Journal of Robotic Surgery最新文献

{"title":"Critical commentary: a meta-analysis assessing the efficacy of concurrent robotic inguinal hernia repair (RIHR) during robotic-assisted radical prostatectomy (RARP).","authors":"Digvijay Singh Rajawat, Rachana Mehta, Ranjana Sah","doi":"10.1007/s11701-025-02531-x","DOIUrl":"https://doi.org/10.1007/s11701-025-02531-x","url":null,"abstract":"","PeriodicalId":47616,"journal":{"name":"Journal of Robotic Surgery","volume":"19 1","pages":"365"},"PeriodicalIF":2.2,"publicationDate":"2025-07-08","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144592666","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 radical trachelectomy in early stage cervical cancer.","authors":"Marta Heras, Myriam Gracia, Pluvio Coronado","doi":"10.1007/s11701-025-02540-w","DOIUrl":"https://doi.org/10.1007/s11701-025-02540-w","url":null,"abstract":"<p><p>Radical trachelectomy represents an alternative for early stage cervical cancer in patients who want to preserve fertility. This procedure can be performed by vaginal, open or minimal invasive approach. The robotic approach may offer some advantages, especially for the surgeon´s ergonomics. Since the evidence is still scarce, larger studies are needed. Our objective is to present a retrospective review of our experience with robotic radical trachelectomy. Descriptive study carried out in Clinico San Carlos University Hospital, Madrid, Spain. We included all our patients with early stage cervical cancer that wished to preserve fertility, from 2023 to 2022. The surgery included bilateral pelvic lymphadenectomy followed by radical trachelectomy and cervical cerclage after confirmation of absence of nodal metastasis. Demographic data of the study population, perioperative and oncological outcomes were analyzed. Seven patients who underwent radical robotic trachelectomy were studied. Median patient age was 30 (range 23-35) years. Median body mass index was 24 (range 19-28). Tumor histology was squamous cell carcinoma in 57% (4) and adenocarcinoma in 43% (3) of the patients. Median surgical time was 285 (range 247-315) min. The median of pelvic nodes obtained was 15 (range 12-40). Two postoperative complications were observed. One patient tried to conceived and had preterm labor. One patient died of the disease. In selected cases, robotic radical trachelectomy is a safe option for patients that wish to preserve their fertility with similar rates of oncological safety and complications than open procedures and a shorter recovery time.</p>","PeriodicalId":47616,"journal":{"name":"Journal of Robotic Surgery","volume":"19 1","pages":"361"},"PeriodicalIF":2.2,"publicationDate":"2025-07-07","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144585279","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":"Comment on \"Postoperative functional complications and quality of life following robot-assisted prostatectomy and radiotherapy in localized prostate cancer: evidence from a systematic review and meta-analysis\".","authors":"Raparthi Aishwarya, Bavurothu Sharanya Kumar","doi":"10.1007/s11701-025-02533-9","DOIUrl":"10.1007/s11701-025-02533-9","url":null,"abstract":"<p><p>The recent meta-analysis by Liu et al. comparing postoperative functional complications and quality of life (QoL) between robot-assisted radical prostatectomy (RARP) and radiotherapy (RT) in localized prostate cancer raises important clinical questions but is constrained by methodological and interpretative limitations. Our commentary identifies four key issues: (1) inadequate adjustment for baseline confounding factors such as age, comorbidities, and androgen deprivation therapy exposure; (2) unstandardized aggregation of patient-reported outcome measures (PROMs), impairing statistical comparability; (3) absence of modality-specific stratification within the RT group, which combines external beam and brachytherapy despite differing toxicity profiles; and (4) overinterpretation of functional outcome trends without accounting for follow-up duration and evolving surgical techniques. These issues undermine the validity of the authors' conclusions regarding RT's superiority in functional recovery. We argue that future comparative effectiveness research should employ harmonized PROM frameworks, robust causal inference methodologies, and biologically stratified cohort analyses. Our critique underscores the need for precise, individualized assessment in treatment decision-making for localized prostate cancer and supports the broader scientific imperative for methodologically sound patient-centered outcomes research in robotic and radiotherapeutic oncology.</p>","PeriodicalId":47616,"journal":{"name":"Journal of Robotic Surgery","volume":"19 1","pages":"357"},"PeriodicalIF":2.2,"publicationDate":"2025-07-07","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144576683","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":"Evidence-based practice and future development of enhanced recovery after surgery (ERAS) in urology: a multidimensional assessment based on the GRADE system.","authors":"Xuezhi Long, Xiaoqin Du, Yubo Wang, Qiuxia Qiu, Jianhao Wu, Yueting Huang, Zhipeng Wen, Binghao Zeng, Jianfeng Liang, Yanchun Pan, Yan Zhao, Guohua Zeng, Di Gu","doi":"10.1007/s11701-025-02506-y","DOIUrl":"10.1007/s11701-025-02506-y","url":null,"abstract":"<p><p>Enhanced recovery after surgery (ERAS) pathways in urology harness multidisciplinary, evidence-based interventions to attenuate surgical stress, expedite recovery, and reduce complications. In this PRISMA-guided review of 80 core publications (23 RCTs, 6 meta-analyses, 9 systematic reviews, 15 guidelines/consensus statements, 18 observational studies, 10 narrative reviews) from 1997 to 2025, we applied ROB 2.0 and GRADE methodology to classify 20 perioperative elements. Sixteen elements-such as preoperative education, carbohydrate loading, goal-directed fluid therapy, multimodal analgesia, early mobilisation, and early oral feeding-achieved high-quality evidence with strong recommendations (A1); three elements (preoperative medical optimisation, fasting regimen, sedative use) received moderate-quality, weak recommendations (B2); and one element (audit) was supported by low-quality, weak recommendation (C2). Implementation of A1 elements in radical prostatectomy, cystectomy, and nephrectomy shortened hospital stay by 1-3 days, cut complication rates by up to 30%, and reduced opioid consumption by approximately 30%. Key challenges include standardising fluid management for minimally invasive and outpatient procedures, improving protocol adherence, and integrating patient-reported outcomes. Future work should prioritise multicenter RCTs for moderate-evidence elements, cost-effectiveness analyses, and development of urology-specific ERAS guidelines incorporating digital monitoring and personalised risk stratification.</p>","PeriodicalId":47616,"journal":{"name":"Journal of Robotic Surgery","volume":"19 1","pages":"358"},"PeriodicalIF":2.2,"publicationDate":"2025-07-07","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC12234605/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144576684","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":"Bowel function and quality of life after robotic and laparoscopic IPAA: a patient-reported outcomes study.","authors":"Tommaso Violante, Davide Ferrari, Nicholas P McKenna, William R G Perry, Eric J Dozois, Kevin T Behm, Kellie L Mathis, David W Larson","doi":"10.1007/s11701-025-02488-x","DOIUrl":"https://doi.org/10.1007/s11701-025-02488-x","url":null,"abstract":"<p><strong>Background: </strong>Minimally invasive ileal pouch-anal anastomosis (IPAA) has become the standard of care for patients with ulcerative colitis or familial adenomatous polyposis, offering numerous benefits over open surgery. However, the impact of robotic surgery on long-term quality of life (QoL) remains poorly defined.</p><p><strong>Objective: </strong>To analyze QoL after robotic and laparoscopic IPAA using a validated patient-reported outcome instrument.</p><p><strong>Design: </strong>This retrospective, STROBE-compliant study analyzed 158 patients who underwent laparoscopic (n = 112) or robotic (n = 46) IPAA at a single, tertiary-care institution.</p><p><strong>Settings: </strong>Data were collected at a single, tertiary-care institution.</p><p><strong>Patients: </strong>The study included 158 patients who underwent laparoscopic (n = 112) or robotic (n = 46) IPAA. All patients had a J-pouch procedure and had at least 12 months of restored intestinal continuity.</p><p><strong>Interventions: </strong>Laparoscopic or robotic IPAA.</p><p><strong>Main outcome measures: </strong>QoL was assessed using a modified, validated Ileoanal Pouch Syndrome Severity Score (IPSS) survey at least 12 months after ileostomy closure.</p><p><strong>Results: </strong>Both groups experienced similar overall QoL, with a high prevalence of severe or extremely severe pouch-related symptoms (55.1%). Robotic IPAA was associated with longer operative times but less blood loss. Worse IPSS scores correlated with hand-sewn IPAA with mucosectomy and postoperative septic complications. Despite these challenges, 92% of patients preferred IPAA over ileostomy.</p><p><strong>Limitations: </strong>Retrospective design and potential for non-response bias. The modified IPSS survey may not fully capture all aspects of QoL.</p><p><strong>Conclusions: </strong>In this cohort, robotic and laparoscopic IPAA resulted in comparable QoL as measured by a validated patient-reported outcome instrument. Significant pouch dysfunction remains prevalent regardless of surgical approach. Modifiable factors, such as hand-sewn anastomosis and septic complications, negatively impact patient-reported outcomes.</p>","PeriodicalId":47616,"journal":{"name":"Journal of Robotic Surgery","volume":"19 1","pages":"360"},"PeriodicalIF":2.2,"publicationDate":"2025-07-07","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144585207","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":"Comment on \"Outcomes of robotic-assisted surgery for pediatric renal tumors: a systematic review\".","authors":"Sharanya Kumar Bavurothu, Aishwarya Raparthi","doi":"10.1007/s11701-025-02530-y","DOIUrl":"https://doi.org/10.1007/s11701-025-02530-y","url":null,"abstract":"","PeriodicalId":47616,"journal":{"name":"Journal of Robotic Surgery","volume":"19 1","pages":"359"},"PeriodicalIF":2.2,"publicationDate":"2025-07-07","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144576682","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":"Automated facial nerve identification in microsurgery with an improved unet.","authors":"Xin Ding, Yu Huang, Yang Zhao, Xu Tian, Qing Zhang, Zhiqiang Gao, Guodong Feng","doi":"10.1007/s11701-025-02501-3","DOIUrl":"https://doi.org/10.1007/s11701-025-02501-3","url":null,"abstract":"<p><p>To develop a deep-learning model that improves the segmentation and detection of Facial Nerve in microsurgery, thereby increasing surgical precision and safety. We collected videos from 25 patients undergoing facial nerve decompression microsurgery. From these videos, we extracted and annotated 2724 images from 14 patients for training and validation (training set: validation set = 2452: 272). Data augmentation techniques were applied to the training set with a five-fold increase (12,260 images). To evaluate the accuracy of our model, we carefully selected and annotated 1674 images from 11 patients who had not been previously trained. We then introduced an Improved Unet model that integrates various attention mechanisms, a feature-rich skip connection mechanism, and a multi-dimensional convolutional block to overcome the challenges faced by traditional Unet models when dealing with blurred or small target images. Compared with the state-of-the-art method, our proposed model achieved the best performance. The FullGrad-generated heatmap certified that the model has learned the Facial Nerve features. The Improved Unet obtained an mIOU of 0.9165 with the validation set and an mIOU of 0.6543 with the test set. In various complex microsurgical environments including blood, occlusion, and blurriness, our model can detect and segment Facial Nerve precisely. The results demonstrate the proposed method is highly promising in providing real-time intraoperative guidance of the critical anatomical structures in microsurgery.</p>","PeriodicalId":47616,"journal":{"name":"Journal of Robotic Surgery","volume":"19 1","pages":"354"},"PeriodicalIF":2.2,"publicationDate":"2025-07-06","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144567995","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":"Comparison of the treatment effect of laparoscopic and robot-assisted single-port laparoscopic pyeloplasty on ureteropelvic junction obstruction in infants.","authors":"Ziqin He, Juntao Li, Yifei Zhang, Chutian Xiao, Wenwen Zhong, Jianguang Qiu, Dejuan Wang","doi":"10.1007/s11701-025-02528-6","DOIUrl":"https://doi.org/10.1007/s11701-025-02528-6","url":null,"abstract":"<p><p>To compare the therapeutic efficacy of conventional laparoscopic pyeloplasty (LP) and robot-assisted single-port laparoscopic pyeloplasty (RSLP) for ureteropelvic junction obstruction (UPJO) in infants and to summarize the preliminary experience and advantage of RSLP. The clinical data of UPJO infants (≤ 12 months) who received LP and RSLP in our center from October 2018 to October 2024 were analyzed retrospectively. A total of 51 patients with UPJO were included, with 11 cases receiving RSLP (8 with left UPJO; 3 with right UPJO) and 40 receiving LP (29 with left UPJO; 11 with right UPJO). In the RSLP group, the median age was 3 months (range: 1-9 months). In the LP group, the median age was 2.5 months (range: 1-11 months). The mean operative time was 217.45 ± 20.77 min for the RSLP group and 258.57 ± 52.56 min for the LP group. The mean time of ureteropelvic anastomosis in the RSLP group was shorter than that in the LP group (79.36 ± 17.74 vs. 99.35 ± 21.03). The mean hospital stay was 6.27 ± 2.53 days for the RSLP group and 6.32 ± 2.71 days for the LP group. The mean postoperative hospital stay was 1.9 ± 0.94 days for the RSLP group and 2.67 ± 2.37 days for the LP group. The mean hospital costs were 57,950.63 ± 1,165.68 yuan for the RSLP group and 30,396.30 ± 5214.06 yuan for the LP group. Significant improvements in the hydronephrosis grading, anterior-posterior renal pelvic diameters, and renal parenchymal thickness were observed in both groups after surgery. RSLP is a safe and effective method for the treatment of UPJO in infants. Compared with LP, RSLP has the advantages of precise suturing, short anastomosis time, and short operation duration, making it an attractive and safe option. However, it faces the disadvantages of higher cost of hospitalization.</p>","PeriodicalId":47616,"journal":{"name":"Journal of Robotic Surgery","volume":"19 1","pages":"353"},"PeriodicalIF":2.2,"publicationDate":"2025-07-06","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144567996","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":"Impact of RoSCo-based preoperative risk stratification on early mobilization and short-term outcomes following robot-assisted laparoscopic partial nephrectomy for renal cell carcinoma: a single-center prospective study.","authors":"Bing-Xin Lin, Xiao-Ya Wang, Ya-Zhen Li, Li-Xia Yao, Shao-Ying Yang, Huai-Ying Zheng, Chun-Sen Xu","doi":"10.1007/s11701-025-02504-0","DOIUrl":"https://doi.org/10.1007/s11701-025-02504-0","url":null,"abstract":"<p><p>This study aimed to evaluate the effectiveness of the RoSCo preoperative risk scoring system, which incorporates the RENAL Nephrometry Score, the Charlson's Comorbidity Index, and body mass index to quantify surgical risk, in guiding individualized early mobilization protocols and to assess associated early postoperative recovery outcomes in patients undergoing robot-assisted partial nephrectomy (RAPN) for renal cell carcinoma (RCC). A prospective, randomized controlled study was conducted involving 82 patients diagnosed with RCC who underwent RAPN between October 2023 and October 2024 at the Department of Urology. Participants were randomized into an experimental group (n = 41) and a control group (n = 41). The experimental group received a RoSCo-guided personalized early mobility protocol, while the control group received conventional enhanced recovery after surgery care. Key postoperative recovery indicators, including time to first ambulation, time to first flatus and defecation, duration of hospital stay, and complication rates, were compared between the two groups. Participants in the experimental group demonstrated a significantly shorter time to first ambulation (18.94 ± 14.31 h) compared to the control group (36.56 ± 12.91 h, p < 0.001). The experimental group also exhibited significantly shorter postoperative hospital stays (5.34 ± 1.56 days vs 7.34 ± 2.98 days, p < 0.001), reduced duration of urinary catheterization (4.68 ± 1.94 days vs 6.00 ± 2.43 days, p = 0.008), earlier time to first flatus (19.99 ± 13.10 h vs 29.66 ± 23.82 h, p = 0.025), and earlier time to first defecation (65.12 ± 19.29 h vs 92.62 ± 39.98 h, p < 0.001). Additionally, the incidence of postoperative abdominal distension was significantly lower in the experimental group (2.44% vs 19.51%, p = 0.029). No statistically significant differences were observed between groups regarding the incidences of postoperative bleeding, urinary leakage, infection, lower back pain, or duration of drainage tube placement (p > 0.05). Preoperative risk stratification using the RoSCo score facilitates the development of personalized early mobilization protocols for patients undergoing RAPN for RCC. This approach is associated with improved early postoperative recovery outcomes, including earlier ambulation, faster gastrointestinal recovery, shorter hospitalization, and reduced catheterization duration, without increasing the risk of postoperative complications.</p>","PeriodicalId":47616,"journal":{"name":"Journal of Robotic Surgery","volume":"19 1","pages":"355"},"PeriodicalIF":2.2,"publicationDate":"2025-07-06","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144576685","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 ureteroenteric reimplantation for ureteroenteric stricture after radical cystectomy: a systematic review and dual meta-analysis.","authors":"Reham Ramadan, Mohamed Tharwat, Abdelwahab Hashem, Diaa-Eldin Taha","doi":"10.1007/s11701-025-02502-2","DOIUrl":"10.1007/s11701-025-02502-2","url":null,"abstract":"<p><strong>Background and objective: </strong>Benign ureteroenteric stricture (UES) is a well-documented long-term complication that can occur after radical cystectomy with urinary diversion (UD). This meta-analysis evaluates the safety and feasibility of Robotic-assisted Ureteroenteric Reimplantation (RUER), with a focus on distinguishing outcomes between Open Ureteroenteric Reimplantation (OUER) and RUER.</p><p><strong>Methods: </strong>We performed an extensive search across multiple databases, including PubMed, Scopus, and Web of Science, to identify studies that assessed outcomes for RUER alone or in comparison to OUER. Relevant data were systematically extracted and recorded in an Excel sheet. Data analysis was performed using OpenMeta [Analyst] and Review Manager Software.</p><p><strong>Results: </strong>This review included 277 UES patients (244 RUER, 33 OUER) with 289 and 35 reimplantations, respectively. RUER had 91.7% success rate and a 7.1% stricture recurrence rate. Intraoperative complications, Clavien-Dindo ≥3 complications, conversion to open approach, and hospital readmission rates were 2.3%, 9.5%, 2.5%, and 7.8%, respectively. Compared to OUER, RUER showed similar success (RR =1.01, p=0.83) and stricture recurrence rates (RR = 0.89, p=0.72) but significantly lower intraoperative (RR =0.13, p=0.01), postoperative (RR = 0.53, p = 0.004), and Clavien-Dindo ≥3 complications (RR =0.27, p =0.01). RUER significantly reduced hospital stay (MD = -3.18 days, p = 0.0002) but showed no significant reduction in operative time (MD= -24.98 min, p=0.29).</p><p><strong>Conclusions: </strong>RUER offers comparable success to OUER with significantly lower complication rates and shorter hospital stays, making it a safe and feasible minimally invasive alternative for strictures ranging from 1 to 3 cm.</p>","PeriodicalId":47616,"journal":{"name":"Journal of Robotic Surgery","volume":"19 1","pages":"356"},"PeriodicalIF":2.2,"publicationDate":"2025-07-06","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC12229966/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144576686","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}