"K" EY rules to improve learning skills in forth arm robotic platform.

The use of robotic-assisted keyhole surgery in gynaecology has expanded in recent years owing to technical advances. These include 3D viewing leading to improved depth perception, limitation of tremor, potential for greater precision and discrimination of tissues, a shorter learning curve and improved comfort for surgeons compared with conventional keyhole and open abdominal surgery. Robotic-assisted keyhole surgery, compared with conventional keyhole surgery, improves surgical performance without increasing operating time, minimises blood loss and intra- or postoperative complications, while reducing the need to revert to abdominal surgery. Moreover, surgeons using a robot experience fewer skeletomuscular problems of their own in the short and long term than those operating without a robot as an additional tool. This Scientific Impact Paper looks at the use of a robot in different fields of gynaecological surgery. A robot could be considered safe and a more effective surgical tool than conventional keyhole surgery for women who have to undergo complex gynaecology surgery or have associated medical issues such as body-mass index (BMI) at 30 kg/m2 or above or lung problems. The introduction of the use of robots in keyhole surgery has resulted in a decrease in the number of traditional open surgeries and the risk of conversion to open surgery after traditional keyhole surgery; both of which should be considered when examining the cost-benefit of using a robot. Limitations of robotic-assisted surgery remain the associated higher costs. In womb cancer surgery there is good evidence that introducing robotics into the service improves outcomes for women and may reduce costs.

Insights from the thoracic surgery residents association early-career development series

Robotic radical cystectomy - revision and resection: An evolution in operative technique and platforms.

Robotic surgery has made significant technological advances, with robotic single-port surgery emerging as an innovative approach. However, this technique requires a reassessment of surgical training because its learning curve (LC) may differ from that of standard robotic procedures. In this comprehensive review, the LC of single-port and standard robotic surgeries in different urological procedures is evaluated and compared. A non-systematic review of robotic surgeries and LCs was performed in September 2024 using relevant articles from PubMed, Scopus and the Cochrane Central Register of Controlled Trials. The review focused on the LCs and structured programmes for robotic procedures. Articles were selected based on their relevance to urological practice and the availability of objective or subjective metrics for assessing the LC. Studies describing institutional protocols, simulation training and modular curricula were also included. Robotic radical prostatectomy, cystectomy, kidney transplantation, nephrectomy (radical and partial), pyeloplasty and single-port procedures were evaluated in relation to the LCs and structured programmes. Key findings highlight significant variability in LC duration depending on the procedure, surgeon's experience, and type of robotic platform. Future research should aim to standardise LC metrics, capture surgeons' baseline experiences and explore innovative training methods, such as simulation-based learning, to ensure the safe and efficient mastery of robotic urological surgery. Collaborative efforts between academic centres and robotic training platforms may facilitate more consistent and reproducible surgical education pathways.

Introduction Over the past two decades, the application of robotic surgery (RS) in pancreatic surgery has steadily increased. RS offers advantages such as reduced blood loss, less postoperative pain, and shorter hospital stays. However, there is still no consensus on its safety, efficacy, and learning curve in pancreatic diseases. This study aims to summarize the current state of RS in pancreatic surgery and to forecast its prospects. Method A literature search was conducted in PubMed using keywords including “robotic surgery”, “pancreatic surgery”, “minimally invasive surgery”, “open surgery” and “laparoscopic surgery”. Studies on robotic surgery in pancreatic surgery were collected, including research comparing robotic surgery with open or laparoscopic surgery. Results RS has been applied to various pancreatic surgeries, demonstrating good safety and feasibility. Compared to open or laparoscopic surgery, robotic pancreatic surgery (RPS) shows favorable short-term outcomes such as reduced blood loss, shorter hospital stays, and lower conversion rates, especially in surgeries with narrow operative spaces or complex anatomical structures. No significant differences were reported in postoperative complications or short-term mortality rates. RPS achieves comparable R0 resection rates, lymph node harvest numbers, and long-term outcomes. However, RPS also presents limitations, including a long learning curve, high surgical costs, a lack of dedicated instruments, and the absence of natural tactile feedback. Conclusion Robotic pancreatic surgery demonstrates favorable short-term and long-term outcomes, showing promising potential for application. Further multi-center randomized controlled trials are needed to determine its safety and efficacy conclusively.

The learning curve has implications for efficient surgical training. Robotic surgery is perceived to have a shorter learning curve than laparoscopy; however, detailed analysis is lacking. The aim of this work was to analyse studies comparing robotic and laparoscopic colorectal learning curves. Simulation studies comparing novices' learning curves were analysed in order to surmise applicability to colorectal surgery. A systematic search of Medline, PubMed, Embase and the Cochrane Library identified colorectal papers (from 1 January 2000 to 3 March 2021) comparing robotic and laparoscopic learning curves where surgeons lacked laparoscopic colorectal experience. Simulation studies comparing learning curves were also included. The learning curve was defined as the period of ongoing improvement in speed and/or accuracy. From 576 abstracts reviewed, three operative and 16simulation studies were included. The robotic learning curve for right colectomy was significantly faster in one study (16 vs. 25 cases) and equal for anterior resection in two studies (44 vs. 41 cases and 55 vs. 55). One study showed fewer complications for robotic patients (14.6% vs. 0%, p =0.013). Ten simulation studies reported faster times and eight recorded error rates favouring robotic surgery. Seven studies measured the learning curve. Four favoured laparoscopic surgery, but operating times were faster using the robotic platform. Operating times for robotic surgery may be faster than laparoscopy when surgeons are inexperienced with both platforms. This may be related to a superior baseline performance rather than a shorter learning curve. Whether a shorter learning curve on the laparoscopic platform will persist for long enough to enable skills to overtake robotic ability needs further investigation.

The aim of this study is to clarify the short-term outcomes of robotic sphincter-preserving surgery for rectal cancer in a retrospective study. The short-term outcomes of robotic sphincter-preserving surgery (n = 130) were retrospectively compared to open (n = 234) and laparoscopic surgery (n = 318) by a propensity score analysis. Robotic surgery was performed more frequently for patients with lower rectal cancer (55%) than open (30%, p < 0.0001) or laparoscopic surgery (36%, p < 0.0001). None of the robotic surgery cases were converted to open surgery. After propensity score matching, robotic surgery was found to be associated with a longer operation time (342 vs. 230min, p < 0.0001) and less blood loss (7 vs. 420mL, p < 0.0001) than open surgery. The overall complication rate of robotic surgery was lower than that of open surgery (13 vs. 28%, p = 0.032). Robotic surgery was associated with a lower incidence of surgical site infections (SSIs) than laparoscopic surgery (0 vs. 7%, p = 0.028). There were no cases of anastomotic leakage after robotic surgery. The circumferential resection margin was involved in 0.8% of the patients who underwent robotic surgery; the incidence did not differ among the treatment groups. Although robotic surgery for rectal cancer was associated with a longer operation time, it was associated with a very low incidence of SSIs. The degree of safety was comparable to both open and laparoscopic surgery.

BackgroundThis retrospective study compared perioperative measures, costs, quality of life and survival after open vs. robotic surgery, among obese women diagnosed with low-grade endometrial cancer.MethodsObese women (body mass index (BMI) ≥ 30) who underwent open or robotic surgery for endometrial cancer, in one of two tertiary medical centers in the center of Israel, 2013–2016, postoperative grade 1–2, were included. Costs per patient, including 30-days post-surgery were calculated. Quality of life was evaluated by Physical and Mental Components of the SF-36 and a recovery from surgery questionnaire. Overall survival outcomes were obtained from patients’ files. Surgical outcomes, including operating and anesthesia times, length of hospital stay, and intraoperative and postoperative complications according to the Clavien-Dindo classification scale were reviewed.ResultsIn all, 138 women with BMI ≥30 underwent open (n = 61) or robotic surgery (n = 77) during the study period. The groups had similar BMI, comorbidities, demographics and tumor characteristics. Robotic surgery was associated with shorter hospital stays (mean 1.7 vs. 4.8 days; P < .0001) and fewer postoperative complications (Clavien-Dindo > 2, 5.2% vs. 19.7%; P = .0008), but longer operating theater time (3.8 vs. 2.8 h; P < .001). Costs are equivalent when at least 350 robotic surgeries are performed annually, not including the initial system costs. Quality of life measures were better after robotic surgery. SF-36 showed better measures for robotic surgery (Physical 56 vs. 39 and Mental 73 vs. 56; P < .01). After robotic surgery, patients tended to recover quicker when compared to open surgery, as they returned to normal activities earlier, with less need for family and governmental assistance (mean recovery time, 23 vs. 70 days; P < 0.006 and mean change in preoperative total functioning score, − 1.5 vs. -3.9: P < 0.05, respectively). Overall, 5-year survival was 89.8% for the open surgery group vs. 94% for the robotic surgery group (log rank, P = 0.330).ConclusionsObese women with low-grade endometrial cancer had better quality of life after robotic vs. open surgery. They also had shorter hospital stays and fewer postoperative complications. Centers with high volumes of robotic surgery can achieve similar costs when comparing both methods. These results were achieved without jeopardizing survival. Our results further emphasize the need for the Israeli healthcare system to include specific reimbursement for robotic procedures in the population we studied.

Robotic surgery offers enhanced precision that can reduce tissue trauma and the systemic inflammatory response compared with laparoscopy. Clinically, a lower inflammatory response is associated with reduced postoperative pain, fewer complications, shorter hospital stay and improved oncological outcomes. This systematic review and meta-analysis compared postoperative trends in biochemical markers of the systemic inflammatory response in laparoscopic versus robotic colorectal surgery. This review was prospectively registered on PROSPERO (CRD420251167614) and reported in accordance with PRISMA guidelines. MEDLINE (PubMed), EMBASE (OvidSP), and Cochrane CENTRAL were searched for primary studies reporting biochemical surrogates of the systemic inflammatory response in adult patients following elective abdominal surgery. Eligible studies were then compared and meta-analysis performed using RevMan(Cochrane, Version 7.2.0). Eight studies (two randomised controlled trials and six observational cohort studies with an overall moderate risk of bias) involving 1,706 patients (n = 714 robotic, n = 992 laparoscopic) met inclusion criteria. C-reactive protein (CRP), albumin, and white cell count (WCC) were the most frequently reported markers of inflammation reported. Postoperative day 3 CRP was significantly lower after robotic surgery compared with laparoscopy [MD − 13.18 mg/l (95% CI − 22.29, − 4.08), p = 0.005), this was further demonstrated in colorectal cancer surgery subgroup analysis [MD -17.22 (95%CI -26.28, -8.17), p = 0.0002 I²= 0%]. Among secondary outcome measures, robotic surgery was associated with a significantly lower complication rate (p = 0.02) and a non-significant trend toward reduced intraoperative blood loss (p = 0.15), despite longer operative duration (mean difference 24 min). There was a non-significant trend towards shorter length of hospital stay with robotic surgery (p = 0.16). This meta-analysis demonstrated that post-operative CRP, a biochemical marker of peri-operative inflammation, was significantly lower in robotic surgery compared with laparoscopy. These findings support the hypothesis that robotic surgery potentially minimises tissue trauma and may contribute to reduced peri-operative inflammation.What does this add to the literature?While emerging evidence suggests that robotic colorectal surgery may elicit a less pronounced postoperative inflammatory response than conventional laparoscopic surgery, prior to this study there lacked a meta-analysis combining all available post robotic colorectal surgery post-operative inflammatory response data. The enhanced dexterity, tremor filtration, and improved three-dimensional visualisation offered by the robotic platform may facilitate more precise tissue handling and minimise collateral tissue trauma, however the precise biological mechanism behind this is not yet fully understood. Consequently, robotic surgery has been associated with lower postoperative inflammatory markers and a reduced physiological stress response in some studies. The implications of a lower systemic inflammatory response post robotic surgery could potentially influence choice of approach for specifically colorectal cancer patients, where a lower systemic inflammatory response, independent of complete resection (R0) and complication rates is associated with better oncological outcomes and survival.Supplementary InformationThe online version contains supplementary material available at 10.1007/s11701-026-03527-x.

Commentary: Safety first!

AimThe National Health Insurance system has reimbursed robotic gastrointestinal surgery since April 2018 in Japan. Additionally, strict facility and surgeon standards were established by the government and the academic society. This study aimed to evaluate the prevalence and safety of robotic surgery using a Japanese nationwide web‐based database.MethodsPatients who underwent the following robotic surgeries for malignant tumors in 2018 were included: esophagectomy (RE), total gastrectomy (RTG), distal gastrectomy (RDG), proximal gastrectomy (RPG), low anterior resection (RLAR), and rectal resections other than RLAR (RRR). The number of cases and surgical mortality rates each month were calculated to evaluate the prevalence and safety of robotic procedures.ResultsA total of 3281 patients underwent robotic gastrointestinal surgery. The monthly number of robotic surgeries nearly doubled in April 2018 when they were initially reimbursed by the National Health Insurance system. Operative mortality rates were 0.9%, 0.4%, 0.2%, and 2.8% for RE (n = 330), RTG (n = 239), RDG (n = 1167), and RPG (n = 109), respectively. No mortality was observed in RLAR (n = 1062) or RRR (n = 374).ConclusionRobotic surgery for gastrointestinal malignant tumors was safely introduced into daily clinical practice along with rigorous surgeon and facility standards in Japan.

Laparoscopic total mesorectal excision (TME) is technically demanding and has a steep learning curve. Moreover, two recent randomized controlled trials have questioned the oncological safety of laparoscopic treatment for rectal cancer. Robotic surgery, thanks to its technical advantages, could potentially overcome the intrinsic limitations of standard laparoscopy. In this paper we will describe the surgical technique of robotic TME and review the recent literature on robotic rectal surgery. Short term, functional and oncological outcomes will be taken into consideration, as well as learning curve and costs. Robotic rectal resection is reported to have lower conversion rates (CRs), better functional outcomes and shorter learning curve, with comparable oncological results. Robotic surgery remains more time consuming and affected by higher costs. The technological advantages provided by the robotic system could probably facilitate the widespread adoption of minimally-invasive TME, that still has a low penetration worldwide. The educational capabilities of the platform, together with structured training programs, could allow novice surgeons to safely approach colorectal surgery.

Robotic surgery was first introduced in the 1980s as a system to aid patients in the battlefield. Since then, robotic surgery has become an important minimally invasive tool and plays an important role in elective surgery among various surgical specialties. However, the role for robotic surgery in the emergent setting is not well established or studied. Robotic surgery has been shown to be advantageous to both patients and operating surgeons. Though limited, studies have found robotic surgery in the acute setting to be safe for patients. These studies found robotic surgery to have improved perioperative outcomes when compared to an open or laparoscopic approach. Additionally, the robotic platform is thought to be an effective tool to prevent conversion to open procedures in emergent settings. Although some studies demonstrate advantages to robotic acute surgery, others have shown increased complications with robotic acute surgery or no distinct advantage when comparing robotic to laparoscopic surgery. Additionally, some of the published papers supporting the use of robotic surgery in the emergent setting may have a degree of bias favoring the robotic platform. Robotic surgery is a mainstay in minimally invasive elective surgery and gaining popularity among patients and surgeons. There are pros and cons to the adaptation of the robotic platform in the acute care setting. Additional large population studies are indicated to determine the true role of the robotic platform in the emergent setting.

As robotic colorectal surgery continues to advance in conjunction with improved recovery protocols, we began implementing robotic surgery (RS) as an option for emergent diverticulitis surgery. Our hospital system utilizes the Da Vinci Xi system, and staff are required to undergo training, making emergent colorectal surgery a feasible option. However, it is essential to determine the safety with reproducibility of our experiences. A de-identified retrospective review was performed of Intuitive's national database which obtained data from 262 facilities from January 2018 through December 2021. This identified over 22,000 emergent colorectal surgeries. Of those, over 2500 were performed for diverticulitis in which 126 were RS, 446 laparoscopic surgery (LS), and 1952 open surgery (OS). Clinical outcome metrics including conversion rates, anastomotic leaks, intensive care unit (ICU) admissions, length of stay, mortality, and readmissions were obtained. The cohort was defined by patients who were seen in the emergency department (ED) with diverticulitis and proceeded to have a sigmoid colectomy within 24h of ED arrival. RS was associated with increased operating time (RS 262, LS 207, OS 182min), but data has shown many benefits of emergent RS compared to OS. We identified significant decreases in ICU admission rates (OS 19.0%, RS 9.5%, p = 0.01) and anastomotic leak rates (OS 4.4%, RS 0.8%, p = 0.04), with borderline improvement in overall length of stay (OS 9.9, RS 8.9days, p = 0.05). When compared with LS, RS showed many comparable results. However, RS witnessed a statistically significant improvement in anastomotic leak rates (LS 4.5%, RS 0.8%, p = 0.04). Importantly, there was a striking difference in conversion rates to OS. LS converted over 28.7% of cases to OS, whereas RS only converted 7.9%, p = 0.000005. Given these findings, RS is another MIS tool that could be a safe and feasible option for the acute management of emergent diverticulitis.

The use of the robotic platform for gastrointestinal surgery was introduced nearly 20years ago. However, significant growth and advancement has occurred primarily in the last decade. This is due to several advantages over traditional laparoscopic surgery allowing for more complex dissections and reconstructions. Several randomized controlled trials and retrospective reviews have demonstrated equivalent oncologic outcomes compared to open surgery with improved short-term outcomes. Unfortunately, there are currently no universally accepted or implemented training programs for robotic surgery and robotic surgery experience varies greatly. Additionally, several limitations to the robotic platform exist resulting in a distinct learning curve associated with various procedures. Therefore, implementation of robotic surgery requires a multidisciplinary team approach with commitment and investment from clinical faculty, operating room staff and hospital administrators. Additionally, there is a need for wider distribution of educational modules to train more surgeons and reduce the associated learning curve. This article will focus on the implementation of the robotic platform for surgery of the pancreas, stomach, liver, colon and rectum with an emphasis on the associated learning curve, educational platforms to develop proficiency and perioperative outcomes.