relative effectiveness can be made.</p>","PeriodicalId":47616,"journal":{"name":"Journal of Robotic Surgery","volume":"20 1","pages":""},"PeriodicalIF":4.2,"publicationDate":"2026-10-12","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"149167648","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":"Robot-assisted ileal ureter replacement for complex ureteral strictures: a systematic review and single-arm meta-analysis of surgical and functional outcomes.","authors":"Saied Mohammed Saied Qasem, Ahmed Naji Ahmed Hassan, Mohamed L Ghanem, Mina Hany Foad Tawfik","doi":"10.1007/s11701-026-04064-3","DOIUrl":"10.1007/s11701-026-04064-3","url":null,"abstract":"<p><p>Complex, long-segment ureteral strictures present significant reconstructive challenges. While open ileal ureter replacement is the historical gold standard, it carries substantial perioperative morbidity. This systematic review and single-arm meta-analysis evaluate the surgical and functional outcomes of robot-assisted ileal ureter replacement (RIUR). Following Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) guidelines, a comprehensive search of four databases was conducted through September 2026 to identify studies reporting adult RIUR outcomes for complex strictures. Outcomes were pooled using random-effects models. Five retrospective cohort studies comprising 110 patients met the inclusion criteria, with radiation-induced injury representing the predominant etiology (44.5%). The pooled surgical success rate was 93.9% (95% confidence interval [CI]: 87.0-97.2%). The pooled major complication rate (Clavien-Dindo grades III-V) was 10.0% (95% CI: 4.0-24.0%), driven primarily by urinary anastomotic leaks, typically managed with prolonged stenting. Pooled rates for metabolic acidosis requiring supplementation and stricture recurrence were 7.4% and 2.6%, respectively, while renal function remained stable or improved across all evaluated cohorts. Pooled mean operative time and estimated blood loss were 339.1 min (95% CI: 310.5-367.7) and 103.7 mL (95% CI: 54.9-152.6), respectively, while length of hospital stay varied widely by regional institutional pathway (median 3.0 days in early-discharge cohorts to 14.2 days in inpatient testing protocols). Current evidence suggests that RIUR represents a feasible and promising minimally invasive option for complex ureteral defects, with observed success rates meeting historical clinical benchmarks and an acceptable perioperative safety profile.</p>","PeriodicalId":47616,"journal":{"name":"Journal of Robotic Surgery","volume":"20 1","pages":""},"PeriodicalIF":4.2,"publicationDate":"2026-10-12","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"149166742","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":"Surgical architecture and component identifiability in robot-assisted radical prostatectomy: a systematic review and network meta-analysis.","authors":"Yucong Chai, Liming Zhang, Bohao Zhong, Peng Xue, Xiaolong Li, Junzhe Dai, Jing Liu","doi":"10.1007/s11701-026-04057-2","DOIUrl":"10.1007/s11701-026-04057-2","url":null,"abstract":"<p><p>Robot-assisted radical prostatectomy (RARP) combines preservation, reconstruction, and support maneuvers within named surgical packages, making component attribution difficult. To determine whether comparative evidence can identify independent surgical-component effects on strict early perfect continence while preserving oncological context. Comparative RARP studies were synthesized within a prespecified surgical-architecture framework. The primary outcome was perfect continence (0 pads/day) at 10-14 weeks. All prespecified bibliographic databases and registries were rerun through 26 September 2026. Randomized evidence underwent pairwise and network meta-analysis; component estimates were interpreted only after a prespecified structural-identifiability gate. Forty-eight reports representing 48 nonoverlapping study families, 98 arms, and 6,665 arm-level participants were included. Six randomized families provided exact strict 3-month events and formed three disconnected subnetworks; four families formed the largest connected network. In that four-family network, risk ratios versus standard RARP were 1.07 (95% confidence interval [CI] 0.65-1.78) for posterior reconstruction (PR), 2.94 (0.92-9.33) for PR plus anterior reconstruction/suspension, and 1.49 (0.63-3.52) for PR plus sling. PR was the only component meeting the prespecified structural gate; this denotes evidence structure, not a precise or validated independent causal effect. Descriptive positive surgical margin estimates were sparse (PR 0.96 [0.50-1.86]; PR plus anterior reconstruction/suspension 1.74 [0.57-5.25]). Confidence in all primary network comparisons was very low. The literature is broad at the level of named RARP techniques but insufficiently connected and replicated to isolate most component-specific effects. Package-level signals should not be reassigned to individual maneuvers unless those components vary independently across replicated comparisons. Future trials should report exact time-specific continence outcomes, explicit arm-level technical details, and replicated component contrasts.</p>","PeriodicalId":47616,"journal":{"name":"Journal of Robotic Surgery","volume":"20 1","pages":""},"PeriodicalIF":4.2,"publicationDate":"2026-10-12","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"149167651","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":"Diffusion and geographic variation in robot-assisted colon resection after reimbursement in Japan: a nationwide billing-based analysis, 2022-2024.","authors":"Takuya Omura, Takahiro Kamihara","doi":"10.1007/s11701-026-04039-4","DOIUrl":"https://doi.org/10.1007/s11701-026-04039-4","url":null,"abstract":"<p><p>This study aimed to quantify how rapidly robot-assisted colon resection billing diffused after reimbursement in Japan and whether geographic variation narrowed as uptake expanded. We analyzed National Database (NDB) Open Data for fiscal years (FYs) 2022-2024. The primary outcome was the robot-assisted share of two laparoscopic billing categories for malignant colon tumor resection (robot-assisted and conventional). Variation across treating-institution prefectures was summarized using the interquartile range (IQR) for absolute spread and the coefficient of variation (CV) and Gini coefficient for relative dispersion. Longitudinal analyses included prefectures with unmasked values in all relevant years; FY2024 permitted a complete 47-prefecture cross-section. The national robot-assisted share rose from 3.38% in FY2022 to 11.40% in FY2023 and 19.55% in FY2024. In the common 33-prefecture panel, the IQR widened from 5.73 to 6.61 and 11.79 percentage points, whereas the CV fell from 1.086 to 0.630 and 0.482 and the Gini coefficient from 0.565 to 0.347 and 0.269. Across all 47 prefectures in FY2024, shares ranged from 0.00% to 41.47%; the complete cross-section was more heterogeneous than the restricted longitudinal panel, and the 14 prefectures excluded because of earlier masking had a lower median share (6.83% versus 18.05%). Rapid national growth did not translate into geographically uniform billing-based uptake. Relative dispersion decreased while absolute percentage-point spread widened, so apparent geographic convergence depended on the scale used. Post-reimbursement surveillance should report both dimensions and account for selection introduced by disclosure-related masking.</p>","PeriodicalId":47616,"journal":{"name":"Journal of Robotic Surgery","volume":"20 1","pages":""},"PeriodicalIF":4.2,"publicationDate":"2026-10-12","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"149168903","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}