Robotic Surgery

It has been found that rectal surgery still leads to high rates of postoperative urinary, fecal, or sexual dysfunction, which is why nerve-sparing surgery has gained increasing importance. To improve functional outcomes, techniques to preserve pelvic autonomic nerves by identifying anatomic landmarks and implementing intraoperative neuromonitoring methods have been investigated. The objective of this study was to transfer a new approach to intraoperative pelvic neuromonitoring based on bioimpedance measurement to a clinical setting. Thirty patients (16 male, 14 female) involved in a prospective clinical investigation (German Clinical Trials Register DRKS00017437, date of first registration 31/03/2020) underwent nerve-sparing rectal surgery using a new approach to intraoperative pelvic neuromonitoring based on direct nerve stimulation and impedance measurement on target organs. Clinical feasibility of the method was outlined in 93.3% of the cases. Smooth muscle contraction of the uri...

Background  Several different categories of professionals, including graduate and specialist medical personnel, nurses and medical laboratory scientists amongst others are engaged in blood transfusion establishments worldwide. Some knowledge by workers outside their own specific specialty and a high degree of integration are required for effectiveness in blood services. Objective  To survey training facilities for blood transfusion in Anglophone West Africa for appropiateness, and to identify areas of deficiency requiring rectification Methods  The contents of training curricula of various institutions were scrutinized. Serving members of blood establishments were interviewed to ascertain their background professional training and present role in their blood establishments. Results  Sufficient numbers of graduate and specialist medical personnel nurses and medical laboratory scientists are being produced in the Region, to provide workforce for blood transfusion establishments. Howev...

com Background: Here we report our experience in treating colon cancer in the 5 years from 200 to 2011. Our surgical clinic treated 49 patients with colorectal cancer, of whom 28 (57.14%) were men of mean age 62 years and 21 (42.86%) were women of mean age 66 years. Methods: In 15 cases, the cancer was related to the rectum (30.61%) and the remaining 34 cases (69.39%) were related to the colon. We found synchronous cancer in two patients. One was found in the blank and the upper right while the second was found in the transverse and sigmoid colon. Six of our patients suffered from coexisting biliary lithiasis and underwent simultaneous cholecystectomy, and simultaneous bile duct exploration for common bile duct lithiasis was performed in one of these patients. Results: Twenty-eight of the patients with colon cancer were treated surgically on an emergency basis. There were two postoperative deaths due to septic shock and multiple organ failure. In total, we noted seven complications,...

Complex upper urinary-tract disorders (CUUTD) pose challenges owing to multifactorial etiology. Evidence on hybrid endoscopic-robotic approaches (HERA) remains limited. We evaluated the efficacy, safety, and outcomes of HERA for CUUTD across adult and pediatric populations. We performed a PRISMA-compliant systematic review and single-arm meta-analysis of pooled proportions (Freeman-Tukey transformation) registered in PROSPERO (CRD420251022229). PubMed, Scopus, Web of Science databases were searched for English full-texts only (last searched: June 22, 2025). Inclusion criteria were: randomized controlled trials (RCTs) and non-randomized studies using HERA for CUUTD. Exclusion criteria were: isolated pathologies, single-modality, non-English, and insufficient data. Populations were grouped as adult, pediatric, or mixed. The independent dual review and risk of bias (RoB) assessment used Joanna Briggs Institute checklists. Heterogeneity (I 2) and publication bias (Egger's test) were evaluated. Fourteen retrospective studies (2005-2023) from international centers (n = 95: 26 adults, 44 pediatric, and 25 mixed populations; low bias) were included. In the absence of comparator arms, our findings represent descriptive pooled estimates of efficacy and safety. Pooled stone-free rate was 90.3% (95% CI 82.9-95.8%; I 2 = 75.8%%) and was higher in adults (100%) than in pediatrics (81.8%; p = 0.0082). Obstruction resolution was 100%; although no intraoperative complications were observed, postoperative complications were noted in 11.6% cases, mostly Clavien-Dindo II-IIIa. The reoperation rate was 9.6%, mean operative time was 185.2 min, and the mean hospital stay was 3.5 days. Stone recurrence and obstruction recurrence were noted in 4.2% and 0% cases, respectively. In selected patients and experienced centers, HERA may achieve high SFR and obstruction resolution with acceptable morbidity; however, the overall strength of evidence is low, heterogeneity is substantial, and publication bias was detected. Findings are preliminary and hypothesis-generating. Rigorous prospective comparative studies with standardized outcome definitions and follow-up are needed before drawing firm practice-changing conclusions.

laparoendoscopy surgery in a single site (LESS) to combine the advantages of robotic surgery with the aesthetic result of a single incision and to overcome LESS limitations in terms of loss of door triangulation, and instrumental collisions This study aims to review the existing studies on RSS hysterectomy in patients with endometrial cancer and verify its safety and feasibility Results Seven studies met the inclusion criteria, and 258 patients were included with a median age of 53 to 64 years and a BMI of 24.6 to 27 kg/m2. The median pre-surgical time ranged from 8 to 12.5 min, the median operative time ranged from 90 to 175 min, the median console time from 46 to 136 min, and the median blood loss from 50 to 145 ml. No intraoperative complications were observed; only a study reported a conversion rate of 1,25%. The median hospital stay ranged from 2 to 3 days. The postoperative complication rate was estimated at 5.42%.

This paper presents the details of a combined hardware/software system, which has been developed to provide haptic feedback for teleoperated laparoscopic surgical robots. Surgical instruments incorporating quantum tunnelling composite (QTC) force measuring sensors have been developed and mounted on a pair of Mitsubishi PA-10 industrial robots. Feedback forces are rendered on pseudo-surgical instruments based on a pair of PHANTOM Omni devices, which are also used to remotely manipulate the robotic arms. Measurements of the behaviour of the QTC sensors during a simulated teleoperated procedure are given. In addition, a method is proposed that can compensate for their non-linear characteristics in order to provide a ‘realistic feel’ to the surgeon through the haptic feedback channel. The paper concludes by explaining how the force feedback channel is combined with a visual feedback channel to enable a surgeon to perform a two-handed surgical procedure better on a remote patient by more...

Objective: Non-intubated video-assisted thoracoscopic surgery (NIVATS) has emerged as a less invasive alternative to conventional intubated VATS (IVATS) for patients undergoing lobectomy for non-small cell lung cancer (NSCLC). However, concerns regarding its safety, efficacy, and oncologic adequacy remain. This meta-analysis aimed to compare perioperative and short-term outcomes between NIVATS and IVATS. Methods: A systematic review and meta-analysis were conducted in accordance with PRISMA guidelines. PubMed, Scopus, and Cochrane CENTRAL were searched through 30 June 2025. Studies comparing NIVATS and IVATS for anatomical lung resections (lobectomy and/or segmentectomy) in NSCLC were included; wedge resections were excluded. Primary endpoints included postoperative complications, operative time, intraoperative blood loss, lymph node yield, and 30-day mortality. Secondary endpoints were chest tube duration, hospital length of stay, anesthetic time, and conversion to thoracotomy rates. Risk of bias was assessed primarily with ROBINS-I; the Newcastle-Ottawa Scale was applied for sensitivity. Results: A total of seven studies (six retrospective and one randomized controlled trial) encompassing 851 patients (374 NIVATS, 477 IVATS) were included. NIVATS was associated with a significantly lower rate of postoperative complications (OR 0.50; 95% CI: 0.30-0.86; p = 0.01; I 2 = 0%), shorter operative time (minutes) (WMD-21.85; 95% CI:-38.49,-5.21; p = 0.01), anesthetic time (minutes) (WMD-4.62; 95% CI:-6.60,-2.65; p < 0.01), and reduced intraoperative blood loss (mL) (WMD-24.36; 95% CI:-30.67,-18.05; p < 0.01). There were no significant differences in lymph node yield or conversion to thoracotomy rates. No 30-day mortality was reported in either group. The quality of included studies was moderate, and publication bias was not evident. Conclusions: NIVATS appears to be a safe and effective alternative to IVATS in selected patients undergoing lobectomy for NSCLC. It offers improved perioperative outcomes without compromising surgical or oncologic standards. Prospective trials are needed to confirm these findings and assess long-term survival.

Objective: Non-intubated video-assisted thoracoscopic surgery (NIVATS) has emerged as a less invasive alternative to conventional intubated VATS (IVATS) for patients undergoing lobectomy for non-small cell lung cancer (NSCLC). However, concerns regarding its safety, efficacy, and oncologic adequacy remain. This meta-analysis aimed to compare perioperative and short-term outcomes between NIVATS and IVATS. Methods: A systematic review and meta-analysis were conducted in accordance with PRISMA guidelines. PubMed, Scopus, and Cochrane CENTRAL were searched through 30 June 2025. Studies comparing NIVATS and IVATS for anatomical lung resections (lobectomy and/or segmentectomy) in NSCLC were included; wedge resections were excluded. Primary endpoints included postoperative complications, operative time, intraoperative blood loss, lymph node yield, and 30-day mortality. Secondary endpoints were chest tube duration, hospital length of stay, anesthetic time, and conversion to thoracotomy rates. Risk of bias was assessed primarily with ROBINS-I; the Newcastle-Ottawa Scale was applied for sensitivity. Results: A total of seven studies (six retrospective and one randomized controlled trial) encompassing 851 patients (374 NIVATS, 477 IVATS) were included. NIVATS was associated with a significantly lower rate of postoperative complications (OR 0.50; 95% CI: 0.30-0.86; p = 0.01; I 2 = 0%), shorter operative time (minutes) (WMD -21.85; 95% CI: -38.49, -5.21; p = 0.01), anesthetic time (minutes) (WMD -4.62; 95% CI: -6.60, -2.65; p < 0.01), and reduced intraoperative blood loss (mL) (WMD -24.36; 95% CI: -30.67, -18.05; p < 0.01). There were no significant differences in lymph node yield or conversion to thoracotomy rates. No 30-day mortality was reported in either group. The quality of included studies was moderate, and publication bias was not evident. Conclusions: NIVATS appears to be a safe and effective alternative to IVATS in selected patients undergoing lobectomy for NSCLC. It offers improved perioperative outcomes without compromising surgical or oncologic standards. Prospective trials are needed to confirm these findings and assess long-term survival.

IntroductionMonopolar electrocautery is the most common dissection and coagulation tool during transoral robotic surgery (TORS) but causes significant collateral tissue damage as opposed to CO2 laser. We aimed at combining both modalities in one robotic instrument arm.MethodsWe developed a steerable CO2‐laser fibre carrier serving as an add‐on to the existing Endowrist® monopolar spatula of the Da Vinci Xi. Feasibility and safety were assessed in a preclinical setting.ResultsOne radical tonsillectomy with monopolar cautery and three with the instrument prototype were performed in two cadavers by two surgeons. No serious prototype‐related intra‐operative difficulties were observed. Safe and efficient switching between energy sources proved possible in all simulated intra‐operative bleeding events. Prototype use allowed for the identification of the majority of key anatomical structures and was scored favourably on NASA‐TLX questionnaires.DiscussionThe reported prototype successfully ...

Eye surgery, specifically retinal micro-surgery involves sensory and motor skill that approaches human boundaries and physiological limits for steadiness, accuracy, and the ability to detect the small forces involved. Despite assumptions as to the benefit of robots in surgery and also despite great development effort, numerous challenges to the full development and adoption of robotic assistance in surgical ophthalmology, remain. Historically, the first in-human–robot-assisted retinal surgery occurred nearly 30 years after the first experimental papers on the subject. Similarly, artificial intelligence emerged decades ago and it is only now being more fully realized in ophthalmology. The delay between conception and application has in part been due to the necessary technological advances required to implement new processing strategies. Chief among these has been the better matched processing power of specialty graphics processing units for machine learning. Transcending the classic ...

Juvenile angiofibroma (JNA) is a relatively uncommon, highly vascular and benign tumor that presents most commonly in adolescent males. Symptoms may persist from months to years and often times, these tumors are asymptomatic until they increase and encroach on critical structures. Because of technological advances both in surgery and radiology, management of JNA patients has been refined. With the advent of more sophisticated capabilities such as CT, MRI, intensity-modulated radiation therapy (IMRT), stereotactic guidance systems as well as advanced embolization techniques, these tumors can be diagnosed and managed more effectively. Patients with juvenile angiofibroma (JNA) are typically silent for years and often present with epistaxis, nasal obstruction, facial numbness, rhinorrhea, ear popping, sinusitis, cheek swelling, visual changes and headaches. In addition to these symptoms, up to one-third of patients with this condition may present with proptosis or other orbital involvement, which are late symptoms and findings. Most physicians agree that surgery is the primary treatment modality for the early-stage disease process. However, controversy arises regarding the best treatment

The traditional open approach is still a common option for colectomy and the most common option chosen for rectal resections for cancer. Randomized trials and large database studies have reported the merits of the minimally invasive approach, while studies comparing laparoscopic and robotic options have reported inconsistent results. Methods: This study was designed to compare open, laparoscopic, and robotic colorectal surgery outcomes in protocol-driven regional and national databases. Logistic and multiple linear regression analyses were used to compare standard 30-day colorectal outcomes in the Michigan Surgical Quality Collaborative (MSQC) and American College of Surgeons National Surgical Quality Improvement Program (ACS-NSQIP) databases. The primary outcome was overall complications. Results: A total of 10,054 MSQC patients (open 37.5%, laparoscopic 48.8%, and robotic 13.6%) and 80,535 ACS-NSQIP patients (open 25.0%, laparoscopic 67.1%, and robotic 7.9%) met inclusion criteria. Overall complications and surgical site infections were significantly favorable for the laparoscopic and robotic approaches compared with the open approach. Anastomotic leaks were significantly fewer for the laparoscopic and robotic approaches compared with the open approach in ACS-NSQIP, while there was no significant difference between robotic and open approaches in MSQC. Laparoscopic complications were significantly less than robotic complications in MSQC but significantly more in ACS-NSQIP. Laparoscopic 30-day mortality was significantly less than for the robotic approach in MSQC, but there was no difference in ACS-NSQIP. Minimally invasive colorectal surgery is associated with fewer complications and has several other outcomes advantages compared with the traditional open approach. Individual complication comparisons vary between databases, and caution should be exercised when interpreting results in context.

Minimally invasive surgery (MIS) for lung cancer has been associated with decreased perioperative morbidity while maintaining similar long-term survival when compared to open thoracotomy. Robotic thoracic surgery constitutes an evolutionary step in this field, beckoning dramatic advancements both in visualization as well as surgical instrument range of motion and ergonomics. As such, robotic thoracic surgery is growing in adoption worldwide. One of its oft-cited disadvantages, however, is increased operative time, especially for less-experienced surgeons. We describe an assortment of tips and tricks that we conclude can safely reduce robotic operative duration.

Objective: The advantages of robot-assisted surgery include shorter incisions, less postoperative pain, perioperative blood loss, and a faster return to daily functions. Thoracic epidural analgesia (TEA) provides highly satisfactory analgesia in abdominal surgery. However, its hypotensive effect, particularly in minimally invasive procedures, exceeds its contribution to rapid recovery. Fascial plane blocks may be more beneficial in that context. This study evaluated the effects of regional analgesia techniques in robotic prostatectomy, nephrectomy, and cystectomy operations. Material and Methods: Following IRB Ethics Committee approval (2021.467.IRB1.134), the records of patients who had undergone robotic prostatectomy, nephrectomy, and cystectomy surgeries were retrospectively reviewed between January 2018 and January 2022.  Results: One hundred and forty patients with full documentation were included in this study. Various regional analgesia methods were used. Fascial plane blocks...

The study is a project to look at the awareness of PCOS among rural women and to compare awareness with and without the intervention of ASHA workers in rural women via robotic surgery. The study is a descriptive type and is confined to the geographical boundaries of the rural districts located in the southern states of the country, viz., Karnataka, Andhra Pradesh, Telangana, Tamil Nadu and Kerala with a structured questionnaire, which was administered through Accredited Social Health Activist (ASHA) to gather the primary data from the rural women. The cluster sampling technique was used to get a total sample size of 600 participants. One commonly used statistical tool during the study is SPSS (Statistical Package for the Social Sciences) to test the hypothesis using a variety of tests, including the Paired T-test, Analysis of Variance, Exploratory Factor Analysis (EFA), and Pearson Correlation. The findings of the study indicated that there is a significant difference in the level of knowledge of the rural women about the PCOS disorder, more specifically in robotic surgery as a practical solution, based on core knowledge determinants, which include Symptoms, Causes, and Risks between ASHA workers for awareness of the medical disorder.

Aim of the study Weight loss surgery (WLS) is efficacious for long-term weight reduction and reduces overall mortality in severely obese patients. The mechanisms implicated for long-term weight loss are not fully understood. Proposed mechanisms include changes in gut hormones and brain regulation of appetite and satiety. We report long-term ghrelin and leptin profiles and changes in food preference and eating behavior after WLS in two adolescents. Patients and methods Two obese females (15 years and 14 years-4 months, respectively) who did not respond to lifestyle changes, including dietary intervention and physical exercise, in combination with medical therapy, underwent robotic-assisted gastroplication. Anthropometric measurements, food habits and eating behavior, metabolic and hormonal changes during long-term post surgical follow-up were monitored. Results Long-term weight reduction was obtained in both patients, with a significant decrease in waist circumference. Resting energy...

Rhabdomyosarcoma is a soft tissue malignant tumor affecting 1% of children from 0 to 14 years. Preoperative imaging may not always be diagnostic for hepatobiliary rhabdomyosarcoma and differential diagnosis with choledochal cyst (CC) could be difficult. We report a case of 2-years-old girl with a strange CC pattern of presentation. A grapelike lesion involving the choledochal and biliary ducts was easily and completely resected by robotic assisted surgery. Since no previous reports were available about oncologic safety of robotic approach, the porto-enterostomy was performed in open surgery. On histologic examination, the specimen revealed a botryoidembryonal rhabdomyosarcoma affecting both the common bile duct and the common hepatic duct. One year postoperatively the child is safe of tumor relapse. Robotic approach seems to be safe and advantageous to obtain a radical excision of the tumor at the porta hepatis, even in case of misdiagnosed malignant lesion mimicking a CC.

Recent advancements (2023-2025) have focused on creating symbiotic human-AI interactions, addressing limitations like surgeon fatigue and variability in techniques [2,3]. This narrative review, adhering to ICMJE guidelines, explores these developments, their applications in general surgery, and associated challenges, aiming to guide clinicians, researchers, and policymakers.

The evolution modern surgical treatment has entered a brand new technology with minimal access techniques redefining how complex tactics are achieved. many of the pioneers in advancing this alteration is international Laparoscopy sanatorium (WLH), a globally recognized institution devoted to training surgeons and gynecologists in laparoscopic and robot surgical procedure. The medical institution offers established laparoscopic schooling courses which are designed to empower scientific experts with superior talents, precision, and self belief to excel in their surgical practice. A top of the line institution for minimal get entry to surgery mounted with the venture present day bringing world-elegance laparoscopic schooling to surgeons and gynecologists, WLH has emerge as a hub brand new excellence in minimum access surgical procedure. located in Gurgaon, India, and additionally with a campus in Dubai, the health facility draws contributors from over 108 international locations. Its schooling packages are not restricted to theoretical know-how however emphasize palms-on latest, making it a unique platform for specialists who aspire to master laparoscopic surgery.

Background. Effective hemostasis and renorrhaphy with intracorporeal suturing are major technical challenges in robot-assisted partial nephrectomy (RAPN). This report outlines the authors' experience with a novel RAPN approach using renorrhaphy with barbed sutures (BSs) and elongated pledgets (R-BEP) in a video. Methods. The R-BEP procedure comprised several steps, including a single layer of monofilament adsorbable running BSs used to close the renal parenchyma, reinforced by elongated polytetrafluoroethylene (PTFE) pledgets. Two PTFE pledgets, approximately 8 to 10 mm in width, were cut to match the resection bed. Suturing began at one end of the resection bed, with bites placed 3 to 5 mm apart. The BSs maintained tension throughout the single-suture bites. Results. The RAPN procedure with R-BEP was performed for 55 patients, including 38 (69.1%) patients with a RENAL score of 7 or higher. The mean operation time was 183.3 ± 51.3 min, and the mean warm ischemia time was 22.5 ± 9.6 min. Complete hemostasis and urostasis were achieved for all the patients without the need for additional clamping or procedures for renorrhaphy. No patient was converted to laparoscopic or open surgery or experienced major intraoperative bleeding. Postoperatively, one patient experienced

While many advances have been made in surgical robotics technology, even for surgeons with relatively high levels of robotic surgery experience, many tasks take less time to perform manually. Although there are other benefits to surgical robotics that may outweigh task completion time, relatively lower efficiency will hinder the adoption of this technology. This study focused on two interface parameters: Control-Display Gain (CDG, i.e., the amount of robot movement resulting from a given robot controller movement) and the optical Zoom level that defines the working field of view. Results from a study with 10 participants suggest that CDG is a promising interface parameter for optimizing movement time in robot-assisted surgical tasks. The results have implications for the development and implementation of intelligent surgeon-robot interface technology and hold the potential to greatly improve the efficiency of roboticassisted surgery techniques.

Hair transplantation is a widely performed surgical therapy for alopecia, encompassing techniques such as Follicular Unit Transplantation (FUT), Follicular Unit Extraction (FUE), and newer robotic-assisted or hybrid approaches. This review examines whether hair transplant procedures can cause nerve damage, and if so, to what extent and in what form. We analyze the anatomy of scalp innervation, the surgical mechanisms by which nerve injury might occur in different transplant techniques, reported complications including localized sensory loss or neuropathic pain, and any implications for systemic or motor (facial) nerves. Recent peerreviewed literature (primarily from the past decade) indicates that transient localized scalp nerve injury is not uncommon after hair restoration surgery, manifesting as temporary numbness or tingling. However, permanent or severe nerve damage is exceedingly rare. The vast majority of sensory disturbances resolve within weeks to months as nerve fibers regenerate. Isolated cases of prolonged neuropathy-such as occipital neuralgia from donor-site nerve trauma-have been documented, but these are exceptional. Importantly, hair transplant surgery has virtually no risk of widespread neurological harm or facial paralysis in standard practice. Overall, with proper technique in FUE, FUT, and modern methods, hair transplants are very safe regarding nerve integrity, causing at most minor temporary sensory changes in a small subset of patients. Patients should be counseled about the possibility of transient scalp numbness, and surgeons should employ nerve-sparing principles, especially during strip harvesting. In summary, hair transplants can cause limited nerve injury (mostly sensory and reversible), and serious or long-term nerve damage is an uncommon complication.

Surgical robotic systems have been available for almost twenty years. The first surgical robotic systems were designed as supportive systems for laparoscopic approaches in general surgery (the first procedure was a cholecystectomy in 1987). The da Vinci Robotic System is the most common system used for robotic surgery today. This system is widely used in urology, gynecology and other surgical disciplines, and recently there have been initial reports of its use in spine surgery, for transoral access and anterior approaches for lumbar inter-body fusion interventions. SpineAssist, which is widely used in spine surgery, and Renaissance Robotic Systems, which are considered the next generation of robotic systems, are now FDA approved. These robotic systems are designed for use as guidance systems in spine instrumentation, cement augmentations and biopsies. The aim is to increase surgical accuracy while reducing the intra-operative exposure to harmful radiation to the patient and operating team personnel during the intervention. We offer a review of the published literature related to the use of robotic systems in spine surgery and provide information on using robotic systems.

Surgical robotic systems have been available for almost twenty years. The first surgical robotic systems were designed as supportive systems for laparoscopic approaches in general surgery (the first procedure was a cholecystectomy in 1987). The da Vinci Robotic System is the most common system used for robotic surgery today. This system is widely used in urology, gynecology and other surgical disciplines, and recently there have been initial reports of its use in spine surgery, for transoral access and anterior approaches for lumbar inter-body fusion interventions. SpineAssist, which is widely used in spine surgery, and Renaissance Robotic Systems, which are considered the next generation of robotic systems, are now FDA approved. These robotic systems are designed for use as guidance systems in spine instrumentation, cement augmentations and biopsies. The aim is to increase surgical accuracy while reducing the intra-operative exposure to harmful radiation to the patient and operating team personnel during the intervention. We offer a review of the published literature related to the use of robotic systems in spine surgery and provide information on using robotic systems.

Background: The Da Vinci Xi-system is not FDA-approved for transoral robotic surgery (TORS), resulting in limited data. Methods: In this single-center prospective study, 90 head and neck cancer patients were consecutively included. The primary objective was to evaluate the safety and feasibility of TORS performed with the Xi-robot, with the rate of safe/successful Xi-TORS surgeries (adequate exposure with complete macroscopical resection and absence of death/unforeseen tracheotomy within 72 h) serving as the primary endpoint. Results: Overall, 79 (87.7%) patients were scheduled for primary TORS, while the remaining 11 (12.3%) were scheduled for local recurrence/second primary after radio(chemo)therapy (salvage setting). Tumors were predominantly oropharyngeal (n = 44, 48.9%) and carcinomas of unknown primary (CUP) (n= 35, 38.9%). The most common histology was squamous cell carcinoma (SCC) (n = 83, 92.2%). Tumor stage (UICC 8th ed.) distribution was I (48.9%), II (21.1%), III (10.0%), and IV (21.1%). The success rate (primary endpoint) was 96.7%. Intraoperative difficulties and complications were encountered in 42.0% and 17.0% of patients, respectively. Postoperativehemorrhage at the TORS site occurred in 9.1%. No treatment-related deaths were encountered. Adjuvant radiation (RT) and chemoradiation (CRT) in the primary TORS group was indicated in 31.2% and 23.4% of patients, respectively. Two-year overall survival (OS) and disease-specific survival (DSS) in the SCC group was 87.6% and 93.2%, respectively. P16-positivity was a positive prognosticator for OS, DSS, and locoregional recurrence-free survival (LRFS) in the primary oropharyngeal SCC group but not in the CUP-group. No long-term tracheotomies were necessary; 4patients (4.5%) needed long-term jejunostomy/gastrostomy tube feeding. In the total patient population, functional baseline level (assessed by FOISscore and MD Anderson Dysphagia Inventory) was regained 24 months postoperatively, and quality of life (assessed by QLQ-H&amp;N35questionnaires) recuperated 1 year postoperatively. The subgroup of patients treated primarily with TORS alone showed quicker functional recovery than the patients treated with TORS + RT/CRT. Conclusions: Xi-TORS is safe, feasible, and yields excellent oncological/functional outcomes.

Background: Vesical paraganglioma is rare and accounts for <0.1% of all urinary bladder tumors. They are mostly functional because of secretion of catecholamines and clinical presentation may mimic like a hyperfunctioning adrenal pheochromocytoma. They are easily misdiagnosed as urothelial malignancy and adequate perioperative attention is not provided. Case presentation: We hereby report a case of 55-year-old Indian lady with silent vesical paraganglioma at anatomically difficult location of bladder neck managed with robot-assisted excision of mass and bladder preservation. Conclusion: Surgery is the mainstay of the treatment that requires total excision of mass. However, minimally invasive bladder-preserving approach should be always kept as an option, if feasible. Robot assistance can help in bladder preservation even in difficult anatomic locations.

Three Dimensional (3D) human heart model is attracting attention for its role in medical images for education and clinical purposes. Analysing 2D images to obtain meaningful information requires a certain level of expertise. Moreover, it is time consuming and requires special devices to obtain aforementioned images. In contrary, a 3D model conveys much more information. 3D human heart model reconstruction from medical imaging devices requires several input images, while reconstruction from a single view image is challenging due to the colour property of the heart image, light reflections, and its featureless surface. Lights and illumination condition of the operating room cause specular reflections on the wet heart surface that result in noises forming of the reconstruction process. Image-based technique is used for the proposed human heart surface reconstruction. It is important the reflection is eliminated to allow for proper 3D reconstruction and avoid imperfect final output. Spe...

Medication and robotic surgery are new approaches in the treatment of lung cancer. To obtain the goal of radical surgical treatment of the tumor, this effective approach takes advantage of the accuracy of robotic surgical system in combination with the pharmacological strategies that are aimed at achieving the highest therapeutic intervention and the minimal toxic effects. Patient selection and survival data are required for desired long-term effects. The success of this method depends on training and learning curves for health care providers. Clinical applications emphasize the necessity of robotic assisted strategies and efficient use of consumables and advanced robotic bronchoscopy. This innovative approach helps to improve the lung cancer treatment by setting a new standard for patient outcomes.

Background: Partial nephrectomy (PN) has a non-negligible perioperative morbidity. Comparative evidence of the available surgical techniques is limited. Objective: To compare the perioperative outcomes of open, laparoscopic, and robotic PN. Methods: Data of 2331 patients treated with PN for cT1 renal tumors were extracted from the RECORd2 database, a prospective multicenter project. Multivariable regression models assessed the relationship between surgical technique and surgical margins,

Background: Adverse events in the operating theatre related to non-technical skills and teamwork are still an issue. The influence of minimally invasive techniques on team performance and subsequent impact on patient safety remains unclear. The aim of this review was to assess the methodology used to objectify and rate team performance in minimally invasive abdominal surgery. Methods: A systematic literature search was conducted according to the PRISMA guidelines. Studies on assessment of surgical team performance or non-technical skills of the surgical team in the setting of minimally invasive abdominal surgery were included. Study aim, methodology, results and conclusion were extracted for qualitative synthesis. Results: Sixteen studies involving 677 surgical procedures were included. All studies consisted of observational case series that used heterogeneous methodologies to assess team performance and were of low methodological quality. The most commonly used team performance objectification tools were 'construct'-and 'incident'-based tools. Evidence of validity for the assessed outcome was spread widely across objectification tools, ranging from low to high. Diverse and poorly defined outcomes were reported. Team demands for minimally invasive approaches to abdominal procedures remain unclear. The current literature consists of studies with heterogeneous methodology and poorly defined outcomes.

Objective: For thyroglossal duct (TGD) cysts which extend into the
tongue base, or have had failed prior excision, exposure through the neck
can be challenging. The aim of this study is to describe a case series of
patients who underwent combined transcervical and transoral robotic
surgery (TORS) to completely excise large or recurrent lingual TGD cysts.
Methods: Retrospective chart review of a case series of 5 adult
patients who underwent combined Sistrunk and TORS approach to
treat large or recurrent lingual TGD cysts at a tertiary care institution.
Results: 3/5 patients had undergone excision in the past, with cyst
recurrence deep to the hyoid bone and extending into the tongue base. 2/5
had not had prior surgery, but the cyst was primarily within the tongue base.
All patients underwent combined excision, with the TORS component
completed first before the transcervical exposure. All patients required
pharyngotomy by the nature and location of the TGD cyst, and all underwent
primary closure through the neck incision. All healed well, resumed
oral intake, and have demonstrated no recurrence in 2-year follow-up.
Conclusion: A combined transcervical and transoral approach is feasible
and successful in treating the adult patient with large or recurrent lingual
TGD cysts that have supra- and infrahyoid extension.

Purpose: Patients with high-risk prostate cancer have historically been treated with multimodal therapy and considered poor candidates for minimally invasive surgery. We reviewed our experiences with robot-assisted radical prostatectomy (RARP) in patients with high-risk clinical features. Materials and Methods: Clinical database review identified high-risk patients undergoing RARP by two highvolume robotic surgeons. D'Amico's criteria for high-risk prostate cancer were utilized: prostate-specific antigen 20 ng=mL, clinical stage T2c, or preoperative Gleason grade 8. About 148 patients were identified in the study group. Mean age at surgery was 60.9 years, and mean body mass index was 27.9. Mean estimated blood loss was 150 cc and the transfusion rate was 2.7%. Median hospital stay was 1 day and the rate of major complications (Clavien grade 3) was 3.4%. Results: Bilateral nerve preservation was feasible in 28.4%, and the rate of positive surgical margins was 20.9%. Final pathology demonstrated extra-capsular disease in 54.1% of patients and 12.3% had lymph node involvement. At 2 years of follow-up, 21.3% of patients had experienced biochemical recurrence or had persistent disease after treatment. Continence was 91.2% (1 pad or less) and total impotence (inability to masturbate) was 48.3%. Conclusions: RARP does not compromise oncologic or functional outcomes in patients with high-risk prostate cancer. Although long-term study is necessary to validate oncologic and functional outcomes, our data suggest that the presence of high-risk disease is not a contraindication to a minimally invasive approach for radical prostatectomy at experienced centers.

Emerging technologies are rapidly transforming surgical
practice, offering unprecedented precision, safety, and efficiency.
Innovations such as robotic surgery, artificial intelligence
(AI), augmented reality (AR), and regenerative medicine
are redefining operative standards [1–4]. However, this
revolution necessitates a corresponding evolution in medical
education to ensure that future surgeons are equipped to
work alongside such advanced tools.

BackgroundRobotic surgery for malignant uterine cancer raises issue of economic sustainability for providers. The objective of this study was to assess the value of surgical admissions for malignant uterine cancer in a University Hospital through an analysis of their costs and outcomes by comparing three different surgical approaches (laparotomy, laparoscopic, and robotic surgery).MethodsHospitalizations between 1 January 2019 and 31 October 2021 for malignant uterine cancer surgery were selected and stratified. For each surgical approach, mean values (with 95% confidence intervals, CI) were calculated for cost items. Moreover, 30-day readmission frequency was calculated for the three approaches compared to each other. ANOVA and Student&#39;s t-test and relative risk (RR) were used for statistical analysis. A break-even analysis was carried out by evaluating the volume of robotic and non-robotic surgical admissions.ResultsA total of 1,336 hospitalizations were included in the study,...

was used for one minute during each step and did not interfere with routine workflow. All surgeons found the system usable for improved spatial awareness. The automatic alignment was considered accurate although having the option of manual alignment was also counted useful by surgeons. Main criticism was switching between console and HMD. CONCLUSIONS: Our study demonstrates feasibility of interactive visualization of 3D mpMRI data during in vivo laparoscopic RARP. Future goals include use of the robot 0 s stereo image viewer instead of HMD and advancement of the MRI-stereo image alignment for direct intraoperative use of mpMRI.

The aim of this review is to assess the role of robotics in pelvic surgery in terms of outcomes. We have also highlighted the issues related to training and future development of robotic systems. Materials and methods: We searched MEDLINE, EMBASE and the Cochrane Databases from 1980 to 2009 for systematic reviews of randomised controlled trials, prospective observational studies, retrospective studies and case reports assessing robotic surgery. Results: During the last decade, there has been a tremendous rise in the use of robotic surgical systems for all forms of precision operations including pelvic surgery. The short-term results of robotic pelvic surgery in the fields of urology, colorectal surgery and gynaecology have been shown to be comparable to the laparoscopic and open surgery. Robotic surgery offers an opportunity where many of these obstacles encountered during open and laparoscopic surgery can be overcome. Conclusions: Robotic surgery is a continually advancing technology, which has opened new horizons for performing pelvic surgery with precision and accuracy. Although its use is rapidly expanding in all surgical disciplines, particularly in pelvic surgery, further comparative studies are needed to provide robust guidance about the most appropriate application of this technology within the surgical armamentarium.

Objectives The presence and size of lateral lymph nodes (LLNs) are important factors influencing treatment decisions for rectal cancer. Awareness of the clinical relevance and describing LLNs in MRI reports is therefore essential. This study assessed whether LLNs were mentioned in primary MRI reports at a national level and investigated the concordance with standardised re-review. Methods This national, retrospective, cross-sectional cohort study included 1096 patients from 60 hospitals treated in 2016 for primary cT3-4 rectal cancer ≤ 8 cm from the anorectal junction. Abdominal radiologists re-reviewed all MR images following a 2-h training regarding LLNs. Results Re-review of MR images identified that 41.0% of enlarged (≥ 7 mm) LLNs were not mentioned in primary MRI reports. A contradictory anatomical location was stated for 73.2% of all LLNs and a different size (≥/&lt; 7 mm) for 41.7%. In total, 49.4% of  all cases did not mention LLNs in primary MRI reports. Reporting LLNs was ...

Introduction: Intercostal cryo nerve block has been shown to enhance pulmonary function recovery and pain management in post-thoracotomy procedures. However, its benefit have never been demonstrated in minimal invasive thoracotomy heart valve surgery (Mini-HVS). The purpose of the study was to determine whether intraoperative intercostal cryo nerve block in conjunction with standard of care (collectively referred to hereafter as CryoNB) provided superior analgesic efficacy in patients undergoing Mini-HVS compared to standard-of-care (SOC). Methods: FROST was a prospective, 3:1 randomized (CryoNB vs. SOC), multicenter trial in patients undergoing Mini-HVS. The primary endpoint was the 48-h postoperative forced expiratory volume in 1 s (FEV1) result. Secondary endpoints were visual analog scale (VAS) scores for pain at the surgical site and general pain, intensive care unit and hospital length-ofstay, total opioid consumption, and allodynia at 6 months postoperatively. Results: A total of 84 patients were randomized to the two arms of the trial CryoNB (n = 65) and SOC (n = 19). Baseline Society of Thoracic Surgeons Predictive Risk of Mortality (STS PROM) score, ejection fraction, and FEV1 were similar between cohorts. A higher 48-h postoperative FEV1 result was demonstrated in the CryoNB cohort versus the SOC cohort (1.20 ± 0.46 vs. 0.93 ± 0.43 L; P = 0.02, one-sided two-sample t test). Surgical site VAS scores were similar between the CryoNB and SOC cohorts at all postoperative timepoints evaluated, but VAS scores not related to the surgical site were lower in the SOC group at 72, 94, and 120 h postoperatively. The SOC cohort had a 13% higher opioid consumption than the CryoNB cohort. One of 64 CryoNB patients reported allodynia that did not require pain medication at 10 months. Conclusions: The results of FROST demonstrated that intercostal CryoNB provided enhanced FEV1 score at 48 h postoperatively

Background This study compared patients undergoing colorectal cancer surgery in 20 hospitals of northern Italy in 2019 versus 2020, in order to evaluate whether COVID-19-related delays of colorectal cancer screening resulted in more advanced cancers at diagnosis and worse clinical outcomes. Method This was a retrospective multicentre cohort analysis of patients undergoing colorectal cancer surgery in March to December 2019 versus March to December 2020. Independent predictors of disease stage (oncological stage, associated symptoms, clinical T4 stage, metastasis) and outcome (surgical complications, palliative surgery, 30-day death) were evaluated using logistic regression. Results The sample consisted of 1755 patients operated in 2019, and 1481 in 2020 (both mean age 69.6 years). The proportion of cancers with symptoms, clinical T4 stage, liver and lung metastases in 2019 and 2020 were respectively: 80.8 versus 84.5 per cent; 6.2 versus 8.7 per cent; 10.2 versus 10.3 per cent; and ...

The surgical treatment of advanced low rectal cancer remains controversial. Extended lymphadenectomy (EL) is the preferred option in the East, especially in Japan, while neoadjuvant radiotherapy is the treatment of choice in the West. This review was undertaken to review available evidence supporting each of the therapies. Methods: All studies looking at EL were included in this review. A comprehensive search was conducted as per PRISMA guidelines. Primary outcome was defined as 5-year overall survival, with secondary outcomes including 3-year overall survival, 3-and 5-year disease-free survival, length of operation, and number of complications. Results: Thirty-one studies met the inclusion criteria. There was no significant publication bias. There was statistically significant difference in 5-year survival for patient who underwent EL (odds ratio, 1.34; 95 confidence interval, 0.09-0.5; P = 0.006). There were no differences noted in secondary outcomes except for length of the operations. Conclusion: There is evidence supporting EL in rectal cancer; however, it is difficult to interpret and not easily transferable to a Western population. Further research is necessary on this important topic.

Laparoscopic adrenalectomy, first described by Gagner, Lacroix and Bolte, has rapidly become the reference standard in the treatment of benign adrenal masses . Although there are no prospective randomized trials comparing laparoscopic and open adrenalectomies, based on retrospective studies, many authors indicate that advantages of the laparoscopic technique are: decreased intraoperative blood loss, fewer intra-and postoperative complications, shorter hospital stay, faster recovery, and decreased pain and narcotic use [2,. Although in many centers laparoscopic adrenalectomy has become the gold standard in the treatment of benign adrenal tumors, there are still areas of controversy concerning the size for resection of a hormonally inactive incidentaloma and appropriateness of laparoscopic procedures in potentially malignant tumors. The objective of the study is to summarize the authors' 10-year experience with laparoscopic adrenalectomy and to analyze the intra-and postoperative complications of the procedure. We reviewed retrospectively the records of 80 patients who had undergone laparoscopic adrenalectomy from January 2002 to January 2012. The first 64 procedures were performed at

In the last years a wide range of new technique offers the possibility to have R0 resection in colorectal cancer. We report our experience about Single Port Laparoscopic Surgery (SPL) for not advanced right colon cancer and about pelvectomy with cilindric Abdominal Perineal Resection (APR) for advanced rectal cancer. SPL offer mainly cosmetic advantages but also quicker recovery. No touch technique with adequate surgical margin and lymphectomy were respected. Operative time of SPL was 85- 115 minutes, the incision was 5 cm long. There were no complications. Length of hospital stay was 4-6 days. With advanced pelvic cancer, pelvic exenteration with en-bloc resection is indicated. Then we propose a case of a 55 years old woman with a pelvic recurrence from a metastatic rectal cancer involving the right obturator fossa, the vaginal stump, the right ureter. Modern surgical technique give us the chance to offer the most appropriate oncologic surgical treatment.