Journal of Robotic Surgery最新文献

{"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}

{"title":"Augmenting colonoscopy with artificial intelligence and robotic assistance: a human-factors scoping review toward a task-based shared autonomy paradigm.","authors":"Luigi Manfredi, Alfredo Annicchiarico, Gianpiero Gravante","doi":"10.1007/s11701-026-03923-3","DOIUrl":"10.1007/s11701-026-03923-3","url":null,"abstract":"<p><p>Colonoscopy is central to colorectal cancer prevention but remains a high-demand psychomotor and cognitive procedure, characterized by operator dependency, variable performance, and substantial physical and mental workload. Increasing evidence links procedural quality and safety to clinician-related factors, including musculoskeletal strain, fatigue, and non-technical skills. Concurrently, artificial intelligence (AI) and robotic technologies are emerging as potential tools to address these limitations. We conducted a scoping review with narrative synthesis of literature on human factors, ergonomics, AI, robotic technologies, and shared autonomy in colonoscopy and surgical robotics. Evidence synthesis: Colonoscopy performance remains limited by non-negligible miss rates and variability driven by both technical and human factors. Ergonomic constraints and cognitive workload contribute significantly to operator strain and may affect vigilance and decision-making. AI systems-including computer-aided detection (CADe), diagnosis (CADx), and quality monitoring-have demonstrated improvements in detection metrics and procedural standardisation, although concerns regarding cognitive offloading and potential deskilling persist. In parallel, emerging robotic and soft-robotic platforms aim to enhance navigation, improve procedural ergonomics, and reduce operator musculoskeletal strain, although clinical evidence remains limited. These technologies converge within a task-based shared-autonomy paradigm integrating physical, perceptual, and cognitive augmentation, with different procedural tasks operating at different levels of human-system control. A task-based shared-autonomy framework may provide a coherent model for integrating AI and robotics into colonoscopy while preserving human supervision and clinical judgement. Future developments should prioritise human-centred design, workflow integration, and multidimensional evaluation strategies to ensure safe and effective clinical implementation.</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/PMC13654901/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"149168866","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":"Post-market safety signals of energy-based surgical devices: a cross-specialty disproportionality analysis of the FDA MAUDE database with robotic-platform validation and regulatory triangulation, 2015-2025.","authors":"Ruifeng Shi","doi":"10.1007/s11701-026-04060-7","DOIUrl":"https://doi.org/10.1007/s11701-026-04060-7","url":null,"abstract":"<p><p>Post-market safety evidence for energy-based surgical devices is fragmented. We characterized adverse-event signals in the FDA MAUDE database, validated them on a third (robotic) platform, and triangulated across regulatory and international sources. Medical Device Reports (2015-2025) under electrosurgical and ultrasonic product codes were analyzed with reporting odds ratios (RORs), stratified by specialty and procedure, with robustness checks. All reports under the robotic-system code were retrieved as a third-platform validation cohort. Signals were triangulated with FDA recalls, 510(k) clearances, the Health Canada and Australian TGA databases, exposure descriptors, and a retrospectively applied Poisson CUSUM feasibility analysis. Among 110,183 deduplicated reports (65.8% electrosurgical, 34.2% ultrasonic), electrosurgical devices showed an electrical-thermal fingerprint (burns ROR 3.84; electric shock ROR 15.34) and ultrasonic devices a mechanical-integrity fingerprint (foreign-body removal ROR 92.74), replicated directionally in Canada and Australia. The fingerprint localized to generator/monopolar components and varied by specialty and procedure. Within the robotic validation cohort, component-stratified analysis partly reproduced these signatures-robot-mounted monopolar instruments retained a burn signal, and robot-mounted ultrasonic instruments carried the highest injury-report share-while cross-platform, same-modality contrasts are reported strictly as report-composition (share-level) comparisons. Reporting artifacts (19.5% placeholder narratives; a 2025 robotic mass-reporting episode comprising 55.8% of the robotic cohort) left fingerprint RORs materially unchanged. A retrospectively applied CUSUM flagged the burn theme more than five years before the 2023-2024 Class I recalls, illustrating-without establishing prospective lead time-the potential of automated monitoring. Energy-modality failure-injury fingerprints were consistent across specialties, delivery platforms, three national databases, and regulatory actions. Automated, artifact-aware surveillance of vigilance databases is a promising complement to pre-market review and warrants prospective evaluation.</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":"149168445","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":"Lymph node yield and station count in early robot-assisted versus established video-assisted resection for non-small cell lung cancer: higher total node counts reflect yield per sampled station.","authors":"Jong-Duk Kim, Yong Seong Lee, Jung Wook Yang","doi":"10.1007/s11701-026-04047-4","DOIUrl":"https://doi.org/10.1007/s11701-026-04047-4","url":null,"abstract":"<p><p>Whether robot-assisted thoracic surgery (RATS) improves nodal staging over video-assisted thoracoscopic surgery (VATS) early in adoption is unknown. We compared occult nodal upstaging and lymph node (LN) retrieval between early RATS and an established VATS practice by one surgeon, and asked whether total LN count reflects the number of stations sampled. Retrospective single-surgeon cohort of consecutive lung cancer resections with systematic LN dissection (2023-2026). Primary outcome: occult nodal upstaging (pathologic N + in clinically N0 patients). Secondary outcomes: LN yield, distinct stations sampled, and yield per sampled station, and perioperative outcomes. Eighty-seven patients qualified (RATS, n = 49; VATS, n = 38; 92.1% of VATS operations after RATS introduction). Occult upstaging was 10.6% vs. 10.5% (95% CI for the difference, - 14.8 to + 13.7% points; not significant). Total LN yield was higher with VATS (13.8 vs. 17.7; p = 0.018), whereas stations sampled were similar (4.7 vs. 4.7; equivalent within post-hoc margins of ± 1 and ± 0.75 but not ± 0.5 stations); yield per sampled station was lower with RATS (2.5 vs. 3.3; p = 0.001), mostly in mediastinal stations. This did not attenuate across the 49 RATS cases and persisted after multivariable adjustment (rate ratio 1.29; 95% CI 1.04-1.60). Operative time was longer with RATS; complications and R0 resection did not differ. No significant difference in occult upstaging was observed, but the study was underpowered and this result is inconclusive. Higher VATS node counts reflected yield per sampled station rather than more stations, for reasons that could not be determined. Station-level yield should be reported alongside total node count.</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":"149166702","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":"Anesthesiological considerations and complications in robotic surgery: a retrospective analysis.","authors":"P Kuhn, M Oremek, A L Kuenster, A Labonte, M Kroeplin, T O Vilz, J Kalff, M Soehle, M Thudium","doi":"10.1007/s11701-026-04045-6","DOIUrl":"10.1007/s11701-026-04045-6","url":null,"abstract":"<p><p>Robotic-assisted surgery has become increasingly prevalent across various surgical disciplines. Understanding anesthesiological factors influencing perioperative outcome is essential for optimizing patient care. This retrospective analysis evaluated 200 patients who underwent robotic surgery across three surgical categories: gastrointestinal (GI, n=60), hepatopancreticobiliary (HPB, n=28), and colorectal (n=112) procedures. We conducted an exploratory analysis of associations between anesthesiological parameters-including fluid management, surgical duration, and blood loss-and clinical outcomes such as intensive care unit (ICU) length of stay, total hospital length of stay, complication severity (Clavien-Dindo classification) using univariable and multivariable regression models. The exploratory analyses suggested potential associations between surgical duration and outcomes across surgical specialties in multivariable analysis. For GI procedures, longer surgical duration was associated with higher odds of severe complications (Clavien-Dindo grade ≥III; OR = 1.80 (1.21, 2.66)). In colorectal surgery, surgical duration was independently associated with both development of severe complications (OR = 1.28 (1.01, 1.62)) and total hospital length of stay (log-scale, β = 0.08 (0.03, 0.12)). Fluid intake was associated with an increased hospital length of stay in colorectal surgery (log-scale, β = 0.10 (0.03, 0.17)). Anesthesiological management, particularly surgical duration and fluid management, showed associations with perioperative outcomes in robotic surgery. The estimated effects provide preliminary insights into the magnitude of these associations and may serve as a basis for hypothesis generation and the design of future prospective studies. Further studies are needed to confirm these findings and to investigate the potential clinical relevance of anesthesiological and perioperative management strategies.</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/PMC13654881/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"149169377","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":"Force feedback and vocal cord dysfunction after robotic esophagectomy: a comparison of the da Vinci 5 and Xi systems.","authors":"Cho Eun Lee, Jiyeon Kim, Danbee Kang, Seong Yong Park","doi":"10.1007/s11701-026-04046-5","DOIUrl":"https://doi.org/10.1007/s11701-026-04046-5","url":null,"abstract":"<p><p>The da Vinci 5 (DV5) is the first robotic platform to integrate force feedback (FFB), which may limit excessive traction and tissue injury. Its clinical impact in robotic transthoracic esophagectomy remains unclear. We compared perioperative outcomes between the da Vinci Xi and DV5 systems. This retrospective study included consecutive patients who underwent robotic transthoracic esophagectomy for esophageal squamous cell carcinoma by a single high-volume surgeon between December 2024 and July 2026. Patients treated with the Xi system without FFB (n = 126) and the DV5 system with FFB (n = 37) were compared. Vocal cord dysfunction (palsy or hypomobility) was assessed by routine postoperative laryngoscopy. Outcomes were analyzed using multivariable logistic regression, with stabilized inverse probability of treatment weighting (IPTW) as a sensitivity analysis. Vocal cord dysfunction was less frequent in the DV5 group (Xi, 33.3% vs. DV5, 13.5%), and the association persisted after multivariable and IPTW adjustment (adjusted odds ratio [OR], 0.33; IPTW OR, 0.27). Vocal cord palsy was also less frequent (27.8% vs. 10.8%), although the difference was not significant after adjustment. In an exploratory analysis, overall 30-day complications were less frequent in the DV5 group (74.6% vs. 54.1%; adjusted OR, 0.43), but the difference was attenuated after IPTW adjustment. Total and recurrent laryngeal nerve lymph node yields did not differ. DV5 with integrated FFB was associated with less frequent vocal cord dysfunction and comparable operative outcomes. These findings may provide the first clinical data suggesting FFB could reduce traction-related nerve injury in robotic esophagectomy.</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":"149171216","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-port robotic and conventional multiport laparoscopic colectomy for colon cancer: an overlap-weighted comparison of perioperative and oncologic outcomes.","authors":"Min Hyeong Jo, Hye Ah Lee, Ho Seung Kim, Soon Sup Chung, Gyoung Tae Noh","doi":"10.1007/s11701-026-04065-2","DOIUrl":"https://doi.org/10.1007/s11701-026-04065-2","url":null,"abstract":"<p><p>Comparative evidence for single-port colectomy with robotic system remains limited, particularly for long-term cancer control. We compared perioperative recovery and oncologic outcomes following single-port robotic surgery (SPRS) and conventional multiport laparoscopic surgery (CMLS) in colon cancer. This retrospective study screened 710 patients treated surgically between March 2019 and February 2025. The analytic cohort was balanced with propensity score overlap weighting (PSOW), after which operative, postoperative, pathologic, and survival data were compared. The analysis included 472 patients (142 SPRS and 330 CMLS). PSOW balanced the four covariates specified in the propensity model. SPRS had a longer mean operative time (255.0 vs. 197.5 min, p < 0.001), but no patient required open conversion (0.0% vs. 3.1%, p = 0.011). Compared with CMLS, SPRS was followed by earlier passage of flatus (2.4 vs. 3.4 days), earlier tolerance of a soft diet (3.3 vs. 4.8 days), and a shorter postoperative stay (7.5 vs. 8.5 days) (all p ≤ 0.001). Pain scores through postoperative day 5 were lower after SPRS (all p < 0.001), whereas complication rates and pathologic measures were similar. Three-year relapse-free survival (RFS) was 95.2% after SPRS and 95.1% after CMLS (p = 0.835); the corresponding overall survival (OS) were 97.2% and 94.8% (p = 0.104). Surgical modality was not an independent predictor of RFS or OS. Within the available follow-up, SPRS provided oncologic results comparable to CMLS while being associated with less postoperative pain and enhanced recovery. These data support SPRS as a feasible approach for selected patients with colon cancer.</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":"149165115","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":"Beyond feasibility: an oncology-first framework for defining the role of robot-assisted surgery in ovarian cancer-patient selection, surgical adequacy, and conversion pathways.","authors":"Gang Hu, Yan Lu, Yan Xin, Chaofan Shi, Yanfang He","doi":"10.1007/s11701-026-04020-1","DOIUrl":"https://doi.org/10.1007/s11701-026-04020-1","url":null,"abstract":"<p><p>Robot-assisted surgery has expanded in gynecologic oncology, but its role in ovarian cancer remains uncertain because oncologic success depends on completion of the required cancer operation rather than on the access route. This critical narrative review evaluates selective use of a robotic approach in apparent early-stage disease, interval cytoreduction after neoadjuvant chemotherapy, exceptional primary cytoreduction, and selected platinum-sensitive recurrence in candidates for secondary cytoreduction. Robotics-specific evidence is distinguished from conventional laparoscopic and mixed minimally invasive surgery (MIS) evidence, which is treated as indirect when a robotics-specific estimate cannot be isolated. Available robotics-specific evidence is predominantly retrospective or feasibility-based, and no randomized robotics-specific trial has established oncologic equivalence to laparotomy. Selected cohorts support technical feasibility and favorable short-term perioperative outcomes more consistently than long-term route equivalence, while patient-reported recovery remains insufficiently characterized. In apparent early-stage disease, intact specimen retrieval, systematic abdominopelvic assessment, and staging completeness are central. In interval and recurrent cytoreduction, complete gross resection is the principal surgical adequacy endpoint, whereas recovery, time to subsequent systemic therapy, patient-reported outcomes, and resource use are complementary endpoints. We propose a three-stage conceptual framework comprising preoperative route assessment, systematic intraoperative reassessment, and predefined conversion criteria. On current evidence, robot-assisted surgery is best regarded as a conditional route for carefully selected patients in experienced centers rather than as a default alternative to laparotomy.</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":"149166776","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}