Objective: To investigate the therapeutic outcomes of patients with horseshoe kidney and hydronephrosis under different surgical approaches and with or without isthmus division. Methods: This study is a retrospective case series research. A retrospective analysis was conducted on the clinical data of 23 patients with horseshoe kidney and hydronephrosis who underwent pyeloplasty at the Department of Urology, the First Affiliated Hospital of Zhengzhou University from January 2016 to December 2023. Among them, there were 11 males and 12 females, with an age of (33±15) years (range:7 to 64 years). Patients underwent preoperative examinations, including ultrasonography of the urinary system, intravenous urography, CT urography, or magnetic resonance urography. Retrograde urography or antegrade ureteropyelography was performed when necessary to clarify the degree of hydronephrosis, the location and length of ureteral stricture. For patients with severe hydronephrosis, a ureteral stricture segment >2 cm, a thick renal isthmus in horseshoe kidney, and markedly variant vasculature, open surgery or robotic surgery is preferred. For those with mild to moderate hydronephrosis, a ureteral stricture segment <2 cm, a thin renal isthmus in horseshoe kidney, and no significant vascular variations, laparoscopic surgery is the first choice. The decision to perform isthmectomy should be made based on a comprehensive intraoperative assessment, including the vascular supply to the isthmus, the degree of surrounding adhesions, and the thickness of the isthmus. Perioperative parameters and complications were recorded and analyzed, and regular follow-up was conducted for all patients. Results: All surgeries were successfully completed. Surgical approaches included open surgery in 4 cases, laparoscopic surgery in 14 cases, and robot-assisted laparoscopic surgery in 5 cases. The operative time for open surgery, laparoscopic surgery and robot-assisted laparoscopic surgery was (125±12) minutes (range: 112 to 141 minutes), (122±50) minutes (range: 60 to 233 minutes), and (130±36) minutes (range: 76 to 174 minutes), respectively. The blood loss (M(IQR)) was 100 (25) ml (range: 50 to 100 mL) for open surgery, 35 (30) ml (range: 10 to 100 mL) for laparoscopic surgery, and 20 (10) ml (range: 20 to 50 ml) for robot-assisted laparoscopic surgery. Among 15 patients who underwent isthmus division with pyeloplasty (division group), the operation time was (138±42) minutes (range: 73 to 233 minutes), with blood loss of 50 (80) ml (range: 20 to 100 ml). For 8 patients in the non-division group who only underwent pyeloureteroplasty, the operation time was (98±27) minutes (range: 60 to 135 minutes), with blood loss of 20 (50) ml (range: 10 to 100 ml). The follow-up time of patients after surgery was 16.0 (49.0) months (range: 1.7 to 84.2 months), with a surgical success rate of 100%. Among the 8 patients in the non-division group, all demonstrated significant improvement in hydronephrosis severity compared to preoperative conditions. Notably, 6 patients who previously experienced frequent lower back pain showed no recurrence of symptoms after ureteral stent removal. In the division group of 15 patients, both subjective symptoms and hydronephrosis severity were markedly reduced. Conclusion: For patients with horseshoe kidney and hydronephrosis, the choice of surgical approach and isthmus management strategy should be determined based on a comprehensive consideration of the etiology of hydronephrosis, the degree of ureteral stricture, anatomical abnormalities, and vascular variations.

MIS techniques achieved in the last decades have improved the quality of interventions and patient recovery, although there are still doubts about how they affect surgeons' health. This study aims to analyze the relationship between surgeon physiological and subjective stress parameters during laparoscopic and robot-assisted laparoscopic surgery (RALS) and the quality of surgical performance by means of wearable technology. This study was conducted in a simulation environment with tasks involving hand-eye coordination and technical surgical skills. Sixteen surgeons from three different surgical disciplines participated in this study using both a conventional laparoscopic technique and the Versius® robotic platform for RALS. Two wearable sensors were used to analyze surgeons' physiological stress, as well as a subjective questionnaire for stress assessment during surgical practice (SURG-TLX). The results of the data analysis showed that stress experienced was reduced in RALS when compared to conventional laparoscopy, and with it the percentage of errors committed. Novice surgeons performed better in most parameters compared to experienced microsurgeons. Surgeons without previous experience in laparoscopic surgery showed an improvement in their stress and surgical performance when using robot-assisted surgery.

Reversal of rocuronium-induced neuromuscular blockade (NMB) is possible with either neostigmine or sugammadex to prevent residual NMB. In adults, sugammadex provides faster reversal and has fewer side effects compared to neostigmine, even when combined with glycopyrrolate. In elderly patients, rocuronium has a longer onset time and duration of action; however, little is known about the reversal of rocuronium-induced NMB with either sugammadex or neostigmine and the recovery of muscle function postoperatively. The aim of this study was to determine the time to full recovery of neuromuscular function, defined as Train of Four ratio (TOF) ≥ 0.9 after reversal with either neostigmine 50 μg kg-1 or sugammadex 2 mg kg-1 in elderly patients aged 75 years or above undergoing total intravenous anaesthesia with rocuronium-induced moderate NMB. We hypothesised that sugammadex 2 mg kg-1 provides a shorter time to TOF ≥ 0.9 compared to neostigmine 50 μg kg-1. We included 41 patients aged ≥ 75 years with American Society of Anesthesiologists (ASA) physical health classes I-IV scheduled for robotic-assisted laparoscopic surgery under total intravenous anaesthesia with rocuronium. Patients were randomised to reversal with neostigmine/glycopyrrolate 50/10 μg kg-1 or sugammadex 2 mg kg-1 if the depth of NMB was within the range from TOF count of 2 to a TOF ratio < 0.60. The primary outcome was time to TOF ≥ 0.9, measured from the start of administration of the reversal agent. Secondary outcomes were signs of residual NMB within 90 min after administration of the reversal agent. A total of 40 patients were evaluated for the primary outcome. A total of 17 patients received neostigmine/glycopyrrolate and 23 patients received sugammadex. Time to TOF ≥ 0.9 was significantly shorter with sugammadex: 147 s (SD 100) vs. 573 s (SD 501) with a difference of 427 s (95% CI: 205 to 648). No difference was found in the occurrence of clinical signs of residual NMB. Time to TOF ≥ 0.9 was shorter after reversal with sugammadex 2 mg kg-1 compared to neostigmine/glycopyrrolate 50/10 μg kg-1 in elderly patients administered rocuronium during total intravenous anaesthesia. For neostigmine a large variation in time to recovery was detected. No significant difference in clinical signs of residual NMB was found. This trial in an elderly surgical cohort assessed reversal times for rocuronium comparing sugammadex and neostigmine. Sugammadex demonstrated faster and more predictable reversal effects in this cohort. ClinicalTrials.gov identifier: NCT06228092.

This study compares robotic-assisted pancreatic surgery (R-PS) and laparoscopic pancreatic surgery (L-PS) outcomes in patients with pancreatic malignancies and medium- to high-risk pancreatic fistulas. A retrospective cohort study was conducted at Guangdong Provincial People's Hospital (2021-2023). The primary endpoints were major complications (Clavien-Dindo grade≥III) and postoperative morbidity. 200 R-PS and 400 L-PS patients were included, with 163 pairs matched. R-PS showed lower conversion rates (2.5% vs. 17.2%, p<0.001), less blood loss (119 vs. 179mL, p=0.013), and faster function recovery (8.2 vs. 9.6days, p=0.038). Postoperatively, R-PS had fewer pancreatic fistulas in malignant (4.1% vs. 32.6%, p<0.001) and moderate to high-risk cases (8.3% vs. 16.7%, p=0.026). R-PS benefits are not procedure-specific. R-PS offers advantages in blood loss, complications, and fistula prevention, suggesting it may be preferable for complex pancreatic surgeries.

In this report, we describe two cases of diaphragmatic endometriosis with concurrent hepatorenal recess peritoneal involvement managed using robotic-assisted laparoscopic surgery with the da Vinci Xi platform. In both patients, diaphragmatic implants and hepatorenal recess peritoneal lesions were excised en bloc, followed by resection of additional pelvic and abdominal lesions. Case 1 involved a 45-year-old woman whose pathology confirmed endometriosis in 28 of 46 sites, including the diaphragm, umbilicus, bowel, hepatorenal recess peritoneum, and pelvic peritoneum. Case 2 involved a 32-year-old woman with histopathologic evidence of endometriosis in 26 of 34 resected sites, including the appendix, diaphragm, hepatorenal recess peritoneum, pelvic peritoneum, and large colon. The total operative times were 344 min for Case 1 and 193 min for Case 2, with estimated blood losses of 50 and 15 mL, respectively. Both procedures were completed using minimally invasive techniques, with uneventful postoperative recovery. To our knowledge, these cases represent the first report of robot-assisted minimally invasive resection of concurrent diaphragmatic and hepatorenal recess peritoneal endometriosis. Robotic surgery offers superior visualization and instrument dexterity, enabling safe excision of complex extrapelvic disease.

Utility and safety of near-infrared fluorescent marking clips for tumor localization in robot-assisted laparoscopic gastric cancer surgery.

We report a young female patient with a giant left renal angiomyolipoma (AML) and multiple left retroperitoneal AML. After undergoing robotic-assisted laparoscopic surgery, the tumor was successfully removed cleanly while preserving the normal renal unit. On the fourth day after surgery, she developed respiratory symptoms, including chylothorax, and was diagnosed with sporadic lymphangioleiomyomatosis (LAM) combined with multiple AML. After receiving sirolimus and symptomatic treatment, the patient recovered and had no recurrence of the disease during the follow-up period. This case demonstrates the significant application of robot-assisted laparoscopic nephron-sparing surgery in the treatment of a giant renal angiomyolipoma (14.0 cm in diameter), highlighting its feasibility and effectiveness in managing complex multifocal disease while preserving renal function.

Robot-assisted surgery for pediatric tumors: A single-center study of 114 cases.

BACKGROUND: The current literature contains a considerable number of reports on robot-assisted pediatric surgery, particularly regarding procedures performed on the genitourinary system. However, reports of operations on the digestive organs—especially the esophagus—are much less common. AIM: To evaluate the efficiency and safety of the robot-assisted esophageal surgery. METHODS: Аn incomparable clinical trial was conducted using the medical records of six patients who underwent robot-assisted thoracoscopic and laparoscopic esophageal surgery over a 24-month period starting in December 2022. All patients were treated in accordance with protocols approved by clinical guidelines or national recommendations for pediatric surgery. The indications for surgery included persistent anatomical and functional disorders unresponsive to conservative therapy, risk of future organ damage, and were determined following thorough examination. Robotic procedures were performed in one patient with a cystic duplication of the thoracic esophagus, two patients with achalasia of the cardiac section, and three patients with gastroesophageal reflux. RESULTS: A total of 18 patients who underwent robot-assisted esophageal surgery were included in the study. Robotic procedures were performed in one patient with cystic duplication of the thoracic esophagus, five patients with achalasia of the cardiac section, and twelve patients with gastroesophageal reflux. The mean age at surgery was 7.6 ± 3.6 years (median = 7.0 [5.0; 10.0]), and mean body weight was 30.6 ± 20.4 kg (median = 23.0 [15.0; 50.0]). The average operative time was 132.7 ± 34.8 minutes (median = 125.0 [105.0; 155.0]). No intraoperative complications such as bleeding, organ perforation, or injury to adjacent structures were recorded, and there were no conversions to laparoscopic, thoracoscopic, or open surgery. The mean stay in the intensive care unit was 17.0 ± 7.8 hours (median = 22.0 [8.0; 24.0]), and the mean hospital stay was 4.0 ± 1.1 days (median = 4.0 [3.0; 5.0]). No significant postoperative complications or recurrence of symptoms were observed during follow-up, and all patients demonstrated normal digestive function throughout the observation period. CONCLUSION: Robot-assisted thoracoscopic and laparoscopic surgical approaches are safe and effective methods for treating esophageal diseases in children.

Background and Objectives: Remimazolam is a recently introduced benzodiazepine that has been increasingly adopted as an alternative to propofol. Although several trials have compared remimazolam with propofol, these studies have primarily focused on induction-related hypotension in non-gynecologic settings. To the best of our knowledge, both intraoperative hypertension and hypotension have not been systematically evaluated throughout the full anesthetic course in the specific physiologic context of robot-assisted laparoscopic gynecologic surgery performed in the steep Trendelenburg position with pneumoperitoneum. Materials and Methods: In this retrospective study, propensity score matching was performed to minimize selection bias. The demographic data of 694 patients, along with the incidence of intraoperative hypertension and hypotension, were collected through a review of medical records. Results: A total of 694 patients met the selection criteria, all of whom underwent total intravenous anesthesia (TIVA) using either remimazolam (n = 321) or propofol (n = 373). After propensity score matching, 317 pairs were analyzed. The incidence of intraoperative hypertension was higher in the remimazolam group (66.2% vs. 52.1%; p < 0.001), whereas hypotension was more frequent in the propofol group (12.0% vs. 5.4%; p = 0.003). Conclusions: TIVA with remimazolam was associated with a higher incidence of intraoperative hypertension compared to propofol, whereas propofol was more likely to cause hypotension in patients undergoing laparoscopic gynecologic surgery.

This study utilizes bibliometric and visualization techniques to systematically analyze global development trends in robot-assisted laparoscopic surgery for gastrointestinal diseases. Using the Web of Science Core Collection and Scopus as the data source, 4,214 relevant articles published between 1999 and 2025 were extracted. Tools such as VOSviewer, CiteSpace, Scimago Graphica, and Origin were employed to analyze academic output, collaboration networks, influence distribution, and research hotspots. The results show significant growth in academic productivity and citation impact in this field, with acceleration after 2020. The United States leads globally in research output and influence, while countries such as China, Japan, Italy, and South Korea also exhibit strong capabilities. At the institutional and author levels, Yonsei University and the Mayo Clinic are high-output institutions, with core scholars such as Hyung Woo Jin and Pigazzi Alessio driving the field. In journal influence, Surgical Endoscopy and Other Interventional Techniques leads in publication quantity, while Annals of Surgery tops quality evaluations with the highest H-index and impact factor. Keyword analysis reveals a shift in research hotspots from early "experience" accumulation to higher level evidence-based studies, with recent focuses on "risk" management and "surgical outcomes" reflecting a discipline-wide transition from technology-centered to patient-centered, full-cycle outcome assessment. This study comprehensively reveals the current status and trends in global robot-assisted laparoscopic surgery research for gastrointestinal diseases, providing directional guidance and research insights for its development and clinical evaluation.

Safety and efficacy of AirSeal® continuous pressure insufflator for pneumoperitoneum maintenance in minimally invasive pediatric urologic surgery.

Objective: This study aimed to compare the clinical efficacy of da Vinci robot-assisted subtotal colectomy with laparoscopic surgery in the treatment of slow transit constipation. Methods: A retrospective cohort study was performed. The clinical and follow-up data of 95 patients with slow transit constipation who underwent robotic or laparoscopic subtotal colectomy at the First Affiliated Hospital of Harbin Medical University from July, 2022 to August, 2024 and had a follow-up period of 6 months were retrospectively analyzed. Patients were divided into a robotic surgery group (43 cases) and a laparoscopic surgery group (52 cases) according to surgical approaches. All patients underwent preoperative colonic transit study, barium enema radiography, defecography, and colonoscopy to confirm the diagnosis of slow transit constipation. There were no statistically significant differences in baseline data between the two groups (all P>0.05). Primary observation indicators included Wexner constipation score, gastrointestinal quality of life score, and the time of first ambulation after surgery. Secondary observation indicators included operation time, intraoperative blood loss, first defecation time, length of hospital stay, postoperative defecation frequency, postoperative complications, surgical satisfaction, and postoperative pain. The Wexner constipation score was evaluated at 6 months after surgery as well, and a total score of 15 or above was defined as constipation; the higher the score, the more severe the constipation. The gastrointestinal quality of life index was also evaluated at 6 months after surgery; the lower the score, the poorer the quality of life. Pain assessment was conducted on the 2nd day after surgery using the visual analogue scale (VAS) for self-assessment, and here a higher score indicated greater pain intensity. Observe the patients' intraoperative and pastoperative conditions. Results: Both groups completed the surgery unevenifullg without conversion to laparotomy, and no severe intraoperative complications occurred. Compared to the laparoscopic surgery group, the robotic surgery group had significantly shorter first ambulation time ([18.5±1.3] hours vs. [24.5±0.6] hours, t=-30.437, P<0.001), first defecation time ([21.2±2.2] hours vs. [24.9±0.9] hours, t=-10.818, P<0.001), and hospital stay ([7.8±1.5] days vs. [9.4±3.3] days, t=-3.069, P=0.003), all P<0.05. There were no statistically significant differences between the two groups in terms of operation time, intraoperative blood loss, postoperative pain score, defecation frequency, or incidence of postoperative complications (all P>0.05). Follow-up at 6 months post-operation also showed no statistically significant differences between the two groups in terms of Wexner score, gastrointestinal quality of life score, daily defecation frequency, or surgical satisfaction (all P>0.05). When comparing the follow-up scores between postoperative and preoperative periods in each group, both Wexner scores (laparoscopic group: [2.2±1.2] vs. [17.7±0.9], t=83.580, P<0.001; robotic group: [2.6±1.2] vs. [17.5±0.8], t=69.274, P<0.001) and gastrointestinal quality of life scores (laparoscopic group: [108.6±4.4] vs. [76.0±4.6], t=-41.442, P<0.001; robotic group: [109.3±6.1] vs. [77.8±6.4], t=-29.939, P<0.001) were significantly improved. No additional complications or recurrence were observed in both groups at 6 months post-operation. Conclusion: Compared to laparoscopic subtotal colectomy, da Vinci robot-assisted subtotal colectomy for slow transit constipation is associated with faster postoperative recovery and shorter hospital stays, and the operative times and therapeutic efficacy are similar between the two approaches.

Robot-assisted laparoscopic partial nephrectomy (RALPN) has increasingly emerged as a primary minimally invasive surgical approach for managing renal masses. In China, most urologic surgeons lack experience in transperitoneal laparoscopic partial nephrectomy, and limited research exists on the learning curve for transperitoneal RALPN. This study applies cumulative sum (CUSUM) analysis to evaluate the learning curve, providing clinical suggestions. We recruited patients who underwent transperitoneal RALPN performed by a single surgeon between March 2017 and December 2023. The learning curve was evaluated using CUSUM analysis of operative time (OT). The curve's peak was used as the cutoff point to stratify patients for comparative analysis of clinical characteristics and perioperative outcomes. In addition, multivariate linear regression analysis was used to identify potential factors influencing OT. 119 patients were enrolled. The curve peaked at the 38th case and subsequently declined, dividing the patients into two groups: the learning phase (38 cases) and the mastery phase (81 cases). OT (115 vs. 150min., P < 0.001), WIT (19 vs. 24min., P < 0.001), and hospital stay (6 vs. 7days, P = 0.005) were lower in the mastery phase. Tumor size (P = 0.027) and surgeon experience (P < 0.001) were identified as potential risk factors for OT. This study demonstrates that the learning curve for transperitoneal RALPN is relatively short. Comparative analysis of perioperative outcomes revealed superior outcomes during the mastery phase. These findings may serve as a benchmark for urologic surgeons' skill acquisition.

To develop a fault identification, troubleshooting, and rapid recovery system for da Vinci robot-assisted laparoscopic surgery (referred to as the "robot") to enhance clinical decision-making and ensure patient safety during robotic procedures. We retrospectively analyzed 4,784 surgeries performed using the "Si" robot at our hospital from September 2014 to May 2023, identifying 105 fault instances, and 776 surgeries using the "Xi" robot from April 2022 to May 2023, with 18 fault instances. Fault repair videos, images, and data from both robots were collected, supplemented by technical support from Chindex Medical Limited and related literature. Based on these data, we established a fault identification, troubleshooting, and rapid recovery system. The system's effectiveness was evaluated by comparing fault rates, fault categories, nurses' accuracy in fault identification and troubleshooting, and repair times before and after system implementation. Significant differences were observed in fault rates, fault categories, nurses' accuracy in fault identification and troubleshooting, and repair times before and after system implementation for both the "Si" and "Xi" robots (all P < 0.05). The "Si" robot showed a significant reduction in non-recoverable fault rates (P < 0.05), while the "Xi" robot demonstrated a significant improvement in recoverable fault rates (P < 0.05). The developed system improved nurses' adherence to operational standards, enhanced fault identification accuracy, reduced repair times, increased robotic surgery efficiency, and improved nursing collaboration quality.

Splenic artery aneurysms (SAA) are the most common visceral aneurysm andmay develop significant risk for rupture and life-threatening complications when more than 3 cm, in pregnancy, or if resembling pseudoaneurysms. Traditional treatment options of open surgical repair and endovascular repair have been extensively studied, but the role of robotic-assisted laparoscopic surgery in definitively managing SAA is emerging as a promising minimally invasive alternative in select pathology. This case aims to present the technical details, challenges, and outcomes of an SAA in a young woman treated with robotic-assisted laparoscopic resection, highlighting the feasibility and efficacy of this approach. A 38-year-old woman with no significant past medical history was incidentally found to have a distal third splenic artery aneurysm measuring 2.2 cm in diameter and was referred to a vascular surgery clinic for further evaluation. Although she was not pregnant at the time, she was undergoing fertility treatments with plans for assisted pregnancy. She requested definitive aneurysm treatment, wished to avoid multiple interventions, and intended to become pregnant via IVF within the coming year, making repeated axial imaging unsuitable for follow-up. Imaging evaluation revealed the aneurysm sac contained one prominent feeding artery and two highly tortuous draining branches. After providing informed consent, the patient underwent successful robotic-assisted laparoscopic excision of the splenic artery aneurysm. Robotic-assisted laparoscopic surgery represents a valuable approach for the definitive management of distal splenic artery aneurysms or aneurysms involving highly tortuous vessels, conditions historically requiring open surgical ligation, resection, or vascular reconstruction. This paper illustrates how challenging aneurysms can be precisely visualized, dissected, and managed using robotic-assisted laparoscopy with the DaVinci surgical system, highlighting key minimally invasive techniques for optimal exposure and vascular control in splenic artery aneurysm repair.

Objective: The primary objective of this study was to evaluate the evolution of surgical approaches in the management of endometrial cancer in Polish tertiary referral hospitals, comparing the use of minimally invasive surgery (MIS) and laparotomy in 2023 versus 2013. Methods: This retrospective observational study analyzed data from tertiary referral centers in Poland. All surgeries performed for apparently early-stage endometrial cancer in 2013 and 2023 were included. Results: A total of 1062 patients were analyzed, with 417 undergoing operations in 2013 and 640 in 2023. In 2013, 92.6% (386/417) of patients underwent laparotomy. By 2023, 80.1% (513/640) of patients were treated using minimally invasive approaches, including laparoscopy (56.2%, 362/640), robotic-assisted laparoscopy (21.7%, 139/640), and vaginal surgery (1.9%, 12/640). No conversions to laparotomy were recorded in 2013. In 2023, 22 conversions occurred-21 in the laparoscopy group (5.8%, 21/362) and one in the vaginal surgery group (8.3%, 1/12). No conversions were reported in the robotic-assisted group. Intraoperative complications were observed in 2.2% (8/362) of laparoscopic cases, and postoperative complications in 4.4% (16/362). In the robotic-assisted group, one intraoperative complication (0.7%) was reported, with no postoperative complications. Conclusions: Over the past decade, there has been a significant shift in the surgical management of endometrial cancer in Poland, with a growing preference for minimally invasive surgery (MIS). The rate of conversion from MIS to laparotomy remains below 6%. Robotic-assisted laparoscopic surgery may offer additional benefits, particularly for obese patients.

Background: There is limited clinical evidence from India comparing robotic-assisted surgery (RAS), laparoscopic surgery (LPS), and open laparotomy (OL) approaches for managing stage 1 endometrial cancer (EC). This multicenter study aimed to evaluate and compare the perioperative and short-term outcomes of these techniques across high-volume Indian institutions.Methodology: This multicenter, retrospective, non-randomized comparative study reviewed medical records of consecutive patients who underwent OL, LPS, or RAS for stage 1 EC between January 2010 and December 2023.Results: A total of 2,090 patient records were analyzed, including 1,223 in the RAS group, 451 in the LPS group, and 416 in the OL group. The average age was 59.66 ± 9.31 years, with no significant differences between groups. The overall mean operative time was 220.51 ± 93.73 minutes, with the RAS group demonstrating a significantly shorter duration than both OL and LPS groups (P < 0.001). The mean estimated blood loss was 128.87 ± 226.75 mL, with the RAS group resulting in the least blood loss, followed by the LPS and OL groups (P < 0.001). The need for intraoperative blood transfusion was also lowest in the RAS group. Intraoperative complications were more frequent in the OL group, while conversion to open surgery was higher in the LPS group (P < 0.001). Hospital stay was shortest in the RAS group (2.71 days), followed by the LPS (3.77 days) and OL (5.95 days) groups (P < 0.001). Postoperative complications were significantly fewer in the RAS and LPS groups than in the OL group. Positive margins were lowest in the RAS group (P < 0.001). Sentinel lymph node sampling was highest in the RAS group (P < 0.001). Patients in the RAS group started adjuvant treatment sooner than the LPS (P < 0.001) and OL (P = 0.004) groups.Conclusions: This study reports the first multicentric evidence for RAS in Indian settings, compared to conventional approaches, and offers encouraging outcomes.

Surgical robots capable of autonomously performing various tasks could enhance efficiency and augment human productivity in addressing clinical needs. Although current solutions have automated specific actions within defined contexts, they are challenging to generalize across diverse environments in general surgery. Embodied intelligence enables general-purpose robot learning with applications for daily tasks, yet its application in the medical domain remains limited. We introduced an open-source surgical embodied intelligence simulator for an interactive environment to develop reinforcement learning methods for minimally invasive surgical robots. Using such embodied artificial intelligence, this study further addresses surgical task automation, enabling zero-shot transfer of simulation-trained policies to real-world scenarios. The proposed method encompasses visual parsing, a perceptual regressor, policy learning, and a visual servoing controller, forming a paradigm that combines the advantages of data-driven policy and classic controller. The visual parsing uses stereo depth estimation and image segmentation with a visual foundation model to handle complex scenes. Experiments demonstrated autonomy in seven game-based skill training tasks on the da Vinci Research Kit, with a proof-of-concept study on haptic-assisted skill training as a practical application. Moreover, we conducted automation of five surgical assistive tasks with the Sentire surgical system on ex vivo animal tissues with various scenes, object sizes, instrument types, and illuminations. The learned policies were also validated in a live-animal trial for three tasks in dynamic in vivo surgical environments. We hope this open-source infrastructure, coupled with a general-purpose learning paradigm, will inspire and facilitate future research on embodied intelligence toward autonomous surgical robots.

In recent years, surgical approaches for treating colorectal cancer have shifted from open surgery to laparoscopic surgery and, more recently, to robot-assisted surgery (RAS), yet their relative impact on postoperative inflammation and pain remains unclear. Therefore, this study aimed to compare the postoperative C-reactive protein/albumin ratio (CRA) and Numerical Rating Scale (NRS) scores between RAS and single-incision laparoscopic surgery (SILS) for right-sided colon cancer to assess which surgical modality might be more minimally invasive. We retrospectively analyzed 180 patients who underwent surgical resection for right-sided colon cancer at Saitama Medical University International Medical Center (Hidaka, Saitama, Japan) between March 2021 and October 2024. Among these patients, 80 underwent RAS (RAS group) and 100 underwent SILS (SILS group). Propensity score matching (PSM) was applied, and 67 patients from each group were selected for comparison. Primary outcomes were the CRA and pain intensity on the NRS on postoperative days (POD) 1 and 3. Secondary outcomes included operative time, blood loss, and major complications (Clavien-Dindo > II). After PSM, there were no significant differences in the patient background variables, including the preoperative CRA, between the groups. The operative time was significantly shorter in the SILS group than in the RAS group (SILS vs. RAS: 157 vs. 193min, p < 0.001). Although the CRA did not differ on POD 1 and 3, the SILS group had a significantly higher CRA than the RAS group. The RAS group had a significantly lower NRS score on POD 1. For right-sided colon cancer surgery, SILS involves fewer and smaller incisions and a shorter operative time. However, RAS was associated with a lower early postoperative inflammatory response and pain in this PSM comparison. The refined precision and reduced tissue manipulation offered by robotic systems may explain these differences.