Robotic Approach Research Articles

Direct anterior approach with conventional instruments versus robotic posterolateral approach in elective total hip replacement for primary osteoarthritis: a case-control study.

The purpose of this study is to compare peri-operative and short-term outcomes in patients who underwent elective total hip replacement (THA) for primary osteoarthritis (OA) with direct anterior approach (DAA) versus a pair-matched cohort of patients who underwent robotic-assisted THA with posterolateral approach. Data from consecutive patients who underwent elective hip replacement from 2021 to 2023 for primary OA were retrospectively retrieved and divided into two groups: the DAA group, who underwent THA with the DAA approach using conventional instruments, and the robotic posterolateral (R-PL group), who underwent robot arm-assisted THA with the posterolateral approach. Comparative assessed outcomes were: operative time, radiographical implant positioning, intake of rescue analgesics, blood loss, transfusion rate, leg length discrepancy and functional outcomes (Harris hip score and forgotten joint score). A total of 100 pair-matched patients were retrieved with a mean age of 66.7 ± 10.7 (range: 32-85) years and a mean follow-up of 12.8 ± 3.6 (range: 7-24) months. No differences in patients' characteristics were detected. Patients in the R-PL group required less rescue tramadol (p > 0.001), ketorolac (p = 0.028) and acetaminophen (p < 0.001). There was no significant difference in the operative time between (MD = 5.0min; p = 0.071). Patients in the DAA group had significantly lower Hb levels at day 1 (p = 0.002) without significant differences in transfusion rate (p = 0.283). Patients in the R-PL group had shorter length of stay (LOS) with a mean difference of 1.8days [p < 0.001; 95% confidence interval (CI) 1.4-2.3]. No difference in clinical outcomes was found [leg length discrepancy (LLD), p = 0.572; HHS, p = 0.558; forgotten joint score (FJS), p = 0.629]. No radiographical differences were measured in cup inclination (MD = 2.0°, p = 0.069), malpositioning [odd ratio (OR) = 0.2; p = 0.141], stem alignment (OR = 0.3; p = 0.485) and stem sizing (OR = 1.5; p = 1.000). There was no difference in complication rate except for lateral femoral cutaneous nerve damage, which was higher in DAA group (p < 0.001). R-PL and DAA THA had comparable short-term clinical and radiological outcomes along with similar complication rates. The R-PL group showed significantly lower Hb drop, rescue analgesic consumption and shorter LOS. This is a preliminary study and no strong recommendation can be provided. Further prospective randomized trials are requested to further investigate the cost-effectiveness of robotic surgery in THA. Level IV, case-control study.

Effect of Soil Properties and Powertrain Configuration on the Energy Consumption of Wheeled Electric Agricultural Robots

Agricultural emissions can be significantly reduced with smart farming, which includes moving away from large conventional tractors to fleets of compact wheeled electric robots. This paper presents a novel simulation modeling approach for an ATV-sized wheeled electric agricultural robot pulling an implement on deformable terrain. The 2D model features a semiempirical tire–soil interaction model as well as a powertrain model. Rear-wheel drive (RWD), front-wheel drive (FWD), and all-wheel drive (AWD) versions were developed. Simulations were carried out on two different soils to examine the energy consumption and tractive performance of the powertrain options. The results showed that energy consumption varies the least with AWD. However, RWD could provide lower energy consumption than AWD with light workloads due to lower curb weight. However, with the heaviest workload, AWD had 7.5% lower energy consumption than RWD. FWD was also found to be capable of lower energy consumption than AWD on light workloads, but it was unsuited for heavy workloads due to traction limitations. Overall, the results demonstrated the importance of taking the terrain characteristics and workload into account when designing electric agricultural robots. The developed modeling approach can prove useful for designing such machines and their fleet management.

Designing an Uncrewed Aircraft Systems Control Model for an Air-to-Ground Collaborative System

&lt;div&gt;In autonomous technology, uncrewed aircraft systems have already become the preferred platform for the research and development of flight control systems. Although they are subjected to following and satisfying complicated scenarios of control stations, this high dependency on a specific control framework limits them in their application process and reduces the flight self-organizing network. In this article, we present a developed multilayer control system protocol with the additional supportive manned aircraft layer (&lt;i&gt;Tender&lt;/i&gt;). The novelty of the introduced model is that uncrewed aircraft systems are monitored and navigated by the tender, and then based on the suggested scheme, data flows are controlled and transferred across the network by the developed cloud–robotics approach in the ground station layer. Therefore, it has been tried to design a semi-autonomous control network to gather data that combines human observation and the automotive nature of uncrewed aircraft systems. To ensure the accuracy and correctness of the model, we simulate our approach in the software-in-the-loop using its web-based interface with new configurations in the hardware and software architecture of the network. Results will be examined by the in-order per message delay, which has recorded a considerably low latency in both the uplink and downlink data transmission processes. This optimization is achieved along with maintaining the quality of data.&lt;/div&gt;

Tampa Difficulty Score: a novel scoring system for difficulty of robotic hepatectomy

BACKGROUNDDifficulty scoring systems (DSS) have been established for laparoscopic hepatectomy and serve as useful tools to predict difficulty and guide preoperative planning. Despite increased adoption of robotics and its unique technical characteristics compared with laparoscopy, no DSS currently exists for robotic hepatectomy. We aim to introduce a new DSS for robotic hepatectomy. METHODS328 patients undergoing a robotic hepatectomy were identified. After removing the first 24 major and 30 minor hepatectomies using CUSUM analysis, 274 patients were included in this study. Relevant clinical variables underwent linear regression using operative time and/or estimated blood loss (EBL) as markers for operative difficulty. Score distribution was analyzed to develop a difficulty-level grouping system. RESULTSOf the 274 patients, neoadjuvant chemotherapy, tumor location, size, type, extent of parenchymal resection, need for portal lymphadenectomy, and need for biliary resection with hepaticojejunostomy were significantly associated with operative time and/or EBL. They were utilized to develop the difficulty scores from 1-49. Grouping system results were: Group 1 (Less Demanding/Beginner): 1-8 (n=39), Group 2 (Intermediate): 9-24 (n=208), Group 3 (More Demanding/Advanced): 25-32 (n=17), and Group 4 (Most Demanding/Expert): 33-49 (n=10). When stratified by group, age, prior abdominal operation, Child-Pugh score, operative duration, estimated blood loss, major resection, 30-day mortality, 90-day mortality, and length of stay were significantly different among the groups. CONCLUSIONSIn addition to established variables in laparoscopic systems, new factors such as the need for portal lymphadenectomy and biliary resection specific to the robotic approach have been identified in this new robotic DSS. Internal and external validation are the next steps in maturing this robotic DSS.

Safety and feasibility of minimally invasive gastrectomy following preoperative chemotherapy for highly advanced gastric cancer

BackgroundThis study aimed to determine the safety and feasibility of minimally invasive gastrectomy in patients who underwent preoperative chemotherapy for highly advanced gastric cancer.MethodsPreoperative chemotherapy was indicated for patients with advanced large tumors (≥ cT3 and ≥ 5 cm) and/or bulky node metastasis (≥ 3 cm × 1 or ≥ 1.5 cm × 2). Between January 2009 and March 2022, 150 patients underwent preoperative chemotherapy followed by gastrectomy with R0 resection, including conversion surgery (robotic, 62; laparoscopic, 88). The outcomes of these patients were retrospectively examined.ResultsAmong them, 41 and 47 patients had stage IV disease and underwent splenectomy, respectively. Regarding operative outcomes, operative time was 475 min, blood loss was 72 g, morbidity (grade ≥ 3a) rate was 12%, local complication rate was 10.7%, and postoperative hospital stay was 14 days (Interquartile range: 11–18 days). Fifty patients (33.3%) achieved grade ≥ 2 histological responses. Regarding resection types, total/proximal gastrectomy plus splenectomy (29.8%) was associated with significantly higher morbidity than other types (distal gastrectomy, 3.2%; total/proximal gastrectomy, 4.9%; P < 0.001). Specifically, among splenectomy cases, the rate of postoperative complications associated with the laparoscopic approach was significantly higher than that associated with the robotic approach (40.0% vs. 0%, P = 0.009). In the multivariate analysis, splenectomy was an independent risk factor for postoperative complications [odds ratio, 8.574; 95% confidence interval (CI), 2.584–28.443; P < 0.001].ConclusionsMinimally invasive gastrectomy following preoperative chemotherapy was feasible and safe for patients with highly advanced gastric cancer. Robotic gastrectomy may improve surgical safety, particularly in the case of total/proximal gastrectomy combined with splenectomy.

The weight of BMI in impacting postoperative and oncologic outcomes in pancreaticoduodenectomy is attenuated by a robotic approach.

This study was undertaken to observe the effect of body mass index (BMI) on perioperative outcomes and survival when comparing robotic vs 'open' pancreaticoduodenectomy. With IRB approval, we prospectively followed 505 consecutive patients who underwent either robotic or 'open' pancreaticoduodenectomy from 2012 to 2021. For illustrative purposes, patients were separated based on the Center for Disease Control and Prevention BMI table but regression analysis was utilized to identify significant relationships involving BMI. Data are presented as median (mean ± SD). Significance was determined at p ≤ 0.05. 205 and 300 patients underwent 'open' and robotic pancreaticoduodenectomy, respectively. Neither sex nor age correlated with BMI in patients undergoing 'open' nor robotic operation. Operative duration correlated with increasing BMI in each operational approach, which was statistically significant for those receiving the 'open' operation (p = 0.02). There were statistically significantly fewer lymph nodes harvested with rising BMI in patients that had an 'open' operation (p = 0.01), but no such difference was found in patients undergoing the robotic approach. Length of stay (LOS) and in-hospital mortality were statistically significantly associated with rising BMI when an 'open' operation was undertaken (p = 0.02 and p = 0.0002, respectively) but not when the robotic platform was utilized. Patients with higher BMI had significantly longer operative duration, smaller lymph node harvest, greater LOS, and increased in-hospital mortality rate when undergoing 'open' pancreaticoduodenectomy, but not robotic pancreaticoduodenectomy. Thus, the robotic platform may attenuate the increased technical and oncologic difficulties associated with a greater BMI in patients undergoing pancreaticoduodenectomy.

Robotic transperitoneal versus retroperitoneal approach for anterior renal mass nephron-sparing surgery.

Robotic nephron-sparing surgery is traditionally performed via a transperitoneal (TP) approach. However, the retroperitoneal (RP) approach has gained popularity, particularly for posterolateral renal masses. The RP approach is associated with shorter operative time, less blood loss, and shorter length of stay, while preserving oncologic outcomes in selected masses. Here, we aim to assess the feasibility of the RP approach in excising anterior renal masses. Patients ≥ 18years of age who underwent robotic nephron-sparing surgery for anterior renal masses were retrospectively identified (2008-2022). Baseline demographics, tumor characteristics, and perioperative data were collected and characterized based on TP vs RP approaches. Wilcoxon rank sum test and Pearson's Chi-squared test were used to compare continuous and categorical variables, respectively. Two hundred and sixteen patients were included-178 (82.4%) underwent TP approach and 38 (17.6%) underwent RP approach. Baseline demographics, preoperative tumor size, and renal nephrometry scores were similar. The RP approach was associated with shorter operative (150 vs 203min, p < 0.001) and warm ischemia time (12 vs 21min, p < 0.001), and less blood loss (20 vs 100cc, p = 0.002) (Table1). The RP approach was associated with shorter length of stay (1 vs 2days, p < 0.001) and less total complications (5.3% vs 19.1%, p = 0.038). Major complication (Clavien-Dindo Grade > 3) rates were similar. There was no difference in positive surgical margin rates or pathologic characteristics. Robotic RP approach for nephron-sparing surgery is feasible for eligible anterior tumors and is associated with favorable perioperative outcomes with preserved negative surgical margin rates. Table1 Patient baseline demographics Overall Transperitoneal Retroperitoneal p value Median/N IQR/% Median/N IQR/% Median/N IQR/% N 216 178 82.4% 38 17.6% Age (years) 60.5 (52.1-67.7) 60.4 (52.8-67.7) 61.6 (49.1-69.2) 0.393 Sex Male 126 58.3% 100 56.2% 26 68.4% Female 90 41.7% 78 43.8% 12 31.6% 0.165 Race White 162 75.0% 137 77.0% 25 65.8% Asian 4 1.9% 2 1.1% 2 5.3% Black 21 9.7% 18 10.1% 3 7.9% Hispanic 26 12.0% 18 10.1% 8 21.1% Other 2 0.9% 2 1.1% 0 0.0% 0.197 Body mass index (kg/m2) < 25 32 14.8% 25 14.0% 7 18.4% 25-30 68 31.5% 55 30.9% 13 34.2% 30-35 60 27.8% 50 28.1% 10 26.3% 35 + 56 25.9% 48 27.0% 8 21.1% 0.808 Prior abdominal surgery Yes 118 54.6% 104 58.4% 14 36.8% No 98 45.4% 74 41.6% 24 63.2% 0.015 Prior kidney surgery Yes 10 4.6% 9 5.1% 1 2.6% No 206 95.4% 169 94.9% 37 97.4% 0.518 Chronic kidney disease stage ≥ 3 Yes 45 20.8% 38 21.3% 7 18.4% No 171 79.2% 140 78.7% 31 81.6% 0.687 Charlson comorbidity index 0 138 63.9% 116 65.2% 22 57.9% 1 46 21.3% 38 21.4% 8 21.1% 2 19 8.8% 13 7.3% 6 15.8% ≥ 3 13 6.0% 11 6.2% 2 5.3% 0.412 Tumor size (cm) 2.7 (2-3.6) 2.8 (2-3.5) 2.55 (2-3.7) 0.796 Tumor laterality Left 100 46.3% 78 43.8% 22 57.9% Right 116 53.7% 100 56.2% 16 42.1% 0.114 Clinical T stage cT1a 186 86.1% 152 85.4% 34 89.5% cT1b 30 13.9% 26 14.6% 4 10.5% 0.509 RENAL Nephrometry score Low (4 to 6) 94 43.5% 76 42.7% 18 47.4% Intermediate (7 to 9) 112 51.9% 94 52.8% 18 47.4% High (≥ 10) 19 4.6% 8 4.5% 2 5.3% 0.829 TE tumor enucleation, SPN standard margin partial nephrectomy, IQR interquartile range.

Optimization Analysis and Design of Electromagnetic Matching Characteristics of Nano Radar Wave Absorbing Materials Based on Computational Intelligence

Nanometer radar wave absorbent is a new type of absorbent with great development prospect, which has important application demand in radar wave application. However, there are great differences in the practical application effects of different nano-radar wave absorbing materials, so it is necessary to optimize and analyze these differences, and the emergence of computational intelligence technology supplements this work. One of the great advantages of computational intelligence is that it does not rely on the correct model of the system when dealing with performance issues, and is affected by a variety of organisms and biota through algebraic methods. The high-level intelligent system with strong cognitive behavior awareness makes each algorithm have the characteristics of parallelism, social behavior, unit intelligence, openness and so on. Based on computational intelligence, this study analyzes the electromagnetic matching characteristics of nano-radar absorbing materials and concludes that: (1) An absorber cell structure with a tunable interface is designed using the tunable FSS bandpass to replace the previous fixed FSS bandpass. The results show that the transmission rate can be adjusted in a certain range and the input loss is low. Meets the design requirements of a customizable absorber. (2) In order to improve the impact force of nano-absorbing materials, it is necessary to analyze the similarities and differences with others, and process the life information after identification. The improved computational intelligence model can extract and analyze the information efficiently and quickly. (3) Under the same thickness of the design, the single-layer fabric has higher electric wave intensity, but the frequency band is narrower, while the double-layer fabric has higher electric wave input bandwidth. Electrical carbon black can be filled with magnetic nanomaterials to enhance radio wave performance. The composite material has very good electric wave mixing performance, and the polar grinding composite nano material is very suitable for improving the magnetic property and the uniformity of the carbon black particles. (4) For a particular secondary channel, consider using a fast numerical algorithm to optimize the path based on the curvature of the key channel. Proper planning in a robotic approach can not only perform the required tasks efficiently, but also improve performance, reduce workload, and extend the lifetime of the robot.

Robotic Transabdominal Approach to Stoma Creation.

Robotic Transabdominal Approach to Stoma Creation.

Comparative analysis of robotic and laparoscopic surgery for mid and low rectal cancer in patients with varied body mass indexes: evaluating of short-term outcomes.

The main aim of this study was to evaluate and contrast the efficacy of robotic and laparoscopic surgical procedures in the treatment of low and mid rectal cancer in different BMI (body mass index) groups. The clinical records of patients who had laparoscopic or robotic proctectomy at a single center between December 2019 and August 2023 were analyzed. Then we utilized a classification framework to categorize individuals based on their BMI into three unique groups: non-obese, overweight, and obese. The short-term efficacy was evaluated. A consecutive sample of 1413 patients was included in this retrospective investigation. 1158 people out of the total sample chose laparoscopic surgery, whereas 255 people chose robotic surgery. In the group of obese people, robotic surgery showed a statistically significant decrease in blood losscompared to laparoscopic surgery (P = 0.026). People who were overweight or obese were in the hospital for a shorter amount of time after robotic surgery than after laparoscopic surgery (P = 0.033 and P = 0.031, respectively). People with different BMIs in the robotic surgery group took less time to have a flatus passage and oral intakethose in the laparoscopic surgery group. Oncological outcomes and the frequency of complicationswere comparable between the two treatments with different BMIs. Surgical resection of patients undergoing low-anterior surgery may benefit from a robotic approach, particularly in overweight and obese patients.

Robotic surgery for bowel endometriosis: a multidisciplinary management of a complex entity

BackgroundBowel endometriosis impacts quality of life. Treatment requires complex surgical procedures with associated morbidity. Precision approach with robotic surgery leads to organ preservation. Bowel endometriosis requires a multidisciplinary management to improve patient outcomes. This study evaluates perioperative outcomes of bowel endometriosis undergoing multidisciplinary planning and robotic surgery.MethodsConsecutive cases of multidisciplinary robotic bowel endometriosis procedures (January 2021–December 2022) were evaluated from a prospectively maintained database in a national endometriosis accredited centre. Patients were managed through a multidisciplinary setting including gynaecologists, colorectal robotic surgeons, and other specialists. Dyschezia (menstrual and non-cyclical) and quality of life were assessed pre- and postoperatively (6 months) through validated questionnaires.ResultsSixty-eight consecutive cases of robotic bowel endometriosis were included. Median age was 35.0 (30.2–42.0) years. Median body mass index was 24.0 (21.0–26.7) kg/m2. Procedures performed were 48 (70.6%) shavings, 11 (16.2%) deep shavings, 3 (4.4%) disc excisions, and 6 (8.8%) segmental resections. One (1.5%) patient required temporary stoma. Median operating time was 150 (120–180) min. There were no conversions/return to theatre postoperatively. Median endometriotic nodule size was 25.0 (15.5–40.0) mm. Two (2.9%) patients developed postoperative complications. Median length of postoperative stay was 2 (2–4) days. Median follow-up was 12 (7–17) months. One (1.5%) patient recurred. Median menstrual dyschezia score improved from 5.0 (2.0–8.0) to 1.0 (0.0–5.7). Median non-cyclical dyschezia significantly improved (p < 0.001) from 1.0 (0.0–5.7) to 0.0 (0.0–2.0). Median quality of life score improved from 52.5 (35.0–70.0) to 74.5 (60.0–80.0).ConclusionsRobotic multidisciplinary approach to bowel endometriosis provides good perioperative outcomes with improvement of dyschezia and quality of life.

Robotic ALPPS for primary and metastatic liver tumours: short-term outcomes versus open approach.

Associating Liver Partition and Portal vein ligation for Staged hepatectomy (ALPPS) is one of the strategies available for patients initially unresectable. High risk of peri-operative morbidity and mortality limited its application and diffusion. We aimed to analyse short-term outcomes of robotic ALPPS versus open approach, to assess safety and reproducibility of this technique. A retrospective analysis of prospectively maintained databases at University of Modena and Reggio Emilia on patients that underwent ALPPS between January 2015 and September 2022 was conducted. The main aim of the study was to evaluate safety and feasibility of robotic approach, either full robotic or only first-stage robotic, compared to a control group of patients who underwent open ALPPS in the same Institution. 23 patients were included. Nine patients received a full open ALPPS (O-ALPPS), 7 received a full robotic ALPPS (R-ALPPS), and 7 underwent a robotic approach for stage 1, followed by an open approach for stage 2 (R + O-ALPPS). PHLF grade B-C after stage 1 was 0% in all groups, rising to 58% in the R + O-ALPPS group after stage 2 and remaining 0% in the R-ALPPS group. 86% of R-ALPPS cases were discharged from the hospital between stages 1 and 2, and median total in-hospital stay and ICU stay favoured full robotic approach as well. This contemporary study represents the largest series of robotic ALPPS, showing potential advantages from full robotic ALPPS over open approach, resulting in reduced hospital stay and complications and lower incidence of 90-day mortality.

Can robotic gastric bypass be considered a valid alternative to laparoscopy? Our early experience and literature review.

Robotic bariatric surgery serves as an alternative to laparoscopy. The technology provides the surgeon with an accurate three-dimensional view, allowing complex maneuvers while maintaining full control of the operating room. We report our experience with this innovative surgery compared with laparoscopy during Roux-en-Y gastric bypass to demonstrate its safety and feasibility. The aim of this study is to evaluate potential differences between the robotic and laparoscopic techniques. Our study retrospectively identified 153 consecutive obese patients who underwent either laparoscopic or robotic gastric bypass (RGB) procedures over a 2-year period at the Department of Medical and Surgical Sciences, University of Foggia. Data on demographics, operative time, conversion rate, length of hospital stay, and mortality were collected and compared between two groups of patients: 82 patients who underwent laparoscopic procedures and 71 who underwent robotic procedures. We analyzed 153 patients who underwent gastric bypass with a mean age of 42.58 years, of whom 74 were female; 71 were treated with a robotic approach and 82 with a laparoscopic approach. The mean operative time was 224.75 ± 10.4 min for RGB (including docking time) and 101.22 min for laparoscopic gastric bypass (LGB) (p < 0.05), which is statistically significant. The median length of stay was 4.1 days for the RGB group and 3.9 days for the LGB group (p = 0.89). There is only one conversion to laparoscopy in the RGB group. We observed only one case of postoperative complications, specifically one episode of endoluminal bleeding in the laparoscopic group, which was successfully managed with medical treatment. No mortality was observed in either group. The statistical analysis shows to support the robotic approach that had a lower incidence of complications but a longer operative duration. Based on our experience, the laparoscopic approach remains a technique with more haptic feedback than the robotic approach, making surgeons feel more confident.This study has been registered on ClinicalTrial.gov Protocol Registration and Results System with this ID: NCT05746936 for the Organization UFoggia (https://clinicaltrials.gov/ct2/show/NCT05746936).

A Portable Artificial Robotic Nose for CO2 Concentration Monitoring

The technological advancements in sensory systems and robotics over the past decade have facilitated the innovation of centralized systems for optimizing resource utilization and monitoring efficiency in inspection applications. This paper presents a novel system designed for gas concentration sensing in environments by implementing a modular artificial nose (emulating the inhalation and exhalation process) equipped with a strategically designed air capture centralization system based on computational fluid dynamics analysis (CFD). The system incorporates three gas identification sensors distributed within the artificial nose, and their information is processed in real-time through embedded systems. The artificial nose is hardware–software integrated with a quadruped robot capable of traversing the environment to collect samples, maximizing coverage area through its mobility and locomotion capabilities. This integration provides a comprehensive perspective on gas distribution in a specific area, enabling the efficient detection of substances in the surrounding environment. The robotic platform employs a graphical interface for real-time gas concentration data map visualization. System integration is achieved using the Robot Operating System (ROS), leveraging its modularity and flexibility advantages. This innovative robotic approach offers a promising solution for enhanced environmental inspection and monitoring applications.

Is Robotic Surgery Beneficial for Rectal Cancer Patients with Unfavorable Characteristic After Neoadjuvant Chemoradiotherapy?

The objective of this study was to compare long-term oncologic outcomes of robot and laparoscopic surgeries for patients with advanced rectal cancer who underwent neoadjuvant chemoradiotherapy (nCRT) followed by radical resection. This study analyzed 3240 rectal cancer patients who underwent radical surgery from 2008 to 2019. Among them, 1204 patients who received nCRT (robotic, n = 316; laparoscopic, n = 888) were analyzed. The oncological outcome according to the number of unfavorable factors (male, body mass index ≥ 25, receiving CCRT) present in patients also was analyzed. We used 1:1 propensity score matching (PSM) to adjust for potential baseline confounders between groups. After PSM, two groups showed similar demographics and pathological results. After PSM analysis, the robotic group showed higher 5-year disease-free survival (DFS) and local recurrence-free survival rates than the laparoscopic group, whereas 5-year overall survival and distant recurrence-free survival rates were similar between the two groups. In addition, by comparing survival rates for each yp stage, it was found 5-year DFS and local recurrence-free survival of the robotic group in yp stage III were significantly higher than those of the laparoscopic group. Five-year DFS was conducted according to the number of unfavorable factors (male, body mass index ≥ 25 kg/m2, and undergoing nCRT) as a subgroup analysis. In patients with all three unfavorable factors, the robotic group showed significantly higher DFS than the laparoscopic group. Robotic approach for rectal cancer after nCRT, especially for patients with yp stage III and unfavorable factors, have the advantage of improving oncologic outcomes even for surgeons specializing in colorectal cancer.

A Comprehensive Review of the Current State of Robot-assisted Laparoscopic Salvage Prostatectomy.

Salvage robot assisted radical prostatectomy (sRARP) is performed for patients with biochemical or biopsy proven, localized prostate cancer recurrences after radiation or ablative therapies. Traditionally, sRARP has been avoided by lower volume surgeons due to technical demand and high complication rates. Post-radiation sRARP outcomes studies exist but remain few in number. With increasing use of whole gland and focal ablative therapies, updates on sRARP in this setting are needed. The aim of this narrative review is to provide an overview of recently reviewed studies on the oncologic outcomes, functional outcomes, and complications after post-radiation and post-ablative sRARP. Tips and tricks are provided to guide surgeons who may perform sRARP. We performed a non-systematic literature search of PubMed and MEDLINE for the most relevant articles pertaining to the outlined topics from 2010-2022 without limitation on study design. Only case reports, editorial comments, letters, and manuscripts in non-English languages were excluded. Key Content and Findings: Salvage robotic radical prostatectomy is performed in cases of biochemical recurrence after radiation or ablative therapies. Oncologic outcomes after sRARP are worse compared to primary surgery (pRARP) though improvements have been made with the robotic approach when compared to open salvage prostatectomy. Higher pre-sRARP PSA levels and more advanced pathologic stage portend worse oncologic outcomes. Patients meeting low-risk, EAU-biochemical recurrence criteria have improved oncologic outcomes compared to those with high-risk BCR. While complication rates in sRARP are higher compared to pRARP, Retzius sparing approaches may reduce complication rates, particularly rectal injuries. In comparison to the traditional open approach, sRARP is associated with a lower rate of bladder neck contracture. In terms of functional outcomes, potency rates after sRARP are poor and continence rates are low, though Retzius sparing approaches demonstrate acceptable recovery of urinary continence by 1 year, post-operatively. Advances in the robotic platform and improvement in robotic experience have resulted in acceptable complication rates after sRARP. However, oncologic and functional outcomes after sRARP in both the post-radiation and post-ablation settings are worse compared to pRARP. Thus, when engaging in shared decision making with patients regarding the initial management of localized prostate cancer, patients should be educated regarding oncologic and functional outcomes and complications in the case of biochemically recurrent prostate cancer that may require sRARP.

Tackling complex thoracic surgical operations with robotic solutions: a narrative review.

The adoption of robotic surgery for general thoracic surgery has rapidly progressed over the last two decades from its application in basic operations to complex pathologies. As such, the purpose of this narrative review is to highlight the collective experience of tackling complex thoracic surgical operations with minimally invasive robotic solutions. Electronic searches of PubMed were conducted for each subtopic, using specific keywords and inclusion criteria. Once identified, the articles were screened through the abstract, introduction, results and conclusion for relevancy, and included based on a standard narrative review inclusion criteria. The role of the robotic approach has increased in thoracic outlet syndrome, chest wall resection, tracheobronchomalacia, airway and sleeve lung surgery, lobectomy after neoadjuvant therapy, complex segmentectomy, giant paraesophageal hernia repair, esophagectomy and esophageal enucleation, mediastinal masses and thymectomy and lung transplantation. Robotic surgery has several advantages when compared to video-assisted and open thoracoscopic surgery. These include better pain control and aesthetic outcome, improved handling of complex anatomy, enhanced access to lymph nodes, and faster recovery rates. Although it is associated with longer operative time, robotic surgery has comparable morbidity rates. The robotic approach to complex thoracic problems is safe, effective, and associated with improved patient outcomes. To encourage wider adoption of robotic technology, increased training and expanded research efforts are essential, alongside improved worldwide access to this technology.

Task-Based Compliance Control for Bottle Screw Manipulation With a Dual-Arm Robot

In this paper, a novel task-based compliance control approach for a dual-arm robot is presented with a bottle screw task. The presented approach aims at overcoming uncertainties from the object model and contact forces during the bottle screw task. A novel framework is proposed to synthesize the task motion planning and compliance control that ensure desired performance of both accuracy and compliant motion. The proposed task-based compliance control approach provides a hierarchical strategy: gross motion planning and fine compliance motion planning. The gross motion planning involves the absolute and relative motion control on a macro scale, while the fine compliance motion planning deals with uncertainties by the compliance control to accomplish a task requiring high precision robustly. A theoretical modeling of the bottle screw task is presented within the proposed framework through the analysis of uncertainties and constraints. The experimental results show that the proposed framework is efficient and robust to operate a set of bottles.

Impact of Body Mass Index ≥35 kg/m2 on Minimally Invasive Adrenalectomy.

Introduction: Obesity is associated with numerous chronic conditions and an increased risk for surgical complications. Laparoscopic and robotic adrenalectomy have proven effective in the resection of adrenal tumors. This study analyzes the outcomes of severely obese patients (body-mass index [BMI] ≥35 kg/m2) following minimally invasive adrenalectomy. Materials and Methods: A retrospective analysis of patients who underwent minimally invasive adrenalectomy at our institution between 2010 and 2023 was conducted. Two matching analyses were performed. The first analysis compared patients with BMI greater versus lower than 35 kg/m2. The second analysis compared outcomes between robotic and laparoscopic adrenalectomy in patients with a BMI ≥35 kg/m2. Results: A total of 278 patients were included in the study. The median tumor size was 29 mm. Adrenal tumors had similar laterality, and most were hormonally active (66.2%). The most common pathological diagnosis was pheochromocytoma (25.5%). No statistical difference was found in peri- and postoperative outcomes between patients with BMI ≥35 and <35 kg/m2 who underwent minimally invasive adrenalectomy. When the surgical approach was compared in severely obese patients, robotic adrenalectomy was associated with shorter hospital length of stay with similar operative time as the laparoscopic approach. Conclusions: Minimally invasive adrenalectomy is safe and feasible in patients with BMI ≥35 kg/m2. Robotic and laparoscopic approaches are both safe and efficient for the resection of adrenal tumors in severely obese patients.

Advancing robust state estimation of wheeled robots in degenerate environments: harnessing ground manifold and motion states

State estimation is crucial for enabling autonomous mobility in mobile robots. However, traditional localization methods often falter in degraded environments, including issues like visual occlusion, lidar performance degradation, and global navigation satellite system signal interference. This paper presents a novel estimation approach for wheeled robots, exclusively utilizing proprioceptive sensors such as encoders and inertial measurement units (IMU). Initially, the motion manifolds extracted from the historical trajectories are used to assist the encoder in realizing the orientation estimation. Furthermore, a hybrid neural network is designed to categorize the robot’s operational state, and the corresponding pseudo-constraints are added to improve the estimation accuracy. We utilize an error state Kalman filter for the encoder and IMU data fusion. Lastly, comprehensive testing is conducted using both datasets and real-world robotic platforms. The findings underscore that the integration of manifold and motion constraints within our proposed state estimator substantially elevates accuracy compared to conventional approaches. Compare with the methods commonly used in engineering, the accuracy of this method is improved by more than 20%. Crucially, this methodology enables dependable estimation even in degraded environments.