Journal of Robotic Surgery最新文献

{"title":"Textbook outcome-based performance assessment during transition to the da Vinci SP system in reduced-port robotic gastrectomy.","authors":"Yerin Lee, Ji Yoon Jeong, Seungho Lee, Jawon Hwang, Sung Hyun Park, Minah Cho, Yoo Min Kim, Woo Jin Hyung, Hyoung-Il Kim","doi":"10.1007/s11701-026-04058-1","DOIUrl":"https://doi.org/10.1007/s11701-026-04058-1","url":null,"abstract":"<p><p>Although reduced-port gastrectomy with the da Vinci SP system offers a dedicated single-port platform, little is known about how an experienced robotic surgeon performs while changing platforms. We examined this transition by applying cumulative sum (CUSUM) analysis to textbook outcome (TO). We retrospectively analyzed 175 consecutive reduced-port robotic gastrectomies performed at a tertiary referral center from July 2021 through August 2025. The primary measure was TO, a composite of six perioperative requirements. Case-sequence performance was examined with CUSUM curves for TO and operative time. Among 175 patients, 164 achieved TO (93.7%; 95% CI, 89.1-96.5%) and 168 achieved adjusted TO (aTO; 96.0%); major complications occurred in 1.7%. The TO-CUSUM curve showed an apparent stabilization after approximately 60 cases, whereas operative-time CUSUM reached its observed nadir at case 107. The later period included more D2 dissections and complex procedures; the TO rate was 96.7% in the early period and 92.2% in the late period. During transition to the da Vinci SP platform, TO-based CUSUM provided a longitudinal description of perioperative quality as case selection and procedural complexity evolved. The distinct TO-CUSUM and operative-time CUSUM trajectories suggest that quality-related performance and procedural efficiency may evolve at different rates during platform transition.</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":"149168987","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":"Unveiling the Chasm in Japanese robot-assisted surgery diffusion: the interplay of surgical volume and intra-specialty spillover.","authors":"Yusuke Natsume, Shingo Kano","doi":"10.1007/s11701-026-04049-2","DOIUrl":"10.1007/s11701-026-04049-2","url":null,"abstract":"<p><p>To examine structural factors associated with the diffusion of robot-assisted surgery (RAS) in Japan, this study examined the associations of annual surgical volume, defined as the sum of open, conventional laparoscopic, and RAS cases, and prior intra-specialty experience with adoption speed. Using the 1st to 10th editions of the National Database of Health Insurance Claims and Specific Health Checkups of Japan (NDB) Open Data across fiscal years 2014-2023, diffusion trajectories were visualized for 21 procedures approved for insurance coverage by 2020 through bivariate plots of annual surgical volume versus RAS replacement rates. RAS diffusion exhibited non-linear dynamics associated with annual procedure volume. In niche markets with < 6,000 annual cases (n = 9), six procedures demonstrated high growth in RAS replacement rate. Conversely, among 12 procedures with ≥ 6,000 annual cases, four did not cross the 16.0% chasm threshold through FY2023, and three required 6 years to surpass it. These patterns were thought to reflect challenges in the transition from specialized centers to general hospitals. Furthermore, a trend consistent with \"intra-specialty spillover\" was observed, wherein procedures approved in FY2020 achieved higher initial adoption than those in FY2018; although inseparable from the overall expansion of RAS since 2018, this suggests that accumulated infrastructure and expertise may facilitate the uptake of subsequent techniques. These findings suggest that RAS diffusion is associated with annual procedure volume, organizational readiness, and specialty‑specific infrastructure alongside technical factors. Future implementation strategies may benefit from infrastructure sharing within and across specialties and resource optimization to bridge the observed diffusion chasm.</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/PMC13654899/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"149168616","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":"Comparative perioperative outcomes of Hugo™ RAS versus laparoscopic and Da Vinci platforms for partial nephrectomy: a systematic review and meta-analysis.","authors":"ZongYing Lv, Ren Zhang, Wei Wei, QinFeng Cai, Man Liu, JiaLi Wu, Qi Liu, ChaoMin Li, JianGuo Xiong","doi":"10.1007/s11701-026-04062-5","DOIUrl":"10.1007/s11701-026-04062-5","url":null,"abstract":"<p><p>Renal cell carcinoma (RCC) is a common urologic malignancy, and for localized T1 tumors, nephron-sparing surgery is now the standard of care. Laparoscopic and image-guided techniques have advanced as robotic platform procedures offer greater operator dexterity and procedural control. The da Vinci platform has dominated robot-assisted partial nephrectomy, but high costs and closed architecture limit broader use. The Hugo™ RAS system, featuring a modular design, has emerged as a promising alternative, with early studies showing feasibility and safety. However, current evidence remains preliminary, mostly single-center and small-sample. This meta-analysis aggregates data and conducts subgroup analyses to compare Hugo™ RAS with other techniques, aiming to provide more precise effect estimates and guide surgical platform selection. The four main databases (PubMed, EMBASE, Web of Science, and Cochrane Library) were thoroughly searched to identify eligible clinical studies. The selected research involved comparative evaluations of surgical metrics of partial nephrectomy performed with Hugo™ RAS vs. the da Vinci system and traditional laparoscopy. This systematic synthesis included four observational cohort studies with a total of 383 subjects. Combined metric evaluations indicated that Hugo™ RAS demonstrated no statistically significant variation relative to alternative minimally invasive approaches regarding surgery duration (MD = 2.81 min, 95% CI [- 37.42, 43.03], p = 0.89), duration of hospitalization (MD = - 0.23 days, 95% CI [- 1.59, 1.13], p = 0.74), intraoperative blood loss (MD = 18.5 ml, 95% CI [- 53.61, 90.6], p = 0.62), serum creatinine following surgery (MD = - 0.05 mg/dl, 95% CI [- 0.18, 0.08], p = 0.44), positive surgical margin incidence (OR = 0.59, 95% CI [0.19, 1.80], p = 0.35), minor-to-moderate postoperative adverse event frequency (OR = 0.98, 95% CI [0.45, 2.17], p = 0.97), major postoperative adverse event frequency (OR = 0.74, 95% CI [0.09, 6.17], p = 0.78), overall postoperative adverse event rate (OR = 1.05, 95% CI [0.39, 2.87], p = 0.92), or successful trifecta attainment (OR = 1.11, 95% CI [0.60, 2.07], p = 0.74). This meta-analysis provided some preliminary evidence: Hugo™ RAS did not demonstrate significant differences compared to other minimally invasive surgical procedures in terms of procedure time, hospital stay, intraoperative blood loss, postoperative renal function, rate of positive margins, postoperative morbidity, and composite success results. Overall, Hugo™ RAS seems to be a reasonable surgical alternative. However, large multi-site randomized clinical trials are still needed to substantiate this finding.</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":"149167860","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 individual complications: textbook outcome in elective minimally invasive cholecystectomy and the role of robotic approach.","authors":"Yau-Ren Chang, Chih-Ho Hsu, Keng-Li Lin, Tiing Foong Siow, Chia-Ling Kuo, Heng-Fu Lin","doi":"10.1007/s11701-026-04066-1","DOIUrl":"https://doi.org/10.1007/s11701-026-04066-1","url":null,"abstract":"<p><p>Textbook outcome (TO) summarizes several desirable perioperative results within a single endpoint, but its use in cholecystectomy remains uncommon. Comparisons between robotic cholecystectomy (RC) and laparoscopic cholecystectomy (LC) have generally relied on individual outcomes. We therefore examined TO after elective minimally invasive cholecystectomy and assessed whether surgical approach was associated with overall perioperative performance and postoperative recovery. We retrospectively reviewed consecutive patients who underwent elective minimally invasive cholecystectomy from January 2024 through December 2025 at a single institution. TO required no conversion to open surgery, an uncomplicated intraoperative and postoperative course, no subtotal cholecystectomy, no unplanned postoperative imaging or reintervention, no ICU admission or readmission, no mortality, and discharge before postoperative day 2. Multivariable logistic regression was used to evaluate factors associated with TO and timely postoperative recovery, supplemented by inverse probability of treatment weighting (IPTW) to account for baseline differences between the RC and LC groups. The elective cohort comprised 257 patients, including 119 RC and 138 LC procedures. TO was achieved more frequently after RC than LC (91.6% vs. 73.9%, p < 0.001), and RC remained associated with TO achievement after multivariable adjustment and IPTW. Although delayed postoperative recovery was the most common reason for TO failure, RC was not independently associated with timely recovery after adjustment. In the acute cholecystitis subgroup, perioperative outcomes did not differ significantly between approaches. TO provides an integrated measure of perioperative outcomes after elective minimally invasive cholecystectomy. RC was associated with a higher likelihood of achieving TO after multivariable adjustment and IPTW, although further multicenter studies are needed to validate these findings.</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":"149170005","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":"Global research landscape and hot‑spot evolution of telesurgery in urology: A bibliometric analysis based on Web of Science Core Collection.","authors":"Jiangwei Man, Lanchun Shao, Rui Yan, Hao Wang, Yalong Zhang, Changhong Xu, Kangyu Wang, Li Yang","doi":"10.1007/s11701-026-03976-4","DOIUrl":"10.1007/s11701-026-03976-4","url":null,"abstract":"&lt;p&gt;&lt;p&gt;To systematically delineate the research landscape and evolutionary trajectory of telesurgery in urology, analyze the global research architecture, core research forces, and frontier hotspot evolution patterns, and provide a bibliometric basis for clinical translation and future research in this field. The Web of Science Core Collection was searched for literature on urological telesurgery from database inception to May 3, 2026. The language was restricted to English, and document types were limited to \"Article\" or \"Review.\" A total of 181 publications were finally included after screening. Multiple bibliometric tools were employed for multi-dimensional analysis: Microsoft Excel 2024 was used to analyze temporal trends in annual publication output and total citation counts; VOSviewer 1.6.20 was used to construct co-occurrence networks of countries/regions, institutions, authors, and journals; CiteSpace 6.4.R1 was used for keyword co-occurrence, clustering analysis, timeline mapping, and burst detection to parse the knowledge structure and hotspot evolution pathways; and the Bibliometrix 4.1.1 package was supplemented to visualize national collaboration patterns and core terminologies. Since 1996, the overall publication output in urological telesurgery has shown a fluctuating upward trend, with a rapid burst phase during 2024-2025. In 2025, 35 articles were published with 898 total citations, indicating that academic impact grew significantly faster than publication volume. In the global research landscape, the United States has long held a dominant position, with absolute advantages in publication scale, core institutions, and international collaboration networks. China started later but has shown the fastest output growth in recent years, though its depth of international collaboration and academic influence still have considerable room for improvement. High-productivity and highly cited authors are predominantly European and American scholars, forming two distinct contribution models: sustained clinical cohort research and foundational theoretical studies. Research outputs are mainly published in authoritative specialty journals of robotic surgery and urology. Keyword analysis reveals that robotic surgery is the core theme, with renal and prostate procedures being the main clinical application scenarios. The field has undergone three developmental stages: laparoscopic technique exploration, clinical feasibility validation, and long-term clinical outcome evaluation. Current frontiers include 5G networks, telepresence surgery, and long-term follow-up outcomes. Urological telesurgery has progressed beyond the nascent stage of technological exploration and entered a phase of rapid development characterized by clinical validation and scaled application. Future efforts should focus on multi-center, prospective clinical studies, refinement of technical standards and safety evaluation systems, and deep integration of robotic technology, communic","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":"149166749","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":"Femoral rotation and medial flexion gap tightness in functional alignment robotic total knee arthroplasty for varus knees.","authors":"Eduardo Frois Temponi, Pedro Henrique Oliveira Gomes, Alexandre Leite de Andrade, Miguel Jourdain Alípio do Vale, Matheus Braga Jacques Soares, Luiz Fernando Machado Soares, Lúcio Honório de Carvalho Júnior","doi":"10.1007/s11701-026-04037-6","DOIUrl":"10.1007/s11701-026-04037-6","url":null,"abstract":"<p><p>Functional-alignment (FA) robotic total knee arthroplasty (TKA) combines component positioning and soft-tissue management. This study described the association between medial flexion-gap tightness and surgeon-selected femoral rotation, together with release grades and intraoperative gap asymmetry in varus knees. This observational single-surgeon study included the 65 varus knees in an 89-knee database. Medial tightness was defined as lateral minus medial preoperative flexion gap. Correlation and ordinary least-squares regression used 63 complete observations. Recorded preoperative, planned and final trial gaps were analysed with endpoint-specific denominators. An exploratory model considered tibial coronal positioning and posterior slope. Selected rotation was associated with medial tightness (Spearman ρ = 0.571; p < 0.001). The univariable fit was rotation = 1.93° + 0.343°/mm × tightness (R² = 0.257; slope 95% CI, 0.194-0.492). The adjusted slope was 0.296°/mm (95% CI, 0.131-0.460; n = 60). Release was mild in 64/65 and moderate in 1/65 knees. Mean absolute final asymmetry was 0.38 mm in extension and 0.29 mm in flexion. Asymmetry <1 mm occurred in 50/60 (83.3%) and 55/59 (93.2%), respectively; 53/58 (91.4%) met ≤1 mm in both positions. Greater medial flexion tightness was associated with greater selected femoral rotation. Predominantly mild release and small final mean asymmetry accompanied the combined workflow. The equation describes one surgeon's decisions and is not a validated surgical rule. These observations do not establish an independent release-sparing effect, clinical superiority of submillimetre symmetry, patellofemoral safety or long-term benefit.</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/PMC13654885/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"149171663","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":"Body mass index and robotic-assisted total hip arthroplasty: current evidence, technical challenges, and clinical implications-a critical review.","authors":"Ekrem Özdemir, Esra Demirel","doi":"10.1007/s11701-026-04044-7","DOIUrl":"https://doi.org/10.1007/s11701-026-04044-7","url":null,"abstract":"<p><p>Higher body mass index (BMI) can increase the technical difficulty of total hip arthroplasty (THA), but whether robotic assistance preserves surgical accuracy in patients who are overweight or obese remains uncertain. This critical review evaluated current evidence regarding BMI-related radiographic, clinical, perioperative, and safety outcomes following robotic-assisted THA. A structured search of MEDLINE/PubMed and ClinicalTrials.gov was conducted through 8 September 2026 and supplemented by targeted citation checking. Owing to substantial clinical and methodological heterogeneity, findings were synthesised narratively without meta-analysis. Eight directly relevant studies, comprising one randomised trial and seven non-randomised studies, were included. Evidence from robotic-assisted THA cohorts did not demonstrate a clear deterioration in acetabular component-positioning accuracy with increasing BMI. Comparisons involving patients who are overweight or obese generally favoured robotic assistance over manual THA for target-zone achievement and restoration of leg length or centre of rotation, whereas patient-reported outcomes (PROMs) and complication rates showed no consistent statistically significant differences; however, the available studies were insufficiently powered to detect differences in uncommon complications, and the absence of significant differences should not be interpreted as evidence of equivalence. Robotic-assisted procedures were generally associated with longer operative times. Interpretation was limited by heterogeneous BMI thresholds, robotic platforms, surgical approaches, radiographic targets, and follow-up durations, together with sparse reporting of BMI-by-treatment interaction analyses. Robotic assistance may therefore help maintain radiographic execution in technically demanding patients with higher BMI; however, the available evidence does not establish that BMI modifies its comparative effectiveness over manual THA. Improvements in PROMs and cost-effectiveness, as well as reductions in complication and revision rates, remain unproven. Prospective studies using harmonised radiographic endpoints and prespecified BMI-by-treatment interaction analyses are required.</p>","PeriodicalId":47616,"journal":{"name":"Journal of Robotic Surgery","volume":"20 1","pages":""},"PeriodicalIF":4.2,"publicationDate":"2026-10-10","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"149168447","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":"Feasibility and perioperative outcomes of Senhance-assisted robotic cholecystectomy: a single-arm meta-analysis.","authors":"Ye Tao, Wen-Tao Lei, Xin-Min Niu, Zheng-Wei Leng, Wei Li","doi":"10.1007/s11701-026-03991-5","DOIUrl":"10.1007/s11701-026-03991-5","url":null,"abstract":"&lt;p&gt;&lt;strong&gt;Background: &lt;/strong&gt;The Senhance Digital Laparoscopy System (SDLS) is an emerging robotic platform with distinctive features, including haptic feedback, eye-tracking camera control, and reusable instruments compatible with standard laparoscopic trocars. However, comprehensive evidence regarding its application in cholecystectomy remains limited. This single-arm meta-analysis was designed to consolidate the current evidence by quantitatively synthesizing key perioperative outcomes-including operative time, console time, docking time, surgical success rate, and postoperative length of hospital stay-to provide a comprehensive, evidence-based assessment of the feasibility and perioperative outcomes of Senhance-assisted robotic cholecystectomy.&lt;/p&gt;&lt;p&gt;&lt;strong&gt;Methods: &lt;/strong&gt;To identify potentially relevant publications, the following electronic databases were systematically queried from their respective inception dates through August 1, 2026: Web of Science, Embase, PubMed, and Cochrane Library. Eligible studies were those reporting perioperative outcomes of Senhance-assisted cholecystectomy. The analysis focused on operative time and console time as primary measures, with docking time, hospital stay, and surgical success rate as secondary measures. all meta-analyses were performed using random-effects models. Subgroup analyses were performed based on economic level, study design, and sample size. Assessment of study quality was conducted using the Joanna Briggs Institute (JBI) case series Critical Appraisal Checklist.&lt;/p&gt;&lt;p&gt;&lt;strong&gt;Results: &lt;/strong&gt;Eight studies comprising 198 patients were included. The pooled operative time was 81.48 min (95% CI: 78.52 to 84.44; I² = 0.0%), console time was 39.35 min (95% CI: 33.29 to 45.41; I² = 90.0%), docking time was 11.54 min (95% CI: 8.37 to 14.70; I² = 96.2%), and length of hospital stay was 1.89 days (95% CI: 0.81 to 2.97; I² = 97.9%). The pooled surgical success rate was 96% (95% CI: 90% to 99%; I² = 50.7%). Subgroup analysis for docking time revealed a significant difference by sample size (p = 0.038), while console time showed no significant differences across subgroups. Sensitivity analysis demonstrated the robustness of the findings for operative time, console time, docking time, and surgical success rate, whereas the length of hospital stay was significantly influenced by a single study (Sasaki, 2023). All included studies were rated as high quality with low risk of bias.&lt;/p&gt;&lt;p&gt;&lt;strong&gt;Conclusions: &lt;/strong&gt;The findings of this single-arm meta-analysis indicate that Senhance-assisted robotic cholecystectomy is both safe and feasible, demonstrating a high surgical success rate, acceptable operative times, and a short postoperative hospital stay. The console time is comparable to that of conventional laparoscopic cholecystectomy, while docking time remains a modifiable factor that can be optimized through experience and team training. However, the heterogeneity in length of hospital stay ","PeriodicalId":47616,"journal":{"name":"Journal of Robotic Surgery","volume":"20 1","pages":""},"PeriodicalIF":4.2,"publicationDate":"2026-10-09","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"149149298","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":"Global consensus framework for the safe and equitable implementation of telesurgery and remote surgical education: a society of robotic surgery supported accelerated Delphi study.","authors":"Vipul Patel, Marcio Covas Moschovas, Bhaskar Somani, Mischa Dohler, Mohamad Omar Al-Kalaa, Alexandre Mottrie, Louis Kavoussi, Saad Al-Dousari, Younes Ahallal, Ajit Sachdeva, Eduardo Parra-Davila, Martin Roche, Kenneth Palmer, Martin Martino, Sharona Ross, Yu Ozawa, Rohan Sharma, Saleh Bubishate, Marco Montesi, Travis Rogers, David Albala, Raymond Leveillee, Carla Pugh, Jay Redan, Xu Zhang, Jacques Marescaux, Adnan Siddiqui, Kenichi Hakamada, Girma Tefera, Louise Agersnap, Prokar Dasgupta, Justin Collins, Shady Saikali","doi":"10.1007/s11701-026-04050-9","DOIUrl":"10.1007/s11701-026-04050-9","url":null,"abstract":"&lt;p&gt;&lt;p&gt;An estimated 160 million additional surgical procedures are required annually to address unmet surgical need globally, with the greatest deficits occurring in low- and middle-income countries. While telesurgery has re-emerged as a feasible model for delivering remote operative expertise, its broader implementation remains constrained by unresolved technical, ethical, regulatory, educational, and governance challenges. We aimed to develop an international multidisciplinary consensus framework to guide the safe, equitable, and scalable implementation of telesurgery and remote surgical education. A Society of Robotic Surgery (SRS)-supported accelerated Delphi consensus process was conducted between February and March 2026. Candidate statements were generated through a comprehensive literature review and refined by a multidisciplinary working group of clinicians, engineers, industry representatives, regulators, and healthcare leaders who convened at a telesurgery conference in Orlando, in February 2026. A three-round electronic Delphi survey was performed using a 7-point Likert scale across nine predefined domains: (1) Global Need, Ethics & Humanitarian Rationale; (2) Technical Infrastructure, Connectivity & Network Performance; (3) Cybersecurity & Data Protection; (4) Surgeon Credentialing, Training & Skill Maintenance; (5) Safety Protocols, Human Factors & Team Dynamics; (6) Clinical Indications, Case Selection & Procedural Scope; (7) Regulatory, Legal, Licensure & Liability; (8) Economics, Administration & Reimbursement; and (9) Industry Responsibilities, Research & Global Roadmap. Consensus was predefined as ≥ 80% agreement (Likert scores 5-7). A total of 153 international experts participated in Round 1, including surgeons, engineers, industry representatives, hospital administrators, and regulatory stakeholders. Participant retention was 79.1% from Round 1 to Round 2 and 90.1% from Round 2 to Round 3. Of 86 core recommendation statements, 83 (96.6%) achieved consensus after three rounds. Consensus was strongest in cybersecurity, safety protocols, clinical indications, regulatory governance, economics, and industry responsibilities, where all statements reached agreement. Three statements failed to achieve consensus, relating to procedure-specific latency thresholds, dual-site credentialing requirements, and telesurgery as a preferred intervention when alternative treatments are available. Four additional terminology statements defining telesurgery, tele-mentoring, tele-proctoring, and tele-preceptoring achieved consensus after a single Delphi round, providing provisional standardized definitions for the field. To our knowledge, this is among the first multidisciplinary consensus frameworks to integrate clinical implementation, remote surgical education, cybersecurity, regulation, economics, and governance within a single Delphi exercise. The findings position telesurgery not only as a model for remote operative care but also as a platform","PeriodicalId":47616,"journal":{"name":"Journal of Robotic Surgery","volume":"20 1","pages":""},"PeriodicalIF":4.2,"publicationDate":"2026-10-08","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"149138831","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":"Navigating decision-making for high-cost robotic surgery in the emergency department: an acute care surgery experience.","authors":"Chih-Yuan Fu, Pei-Hua Li, Sheng-Yu Chan, Feng-Ren Hsieh, Yu-Hao Wang, Ting-An Hsu, Chien-Hung Liao","doi":"10.1007/s11701-026-04038-5","DOIUrl":"10.1007/s11701-026-04038-5","url":null,"abstract":"<p><p>Although robotic surgery is increasingly applied in acute care surgery (ACS), the preoperative decision-making process in the emergency department (ED) remains poorly understood. This study evaluated the feasibility and factors associated with choosing high-cost robotic surgery in an acute setting. This single-center retrospective study included ED patients undergoing urgent cholecystectomy between December 2025 and July 2026. Decision-making metrics and sociodemographic factors were compared between robotic (RC) and laparoscopic cholecystectomy (LC). Multivariable logistic regression identified factors independently associated with choosing RC, and a subgroup analysis evaluated whether the decision was finalized during the ED stay among RC patients. Among 107 patients, 46 (43.0%) underwent RC and 61 (57.0%) underwent LC. RC patients required a longer time from consultation to consent (19.1 vs. 11.4 h, p < 0.001) and more counseling sessions (2.4 vs. 1.1, p < 0.001). Nevertheless, 54.3% of RC patients finalized their decision during their ED stay. Younger age (OR = 0.891, 95% CI 0.813-0.976, p = 0.013), family presence in the ED (OR = 5.001, 95% CI 4.213-5.936, p < 0.001), a greater number of counseling sessions (OR = 1.276, 95% CI 1.064-1.530, p = 0.009), and commercial insurance coverage (OR = 2.235, 95% CI 1.899-2.630, p < 0.001) were independently associated with choosing RC. Among RC patients, younger age and greater family involvement were associated with finalizing the decision during the ED stay (both p < 0.001). High-cost robotic surgery can be integrated into the ACS setting despite a more complex decision-making process. Patient, family, financial, and counseling-related factors were associated with the choice of robotic surgery.</p>","PeriodicalId":47616,"journal":{"name":"Journal of Robotic Surgery","volume":"20 1","pages":""},"PeriodicalIF":4.2,"publicationDate":"2026-10-08","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"149138894","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}