Robot-assisted Surgery Research Articles

The state of robotic surgery in Spain: Results of a national survey on robotic surgery.

To assess the present state of robotic surgery and the surgical approaches employed by urology departments utilizing robotic systems in Spain. An email invitation was sent to heads of urology departments in public and private hospitals with surgical robots. A 78-question online questionnaire was distributed, and data were collected over 3 months. Of 82 invitations, 57.31% responded, mostly male (95.7%) urologists over 50 years old, with 77.8% having more than 20 years of practice. About 45.7% worked in both public and private settings. Most units use robots 1-3 days per week, with 56.1% of these units having 1-3 surgeons trained. 92.3% of respondents had laparoscopic experience, and 71.1% received robotic surgery training from the robot company. Radical prostatectomy, pyeloplasty, and cystectomy are mainly performed robotically, while other surgeries vary in approach. Robotic surgery has been firmly established in Spain, although the percentage of surgeries in robotic units remains low. Radical prostatectomy, pyeloplasty, and radical cystectomy with diversion are the most commonly performed techniques using robotic approaches.

Robot-assisted retroperitoneoscopic kidney surgery with Versius®.

Robot-assisted retroperitoneoscopic kidney surgery with Versius®.

The Integration of Robotics in Surgery: Advancements, Challenges, and Future Prospects

The integration of robotics in surgery marks a transformative advancement in modern medicine, offering unprecedented precision, control, and minimally invasive options. This paper explores the evolution of robotic-assisted surgical systems, from early prototypes to sophisticated platforms like the da Vinci Surgical System, which have redefined operative procedures across multiple specialties. By analyzing key advancements, including enhanced visualization, precise articulation, and AI-assisted decision-making, this study highlights how robotics improves surgical outcomes, reduces recovery times, and minimizes complications. Despite these benefits, the adoption of surgical robotics faces challenges, including high costs, steep learning curves for surgeons, and regulatory hurdles. Additionally, the ethical implications of robotic autonomy in critical medical procedures prompt ongoing debate. This paper also examines the future prospects of robotics in surgery, such as AI-driven diagnostics, remote surgeries, and potential full automation. Through a comprehensive review, this study seeks to provide a nuanced understanding of the impact of robotics on surgical practice and healthcare outcomes, offering insights into both the potential and limitations of robotic integration in surgery.

Open versus robotic-assisted techniques for multivisceral pelvic resections of locally advanced or recurrent colorectal and anal cancers: short-term outcomes from a single centre

BackgroundPelvic exenterations are now established as a standard of care for locally advanced and recurrent rectal cancer. Traditionally, these radical and complex operations have been performed via an open approach, but with the increasing expertise in robotic-assisted surgery (RAS), there is scope to perform such cases robotically. This study compares outcomes from open and RAS pelvic exenterations.MethodsThis retrospective observational study includes all pelvic exenterations for locally advanced or recurrent colorectal cancers performed in a single centre between September 2018 and September 2023. Cases were grouped into open or RAS surgery and classified in terms of operative extent and complexity. The primary outcome was resection margin status. Secondary outcomes were postoperative morbidity, length of stay and blood loss.ResultsThirty-three patients were included. Nineteen (57.6%) cases utilised an open technique, and 14 (42.4%) used RAS. Patient characteristics and operative complexity were equivalent between groups. R0 rate (63.1% vs 71.4%, p = 0.719), median haemoglobin drop (19 (11–30) g/L vs 13 (5–26) g/L, p = 0.208) and postoperative morbidity (18/19 (94.7%) vs 9/14 (64.3%), p = 0.062) were equivalent. Length of stay (16.0 days (8–25) vs 9.5 days (6–16), p = 0.047) was shorter in the RAS group.ConclusionsShort-term surgical and histopathological outcomes are equivalent in this small cohort of patients. This study suggests that RAS may be a safe and effective method for performing pelvic exenterations for colorectal malignancies. Larger-scale and robustly designed prospective studies are required to confirm these preliminary findings and report on long-term oncological outcomes.

What Is Needed to Determine and Potentially Improve the Clinical Effectiveness and Cost-Effectiveness of Robot-Assisted Reconstructive Urinary Tract and Pelvic Floor Surgery?-ICI-RS 2024.

Robot-assisted (RA) surgery has many advantages for urinary tract and pelvic floor reconstruction (UTPFR) but its application is only slowly increasing. Studies are limited in number, patients and follow-up duration. The low-volume high-complexity nature of UTPFR warrants specific research to evaluate the potential role of the RA approach. During its 2024 meeting in Bristol, the International Consultation on Incontinence-Research Society (ICI-RS) reviewed the current literature on RA UTPFR. Priority research questions and strategies were explored in a proposal. Four different topics were discussed. (1) Large multicentre prospective studies on RA UTPFR are needed to evaluate clinical effectiveness and safety. The RA approach needs to be prioritized in specific procedures and patients, to first improve patient care where gains are highest. (2) Models for cost-utility analysis for RA UTPFR are needed to (re)direct limited resources as efficiently as possible in a quickly changing technological field. (3) A modular curriculum for training UTPFR surgeons to become RA certified needs to be developed, to allow valid interpretation and comparison of outcomes. (4) Technological improvements to address tissue handling, accessibility, efficiency and sustainability are needed. Digitalization can be a gamechanger for RA UTPFR through telesurgery (training and expertize coverage), augmented reality and artificial intelligence providing intra-operative assistance, assessment and feedback. The proposal discussed the need for studies on clinical and cost effectiveness, safety, and training curriculum development for RA UTPFR. Recent technological developments hold great promise for RA UTPFR. High-priority research questions were identified.

Enhancing decision-making with linear diophantine multi-fuzzy set: application of novel information measures in medical and engineering fields

This study offers a comprehensive analysis of novel information for linear diophantine multi-fuzzy sets and illustrates its applications in practical scenarios. We introduce innovative similarity metrics tailored for linear diophantine multi-fuzzy sets, including Cosine similarity, Jaccard similarity, and Exponential similarity. Additionally, we propose Entropy, Inclusion, and Distance measures, providing a robust theoretical foundation supported by developed theorems that explain the interactions between these metrics. The practical implications of these theoretical advancements are demonstrated through various case studies. Specifically, we apply the similarity measures to predict preeclampsia, a severe condition affecting pregnant women, showcasing their potential in medical diagnostics. The entropy measure is used to identify the optimal materials manufacturing method for medical surgical robots, underscoring its importance in ensuring patient safety and the effectiveness of medical procedures. Furthermore, the inclusion measure is employed in pattern recognition tasks, highlighting its utility in complex data analysis. The comparative and superiority analysis shows the effectiveness of our research. The novel aspect of this study is the implementation of information metrics for LDMFS. These efforts aim to enhance the impact and practical applicability of linear diophantine multi-fuzzy sets, fostering innovation and improving outcomes across multiple fields.

From Surgical Procedures to Glovebox Processing: Enhancing Safety and Efficiency in Glovebox Operations for High-Consequence Materials

High-consequence materials, such as nuclear waste, pose significant risks if improperly handled. Gloveboxes provide a controlled environment to manage these materials safely, yet they present challenges in operator safety, efficiency, and ergonomics. This paper addresses these challenges by presenting a proof-of-concept framework for Semi-Autonomous Robot Teleportation for Nuclear Glovebox Processing (SART-NGP). Unlike the existing manual systems already in use at nuclear facilities, the SART-NGP framework incorporates adjustable autonomy capabilities, drawing inspiration from advancements in surgical robotics. By integrating high-level human inputs, semi-autonomous execution, robust feedback mechanisms, and a simulator-based interface, this framework significantly enhances safety and efficiency while alleviating ergonomic concerns associated with glovebox processing in nuclear facilities. Although we have not fully solved the challenges associated with nuclear glovebox processing, our research provides promising insights and methodologies that may significantly improve the management of high-consequence materials and augments existing efforts in self-driving labs for glovebox operations. The findings suggest that the SART-NGP framework holds substantial potential for enhancing glovebox processing in nuclear facilities, with future work focusing on its real-world implementation and evaluation.

The experience with Hugo™ robot-assisted surgery on complex gynecological patients in Panama.

The Hugo™ robotic assisted surgery system is a relatively new robotic platform developed by Medtronic. The study objective was to describe the experience of using Hugo™ robotic assisted surgery in gynecological surgeries and compare robotic assisted surgery-related outcomes between complex and non-complex gynecological patients at the Pacifica Salud Hospital. We performed secondary data retrospective analysis of 144 consecutive patients who underwent gynecological surgery with Hugo™ robotic assisted surgery system (Medtronic) at the Pacifica Salud hospital in Panama City from July 19, 2021, to August 3, 2023. Complex patients were defined as those with one or more risk factors for surgery complications. Descriptive analysis of participants' sociodemographic and robotic assisted surgery-related characteristics. Due to the non-normal distribution of the RAS-related numeric variables, we compared these variables between complex and non-complex cases of gynecological patients using Kruskal-Wallis's test. The study found that Hugo™ robotic assisted surgery system was safe for gynecological surgery in patients with and without risk factors for developing major surgery complications. None of the patients experienced any complications, and they had short hospital stays with low blood loss without requiring a blood transfusion. The Hugo™ robotic assisted surgery system was technically sound and did not present technical failures. The results could be a reference for adopting this technology and developing best practices in the Latin American region.

Comparison of outcomes between single-port and multi-port robotic radical nephrectomy.

Single-port (SP) robotic surgery is a novel technology, and although there is emerging data, it remains limited in assessing single-port (SP) robot-assisted surgery as an alternative to multi-port (MP) platforms. To compare perioperative and postoperative outcomes between SP and MP robotic technologies for radical nephrectomy (RN). This is a retrospective cohort study of patients who have undergone robot-assisted radical nephrectomy using either the SP or MP technology. Baseline demographics, clinical, tumor-specific characteristics, and perioperative and postoperative outcomes were compared using χ2, t-test, Fisher exact test, and Mann-Whitney U test. Multivariable analyses were conducted using robust, Poisson, and logistic regressions. A total of 341 patients underwent robotic RN with 47 patients (14%) in the SP group. The two groups exhibited similar baseline characteristics, with no significant differences in age, sex, body mass index, Charlson comorbidities index, and tumor laterality. However, SP group had a smaller average tumor size (5.1cm vs 6.4cm, p = 0.009). The SP had longer operative time (178 ± 84min vs 142 ± 75min; p = 0.011) but showed no significant difference in the estimated blood loss, blood transfusion rate, length of stay, overall 30-day and major complication rates. Controlling for other variables, SP was significantly associated with a longer operative time and shorter length of stay. SP is associated with longer operative time but offers advantages such as smaller incisions and shorter hospital stays with a comparative safety profile to MP for radical nephrectomy.

Comparison between robotic-assisted Kasai portoenterostomy and open Kasai portoenterostomy in patients with biliary atresia.

Robotic-assisted Kasai portoenterostomy (RAKPE) is regarded as a treatment option for patients with biliary atresia (BA). We aimed to compare the clinical outcomes of RAKPE to the open Kasai portoenterostomy (OKPE). A retrospective review was conducted on a total of 74 type III BA patients who underwent RAKPE (RA group, n = 36) or OKPE (OP group, n = 38) from January 2018 to December 2022. The study analyzed demographic characteristics, intraoperative findings, and postoperative outcomes. The operative time in the RA group was significantly longer than that in the OP group (218.61 ± 31.70min vs 178.50 ± 27.90min, P < 0.05). The estimated blood loss in RA group was significantly lower than that in the OP group (8.65 ± 2.30mL vs 17.55 ± 3.60mL, P < 0.05). The recovery time of bowel sounds was significantly shorter in RA group than in the OP group (0.96 ± 0.12days vs 2.84 ± 0.37days, P < 0.05). All patients had bile-stained stools within 1-3days after surgery. The clearance rate of jaundice at 3 and 6months were significantly higher in RA group than in OP group (69.44% vs 60.53%, 75.00% vs 68.42%, P < 0.05). The rate of cholangitis in RA group was similar to that in OP group (50.00% vs 52.63%, P > 0.05). The native liver survival rate during the follow-up period was comparable between two groups (66.67% vs 63.16%, P > 0.05). Robotic-assisted Kasai surgery offers advantages in short-term outcomes and the clearance of jaundice in patients with type III BA.

A comparison of analgesic efficacy between oral pregabalin, gabapentin, and melatonin as non-opioid anaesthesia for robotic-assisted laparoscopic surgeries: A prospective randomized double-blinded clinical study

A comparison of analgesic efficacy between oral pregabalin, gabapentin, and melatonin as non-opioid anaesthesia for robotic-assisted laparoscopic surgeries: A prospective randomized double-blinded clinical study

Study on accuracy of prosthesis size selection for Naton robot-assisted medial unicondylar knee arthroplasty

To analyze the accuracy of prosthesis size selection in Naton robot-assisted medial unicondyle knee arthroplasty by comparing the actual prosthesis size used during operation and the preoperative planning. The clinical data of 100 patients (110 knees) who underwent Naton robot-assisted medial unicondylar knee arthroplasty between June 2023 and July 2024 was retrospectively analyzed, including 47 knees on left side and 63 knees on right side. There were 37 males (40 knees) and 63 females (70 knees) with a mean age of 65.4 years (range, 59-71 years). Body mass index was 22.2-28.6 kg/m 2 (mean, 25.4 kg/m 2). The disease duration ranged from 1 to 8 years (mean, 3.4 years). Preoperative planning was performed by Naton robotic surgical system based on lower limb CT data. The final prosthesis size after osteotomy was recorded and compared with the preoperative plan to analyse whether it was consistent with the preoperative plan, as well as the situation of knee flexion and extension gaps (<0.5 mm, >2.0 mm) corresponding to the different models of prostheses. During operation, 5 patients (5 knees) were treated with traditional UKA due to mechanical arm failure, software obstacles, significant bone amputation bias, or loose reference frame, and were excluded from the final analysis. The remaining 95 patients (105 knees) successfully received Naton robot-assisted surgery, and no related complications occurred. The prosthesis size was consistent with the preoperative plan in 101 knees (96.2%) on the femur side, 100 knees (95.2%) on the tibia side, and 97 knees (92.4%) on both femur and tibia sides. The prosthesis size was inconsistent in 3 cases (2.86%) on the femur side alone, 4 cases (3.81%) on the tibial side alone, and 1 case (0.95%) on both femur and tibial sides. Among the prostheses with different models, the flexion and extension gaps were less than 0.5 mm in 3 knees, the flexion gap was less than 0.5 mm and the extension gap was more than 2.0 mm in 3 knees, and the flexion gap was more than 2.0 mm and the extension gap was less than 0.5 mm in 2 knees. The accuracy of prosthesis size selection for Naton robot-assisted medial unicondylar knee arthroplasty is relatively high.

Choroidal and retinal alteration after long-term use of tadalafil: a prospective non-randomized clinical trial.

The purpose of this study is to investigate choroidal and retinal vascular features in patients taking PDE5is by measuring dynamic vascular alterations and neurostructural features of the retina before and after oral tadalafil administration. The current clinical research involved 22 patients treated with tadalafil 20 mg on alternate days (OAD) after nerve-sparing robotic radical prostatectomy (NS-RARP) for prostate cancer. Patients underwent SD-OCT to assess ganglion cell complex (GCC), retinal nerve fiber layer (RNFL), and subfoveal choroidal thickness (SFCT), as well as OCTA to assess superficial capillary plexus (SCP), deep capillary plexus (DCP), choriocapillaris (CC), foveal avascular zone (FAZ), and radial peripapillary capillary thickness (RPC). All patients were evaluated at baseline (t0), and 3 (t1) and 6 (t2) months after the use of oral tadalafil. A statistically significant reduction in DCP and CC vessel density was found at t2 compared to baseline. According to the SFCT parameter, a statistically significant increase was observed from t0 to t1, and from t1 to t2. GCC parameter increased at t2 compared to baseline in a statistically significant way. No statistically significant differences were recorded between t0, t1 and t2 for the SCP, RPC, FAZ area, RNFL parameter. Retinal and optic disc toxicity may be detected using modifications of capillary vessel density. Further studies are needed to detect the possible progression or regression of ocular or systemic vascular complications in long-term follow-up.

OGC SO41 - Omentopexy Technique in Robotic Assisted Minimally Invasive Oesophagectomy

Abstract Background Laparoscopic omentopexy has been shown to reduce the rates of post-oesophagectomy diaphragmatic hernia (PODH) in a retrospective cohort study in a UK specialist centre. We aimed to demonstrate the technique during robotic-assisted minimally invasive oesophagectomy (RAMIE) with video capture. Method The Versius (CMR Surgical) robotic system was used in the abdominal stage of RAMIE performed on a 63 year old male with a poorly differentiated oesophageal adenocarcinoma. No previous abdominal surgery had been performed on this patient. Video capture was used to record this part of the procedure. Results Ports were inserted in standard configuration to allow fashioning of a gastric conduit. Following this the greater omentum was secured to the anterior abdominal wall around the jejunostomy site. No immediate complications were observed. Conclusion The Versius system can be used to successfully perform omentopexy with standard port positioning. Omentopexy was successfully performed with no immediate complications, did not significantly prolong procedural time and may reduce risk of PODH. The authors support the use of this technique in robotic-assisted surgery for reducing risk of PODH and support further work to validate this technique in cohort studies.

Artificial intelligence in robot-assisted radical prostatectomy: where do we stand today?

The development of Artificial Intelligence (AI) is one of the most revolutionary changes in modern history. The combination of AI and Robotic surgery can be used positively for better patient outcomes. We aimed to conduct a review of AI and its role in robotic radical prostatectomy in modern day surgical practice. We conducted a literature review on this topic with specific discussion about whether the surgeon can be replaced by robots with AI capabilities based on latest studies available in the literature. We have presented a comprehensive overview of AI in robotic surgery. We conclude that AI capabilities are to assist the surgeon and the team to improve patient outcomes. Robots cannot replace the surgeon in the near future. Robots with AI capabilities can be only used as an adjuvant to complement the surgical team and not replace them.

Open versus robotic transversus abdominis release for ventral hernia repair: an updated systematic review, meta-analysis, and meta-regression.

Posterior component separation using transversus abdominis release (TAR) is well established as an option for repair of large hernia defects. TAR can be performed robotically (rTAR) or open (oTAR) with limited data to demonstrate benefit and guide decision making. We conducted a systematic review and meta-analysis comparing rTAR and oTAR approaches for ventral hernia repair (VHR). We searched Pubmed, Embase, Cochrane, and Web of Science for studies comparing rTAR and oTAR for VHR. Hybrid rTAR was not included in our analysis. Our primary outcomes were overall postoperative and intraoperative complications, surgical site occurrences (SSO), SSO requiring surgical intervention (SSOPI), surgical site infection (SSI) superficial or deep, and fascial closure. Additional outcomes were operative time (OT), readmission, length of hospital stay (LOS). We performed sensitivity analysis to explore reasons for heterogeneity and outliers, and a proportional meta-analysis of conversion during rTAR. We performed a meta-regression exploring the relationship of BMI, hernia defect and mesh width rTAR/oTAR with the analyzed outcome within each study. 503 studies were screened and seven studies were included in this analysis. Our sample totaled 780 patients, of which 298 (38.2%) underwent rTAR. Defect width ranged between 8.7 to 13.5cm (cm) for rTAR and 10 to 13.5cm for oTAR. Mean mesh area ranged from 66.9 to 980cm2 and from 51.3 to 1344cm2 for rTAR and oTAR respectively. We found lower overall complications (9% versus 24.6%; RR 0.43; 95% CI 0.26 to 0.73; P < 0.01) and intraoperative complication (5.9% versus 9.1%; RR 0.44; 95% CI 0.22 to 0.88; P = 0.02) rates for the rTAR group. There was no difference in fascial closure between the groups (99% versus 94.6%; RR 1.05; 95% CI 0.99 to 1.11; P = 0.11). rTAR presented lower SSI rates (2.5% versus 7.8%; RR 0.33; 95% CI 0.13 to 0.8; P = 0.01). No differences were found in SSO (16.3% versus 13.7%; RR 0.87; 95% CI 0.51 to 1.48; P = 0.6) or SSOPI (5.4% versus 8.9%%; RR 0.5; 95% CI 0.22 to 1.15; P = 0.1) rates. No statistically significant differences were found in superficial SSI (0.76% versus 3%; RR 0.36; 95% CI 0.07 to 1.75; P = 0.21) and deep SSI (0% versus 4.2%; RR 0.23; 95% CI 0.02 to 3.12; P = 0.27). Open surgery presented a lower OT (MD -67.7min; P < 0.001), but robotic surgery showed a reduced LOS (-3.9days; 95% CI -4.8 to -3.1; P < 0.001). No differences were found in readmission and 1year recurrence rates. The proportional meta-analysis showed a conversion to open rate of 6.4 per 100 patients (95% CI 3.3 to 12 patients) during rTAR. Meta-regression presented no statistically significant influences of rTAR/oTAR mesh width and defect width relations and BMI, despite the analysis was limited by the low number of studies. Robotic TAR may be associated with lower intraoperative and postoperative complications, lower SSI, shorter LOS, and longer operative times when compared to oTAR. Given the limitations of the included studies, randomized trials are needed to better evaluate the impact of the robotic-assisted surgery for complex abdominal wall reconstruction. CRD42024540991.

The Role of Robotics in Enhancing Precision and Outcomes in Orthopedic Surgery

The advent of robotics has significantly transformed orthopedic surgery, addressing challenges inherent in traditional manual techniques, such as variability in outcomes and precision limitations. Robotics enables millimeter-level accuracy, minimizes human error, and allows for personalized, minimally invasive procedures. Historical milestones, from the pioneering ROBODOC system in 1992 to advanced platforms like MAKO and ROSA, illustrate the progressive adoption of robotic systems, particularly in joint replacement and spine surgeries. Comparative studies demonstrate enhanced precision and reduced recovery times for robotic-assisted surgeries compared to conventional methods, with quantifiable improvements in alignment accuracy and postoperative outcomes. Key applications include joint arthroplasties, spinal surgeries, and complex trauma cases, where robotic assistance ensures accurate implant positioning, improved functional outcomes, and higher patient satisfaction rates. However, barriers such as cost, access disparities, and the learning curve persist. Emerging technologies, including artificial intelligence, augmented reality, and haptic feedback, are anticipated to further enhance robotic precision and broaden accessibility. As robotic systems become integral to orthopedic practice, ongoing advancements promise to elevate surgical standards, offering reliable, patient-specific solutions that improve both procedural consistency and quality of life.

Temperature and state-dependent electrical conductivity of soft biological tissue at hyperthermic temperatures

Objective: We present a physics-based, temperature and state-dependent electrical conductivity model for soft biological tissue under thermal therapies with a quantified damage parameter that represents the state of soft biological tissue (degree of denaturation). Most existing models consider electrical conductivity to be only temperature-dependent and evaluate tissue damage during post-processing after temperature calculation. Our model allows tissue damage to be coupled into the thermal model for a more accurate description of both RF ablation and electrosurgery. Methods: We model the denaturation process with an Arrhenius-type differential equation for chemical kinetics and a modified Stogryn equation for electrical conductivity under state transition. We present experimental data from two types of heating procedures at 128 kHz to validate and showcase the capability of our model. Results: Our model is able to capture the change in electrical conductivity during heating, cooling, and reheating procedures, which distinguishes different states and shows the irreversibility of denaturation. The model also accurately captures tissue change during slow cooking at a constant temperature, highlighting a state dependence. Conclusion: By incorporating state dependence into the model for electrical properties, we are able to capture the denaturation process more accurately and distinguish different degrees of damage. Our model allows the modeling of procedures involving repeated heating or cooling, which is impossible for models without a state dependence. While being able to adapt to patient-specific needs, the model can be used to improve planning and control in future robot-assisted surgeries to reduce unnecessary damage.

Experience of using robot-assisted (da Vinci) operations in the treatment of common endometriosis

Background. Currently, genital endometriosis is considered as one of the most severe conditions in women of reproductive age, which has detrimental consequences for social, professional and psychological functioning. It ranks third in the structure of gynecological diseases after inflammatory diseases of the female reproductive system and uterine fibroids. Because of this, it acquires a more pronounced social significance and ceases to be only a medical problem. Aim. To study the results of surgical treatment of patients with severe forms of genital endometriosis using the da Vinci surgical robotic complex.Materials and methods. A retrospective analysis of the treatment results of 51 patients operated on at the N.I. Pirogov National Medical and Surgical Center for the period from January 2015 to July 2024, who underwent robot-assisted (da Vinci) operations for deep endometriosis involving neighboring organs. The duration of surgery and hospital stay, the amount of blood loss, the frequency of intra- and postoperative complications, the clinical course of the disease in the long-term postoperative period, the frequency of detection of residual infiltration in the postoperative period, and the implementation of reproductive plans were analyzed.Results. The duration of the surgical intervention was 220.8 ± 21.87 minutes. The postoperative bed-day was 6.9 ± 1.5 bed days. The average blood loss was 160.2 ± 67.58 ml. There were no intraoperative complications. Postoperative complications accounted for 7.8 %. Residual infiltration occurred in 11.7 % of cases. 94.1 % of the patients had no clinical symptoms of endometriosis in the long-term postoperative period. The pregnancy rate was 31.9 %.Conclusion. Surgical treatment of deep endometriosis using da Vinci surgical robotic complex in the amount of radical removal of endometrioid infiltrate has a positive effect on both the clinical course of the disease and the reproductive potential of a woman. Real-time fluorescence navigation has demonstrated additional imaging capabilities in robotic surgery for deep endometriosis, potentially increasing the radicalism of surgical treatment of infiltrating endometriosis and may lead to a reduction in recurrence rates.

Trajectory Planning and Adaptive Fuzzy PID Control for Precision in Robotic Vertebral Plate Cutting: Addressing Force Dynamics and Deformation Challenges

This study explores trajectory planning and cutting force control for spinal surgical robots, focusing on managing cutting deformation and vibration during vertebral plate cutting—a critical challenge in robotic spinal surgery. Through theoretical analysis, simulation, and experimental validation, the research addresses the complexities of cutting force dynamics and the associated deformations. A dynamic equation for vertebral plate cutting is established, providing a theoretical foundation for trajectory planning. A new trajectory planning method using B-spline curves and an interpolation point constraint formula is introduced, enabling precise robot trajectory control. Additionally, an adaptive fuzzy PID control strategy with force feedback is proposed to dynamically adjust the feed rate, effectively suppressing cutting deformation and vibration in real time. Simulations and experiments validate the effectiveness of these methods in reducing force fluctuations and enhancing control stability. The findings offer valuable guidance for improving the performance and safety of spinal surgery robots, optimizing their trajectories, incorporating dynamic sensing, and enhancing safety controls. Future research should focus on refining control strategies for more complex surgical scenarios and validating their applicability under conditions closer to actual surgical environments. This work provides theoretical and practical insights into advancing robotic spinal surgery, contributing to better surgical outcomes and patient safety.