Journal of Robotic Surgery最新文献

{"title":"Research on the spectrum of complications in robotic surgery for obese urologic patients: a 6-year retrospective study.","authors":"Yan Kan, Sheng Tai, Zihan Wang","doi":"10.1007/s11701-025-02584-y","DOIUrl":"10.1007/s11701-025-02584-y","url":null,"abstract":"<p><p>The prevalence of obesity has reached epidemic proportions globally, with obese patients facing significantly higher perioperative risks due to anatomical and physiological challenges. While robot-assisted surgery (RAS) offers potential advantages through 3D high-definition imaging and tremor filtering capabilities, comprehensive safety data for obese patients remains limited. This study aimed to evaluate the safety profile and complication spectrum of robotic surgery in obese patients. A retrospective observational study was conducted at the First Affiliated Hospital of Anhui Medical University from January 2019 to March 2025. Inclusion criteria were age ≥ 18 years, BMI ≥ 28 kg/m², and da Vinci robotic system-assisted surgery. Clinical data including patient characteristics, surgical outcomes, and complications were analyzed. Patients were stratified by obesity severity: mild (28 ≤ BMI < 32.5 kg/m²), moderate (32.5 ≤ BMI < 37.5 kg/m²), and severe (37.5 ≤ BMI < 50 kg/m²). A total of 299 obese patients were included: 109 underwent radical prostatectomy, 150 partial nephrectomy, and 40 ureteral reconstruction. No robotic malfunctions or conversions to open surgery occurred. Overall complication rates were low, with incisional pain (5.7%) and fever (2.3%) being most common. Complications were predominantly Clavien-Dindo grades I and II. Serious complications including pulmonary embolism (0.3%), delayed bleeding (0.3%), and critical myoglobin value (0.3%) occurred rarely. BMI subgroup analysis revealed complication rates of 11.3% in mild obesity, 5.3% in moderate obesity, and 0% in severe obesity, suggesting higher BMI did not increase complication rates. Robot-assisted surgery demonstrates a high safety profile in obese patients with low overall complication rates. While most complications were minor and manageable, attention should be paid to postoperative pain management, infection prevention, and thromboembolic risk assessment. These findings support the safety and feasibility of robotic surgery in the obese population.</p>","PeriodicalId":47616,"journal":{"name":"Journal of Robotic Surgery","volume":"19 1","pages":"407"},"PeriodicalIF":2.2,"publicationDate":"2025-07-20","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC12277221/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144676164","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 simulation in urology training: implementation, curricula, and barriers across U.S. residency programs.","authors":"Max J Bouvette, Brennan Lee, Nathan Bradley","doi":"10.1007/s11701-025-02591-z","DOIUrl":"https://doi.org/10.1007/s11701-025-02591-z","url":null,"abstract":"<p><p>Robotic surgery has transformed urology. Simulation-based robotic training allows residents to develop skills in a controlled, risk-free environment and enhances proficiency. Our objective was to assess the integration of robotic simulation training in U.S. urology residency programs, focusing on adoption, curriculum types, mandatory status, and barriers to implementation. We distributed a Qualtrics survey to U.S. urology residency program directors to assess the presence and structure of robotic simulation curricula. If a program director did not respond, an email was sent to the program coordinator to survey them on the presence and structure of a curriculum. We surveyed only program directors' views of simulation training and assessed their responses using a 5-point Likert scale. Surveys were sent to 150 programs, with 33 (22%) responding; 17 program directors (51.5%) and 16 coordinators (48.5%). Of the responding programs, 31/33 (93.9%) reported access to and utilization of robotic simulation training. Simulation training was mandatory for residents in 21/31 (67.7%) of these programs. Structured curricula with objectives were reported by 16/31 programs (51.6%), while 15/31 (48.4%) relied on informal or self-directed methods. Supervised simulation training was reported by 24/31 programs (77.4%). Program directors viewed simulation training as beneficial, with an average agreement rating of 4.18/5 for its educational role and impact on performance. Our survey shows that most urology training programs have adopted robotic simulation; however, not all programs have made it mandatory for residents or implemented a structured learning curriculum. Addressing these issues could promote more uniform training practices.</p>","PeriodicalId":47616,"journal":{"name":"Journal of Robotic Surgery","volume":"19 1","pages":"406"},"PeriodicalIF":2.2,"publicationDate":"2025-07-20","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144668689","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-assisted primary ventral and incisional hernia repair: a comprehensive comparative analysis of rv-TAPP, r-Rives, and r-TARUP techniques.","authors":"Danilo Coco, Silvana Leanza","doi":"10.1007/s11701-025-02489-w","DOIUrl":"10.1007/s11701-025-02489-w","url":null,"abstract":"<p><p>Robotic-assisted surgery has transformed hernia repair by improving precision, minimizing postoperative complications, and accelerating recovery. This study evaluates three robotic techniques-robotic transabdominal preperitoneal (rTAPP), robotic Rives (rRives), and robotic transabdominal retromuscular umbilical prosthetic (rTARUP)-for treating primary ventral and incisional hernias. Following PRISMA guidelines, a systematic review and meta-analysis were conducted. Databases such as PubMed, Embase, Cochrane Library, and Web of Science were searched for studies comparing rTAPP, rRives, and rTARUP. Key outcomes included recurrence rates, surgical duration, and postoperative complications, with secondary outcomes assessing hospital stay and cost-effectiveness. Statistical analyses were performed using RevMan 5.4 and STATA 16, calculating pooled odds ratios (OR) and mean differences (MD). Heterogeneity was measured via I² statistics, and publication bias was evaluated using the Egger test. The analysis included 18 studies encompassing 1,500 patients. rTAPP showed shorter operative times (MD: - 25.3 min, 95% CI: - 30.1 to - 20.5, *p* < 0.05) and reduced recurrence rates (OR: 0.45, 95% CI: 0.30-0.68, *p* < 0.01) compared to rRives and rTARUP. However, rTARUP was linked to fewer postoperative complications (OR: 0.65, 95% CI: 0.50-0.85, *p* < 0.05). No significant publication bias was detected (Egger test, *p* = 0.12). Robotic hernia repair techniques offer unique benefits: rTAPP is more efficient, while rTARUP reduces complications. These results emphasize the need for personalized surgical approaches.</p>","PeriodicalId":47616,"journal":{"name":"Journal of Robotic Surgery","volume":"19 1","pages":"405"},"PeriodicalIF":2.2,"publicationDate":"2025-07-20","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144668706","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":"Visualization of parenchymal deformation during renorrhaphy: a novel deformation index in a simulated kidney model.","authors":"Tomoyuki Tatenuma, Hikaru Takiyama, Takahiro Yamada, Kota Kobayashi, Ryosuke Jikuya, Go Noguchi, Hiroki Ito, Komeya Mitsuru, Yusuke Ito, Kentaro Muraoka, Hisashi Hasumi, Kazuhide Makiyama","doi":"10.1007/s11701-025-02580-2","DOIUrl":"https://doi.org/10.1007/s11701-025-02580-2","url":null,"abstract":"<p><p>The objective of this study is to evaluate mechanical tension on the renal parenchyma during partial nephrectomy using a novel index and compare the effects of different suture techniques on strain in a simulated model. A kidney-shaped urethane resin model with surface markers was created to measure deformation. Three-dimensional scanning assessed deformation before and after suturing. Strain values were calculated using finite-element shape functions on a triangular mesh. Distance from the centerline of the suture was also measured. The standard suturing method was defined as continuous stitches using self-retaining barbed sutures. Based on this standard, variations were introduced in suture material, suturing technique (continuous or interrupted), number of stitches, and the distance from the defect edge. Seven suture patterns were tested. Deformation values were higher when sutures were placed farther from the defect margin and lower when placed closer. Interrupted, tight, sparse, and multifilament suture patterns produced strain values similar to those of the standard technique. Narrow suture pattern tended to have longer distances from the centerline than the wide suture pattern. Interrupted and multifilament suture patterns also showed slightly longer distances than the standard pattern. This is the first study to visualize and quantify strain distribution during renorrhaphy using deformation values. The findings suggest that the distance of suture placement from the limbus may impact parenchymal strain. Despite limitations such as a small sample size and use of simulated models, these results offer insights into optimizing renorrhaphy techniques to minimize tissue stress. Future studies with larger sample sizes are warranted.</p>","PeriodicalId":47616,"journal":{"name":"Journal of Robotic Surgery","volume":"19 1","pages":"402"},"PeriodicalIF":2.2,"publicationDate":"2025-07-18","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144660786","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":"Development of an artificial intelligence algorithm for automated surgical gestures annotation.","authors":"Rikke Groth Olsen, Flemming Bjerrum, Annarita Ghosh Andersen, Lars Konge, Andreas Røder, Morten Bo Søndergaard Svendsen","doi":"10.1007/s11701-025-02556-2","DOIUrl":"10.1007/s11701-025-02556-2","url":null,"abstract":"<p><p>Surgical gestures analysis is a promising method to assess surgical procedure quality, but manual annotation is time-consuming. We aimed to develop a recurrent neural network for automated surgical gesture annotation using simulated robot-assisted radical prostatectomies. We have previously manually annotated 161 videos with five different surgical gestures (Regular dissection, Hemostatic control, Clip application, Needle handling, and Suturing). We created a model consisting of two neural networks: a pre-trained feature extractor (VisionTransformer using Imagenet) and a classification head (recurrent neural network with a Long Short-Term Memory (LSTM(128) and fully connected layer)). The data set was split into a training + validation set and a test set. The trained model labeled input sequences with one of the five surgical gestures. The overall performance of the neural networks was assessed by metrics for multi-label classification and defined Total Agreement, an extended version of Intersection over Union (IoU). Our neural network could predict the class of surgical gestures with an Area Under the Curve (AUC) of 0.95 (95% CI 0.93-0.96) and an F1-score of 0.71 (95% CI 0.67-0.75). The network could classify each surgical gesture with high accuracies (0.84-0.97) and high specificities (0.90-0.99), but with lower sensitivities (0.62-0.81). The average Total Agreement for each gesture class was between 0.72 (95% CI ± 0.03) and 0.91 (95% CI ± 0.02). We successfully developed a high-performing neural network to analyze gestures in simulated surgical procedures. Our next step is to use the network to annotate videos and evaluate their efficacy in predicting patient outcomes.</p>","PeriodicalId":47616,"journal":{"name":"Journal of Robotic Surgery","volume":"19 1","pages":"404"},"PeriodicalIF":2.2,"publicationDate":"2025-07-18","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC12274238/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144668688","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":"Correlations of kinematic data with robotic experience and duration of practice on complications and readmissions.","authors":"Daniel P Dolan, Fatemehsadat Pezeshkian, Anupama Singh, Emanuele Mazzola, Jon O Wee","doi":"10.1007/s11701-025-02557-1","DOIUrl":"https://doi.org/10.1007/s11701-025-02557-1","url":null,"abstract":"<p><p>Robotic surgery is increasingly prevalent in thoracic surgery. Studies of specific kinematic data on outcomes are missing. The object of this study was to examine correlations between years in practice, robotic experience, and kinematic (motion) data on complications and readmissions. Kinematic data from the first lymph node dissection of anatomic robotic lung resections were combined with data from a prospectively maintained single institution database. Kinematic data included arm movement speed, economy of motion, and camera movement. Lobectomies and segmentectomies were matched and propensity-score weighted with inverse-probability treatment weights. Pearson's correlations, between years in practice, robotic experience, and kinematic data; and logistic regression; between years in practice and robotic experience on complications and readmissions were done. Lobectomies, 42, and segmentectomies, 31, from 2022 to 2023 were included. After matching, lymph nodes sampled were greater with lobectomies than segmentectomies, but other data were well matched; nodes sampled with lobes 13.4 vs 7.6 with segments, p < 0.001. Years in practice and robotic experience were not correlated with complications or readmissions. Significant correlations were noted between kinematic data and robotic experience. Length of stay had a negative correlation with robotic experience, -0.16, p < 0.001. No odds ratios were significant. In this small series, decreased length of stay was correlated with increased robotic experience which was a stronger outcome determinant than practice years. The complications and readmissions were not correlated with either measure. Increasing robotic experience may help optimize patient care but additional data are needed to establish usefulness of specific kinematic data.</p>","PeriodicalId":47616,"journal":{"name":"Journal of Robotic Surgery","volume":"19 1","pages":"403"},"PeriodicalIF":2.2,"publicationDate":"2025-07-18","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144660782","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":"Performance and operative outcomes' evaluation of a hand-held articulating laparoscopic device: a prospective clinical trial on the HandX™ platform.","authors":"Nir Messer, Amir Ben Yehuda, Yuri Manoskin, Adam Abu-Abeid, Yonatan Lessing, Fahim Kanani, Eran Nizri, Guy Lahat, Amir Szold","doi":"10.1007/s11701-025-02539-3","DOIUrl":"https://doi.org/10.1007/s11701-025-02539-3","url":null,"abstract":"<p><p>The advent of laparoscopic surgery has revolutionized general surgery, yet ergonomic limitations of conventional instruments persist. Robotic platforms have addressed some of these issues but are hindered by high costs and complexity. Hand-held articulating laparoscopic instruments offer a potential intermediary solution. This study assesses the HandX device performance and post-operative outcomes. This prospective, single-arm trial enrolled 60 patients intended for elective minimally invasive abdominal surgery from March 2018 to January 2022 at Assuta Medical Center and Shamir Medical Center. The study evaluated the hand-held device performance, deficiencies, conversion rate, and post-operative complications within a minimum of 14 days. Sixty patients underwent MIS using the evaluated device without conversion to conventional instruments. The predominant indication for surgery was abdominal wall hernia (48.3%), followed by cholecystectomy (15%). The mean System Usability Scale for evaluating device performance was 84.9, indicating high usability. One device deficiency was noted. No intraoperative complications or device-related post-operative morbidity were observed. Postoperative complications included one superficial surgical site infection and non-device-related medical events. The HandX device exhibits a favorable user experience with no device-related morbidity. Hand-held articulating devices offer a valuable intermediary between conventional laparoscopic instruments and robotic platforms.</p>","PeriodicalId":47616,"journal":{"name":"Journal of Robotic Surgery","volume":"19 1","pages":"401"},"PeriodicalIF":2.2,"publicationDate":"2025-07-18","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144660784","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":"Pencil cleaning technique for robotic liver parenchymal transection: a step further to systematization beyond the microfracture-coagulation method.","authors":"Jordi Navinés-López, Fernando Pardo Aranda, Manel Cremades Pérez, Alba Zárate Pinedo, Sara Sentí Farrarons, Victoria Lucas Guerrero, Francisco Espin Álvarez, Esteban Cugat Andorrà","doi":"10.1007/s11701-025-02480-5","DOIUrl":"10.1007/s11701-025-02480-5","url":null,"abstract":"<p><p>Robotic liver resections based on Laennec's capsule pedicular driven dissection is a challenging surgical procedure, because of the intrinsic relationship between the liver parenchyma and the main intrahepatic vessels. The absence of anatomical landmarks and the frailty of the fine vascular structures requires broad experience, anatomical knowledge and refined technical skills to successfully perform such a procedure. As robotic platforms do no offer the standard laparoscopic advanced tools for liver resection, real robotic approach has been proposed as a default technique for the liver parenchymal transection, precise robotic anatomical and parenchymal-sparing liver resection, and pedicle driven dissection, like the microfracture-coagulation method. A more specific refinement of the real robotic approach, similar to the pencil cleaning process, useful in very careful deep dissections, is defined towards the standardization of the real robotic approach in advanced liver surgery. The rationale of the method, its indications and tips and tricks are described in detail.</p>","PeriodicalId":47616,"journal":{"name":"Journal of Robotic Surgery","volume":"19 1","pages":"399"},"PeriodicalIF":2.2,"publicationDate":"2025-07-17","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC12270959/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144660783","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: Performance and adaptability comparison between medical students and experienced neurosurgeons using a robotic exoscope with a head-mounted display.","authors":"Zhang Peng, Tang Chao","doi":"10.1007/s11701-025-02578-w","DOIUrl":"https://doi.org/10.1007/s11701-025-02578-w","url":null,"abstract":"","PeriodicalId":47616,"journal":{"name":"Journal of Robotic Surgery","volume":"19 1","pages":"398"},"PeriodicalIF":2.2,"publicationDate":"2025-07-17","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144660781","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 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}