Robotic Approach Research Articles

Robotic hiatus hernia surgery: learning curve and lessons learned

New procedures like the robotic approach require proficiency to ensure patient safety and satisfactory functional results. Hiatal hernia surgery serves as a suitable training procedure for upper gastrointestinal tract surgeons transitioning to the robotic approach. This study aims to evaluate the outcomes of implementing the robotic approach in hiatal hernia surgery at a tertiary hospital and to assess the associated learning curve. A retrospective review was conducted on 54 patients (58 surgeries) between June 2019 and March 2024, including both primary and revision robotic antireflux surgeries. The study focused on perioperative outcomes, symptom resolution, and the surgical learning curve, assessed using Cumulative Sum analysis. The results showed that global surgical time averaged 124 ± 57 (54–350) min, 127 ± 38 (116–139) for Primary Surgery and 164 ± 84 (115–212) min for Revisional Surgery. There were no conversions to laparoscopic or open approach. The global median of hospital stay was 2 days (2 for Primary Surgery and 3 for Revisional Surgery) and three patients required readmission (2 for Primary Surgery and 1 for Revisional Surgery). Postoperative complications occurred in 3 patients. Symptom resolution was achieved in 90% of Primary Surgery group and 85.7% of Revisional Surgery group. Learning curve described three phases: 1-training (case 1 to 14), 2-plateau (15 to 25) and 3-expertise phase (25 onwards). The robotic approach in hiatal hernia surgery is feasible with minimal morbidity, short hospital stays, and excellent functional results. With previous experience in laparoscopic approach and esophagogastric surgery the learning curve can be reduced to 14 procedures.

Retrospective matched case-control comparison of Totally Robotic Sleeve Gastrectomy (RSG) during the learning curve with Laparoscopic Sleeve Gastrectomy (LSG): why is operative time different?

Robotic approach is slowly rising in metabolic surgery, and laparoscopy is still considered the gold standard for Sleeve Gastrectomy. Aim of our study was to assess and compare outcomes of RSG through a matched comparison with LSG. Retrospective search of prospectively maintained database of our surgical department was carried out find all consecutive patients who underwent RSG from April 2023 to August 2024. Each subject who underwent RSG was matched one-to-one with a patient treated with LSG in the same period. Operative time (docking + console time for the robotic procedures), length of stay, need for rescue drugs, and perioperative complications were recorded calculated and compared. A total number of 50 patients (25 RSG and 25 LSG) were included in the present analysis. Operative time in the LSG group was significantly shorter than in the RSG group (57.8 ± 12.3 VS 80.6 ± 16.6min, p < 0.01), but it was comparable to console time (57.8 ± 12.3 VS 56.9 ± 19.6, p = 0.85). Mean docking time was 23.7 ± 11min. Length of stay, readmissions, conversion to laparoscopy/open surgery, early complications, and rescue drugs administration were comparable between the two groups. Age, sex, and BMI were not good predictors neither of laparoscopic nor robotic operative time. RSG during the learning curve proved as safe as LSG, but it was associated with longer operative time due to the duration of the docking step. Operation length may become comparable once the learning curve plateau is reached. Age, BMI, and sex are not good criteria of choice between the two approaches.

Laparoscopic pancreatic enucleation: how far should we go for parenchyma preservation? A study by the French National Association of Surgery.

Pancreatic enucleation is indicated for selected patients and tumours with very low oncological risk to preserve a maximum of healthy pancreatic parenchyma. Minimally invasive pancreatic enucleation (MIPE) is increasingly performed. This study aims to assess the impact of tumor location and center experience on textbook outcomes (TBO) in patients undergoing MIPE. Retrospective nationwide multicentric cohort study including MIPE performed between 2010 and 2021. Tumor localization was classified as head/uncus, neck or body/tail (results are presented in this order). Centers were classified according to a mean volume of MI pancreatectomies performed per year: lower (< 5/year), intermediate (5 to 10/year) and higher volume (≥ 10/year). TBO was defined as meeting all 6 criteria: no postoperative pancreatic fistula (POPF), no post-pancreatectomy haemorrhage (PPH), no bile leak, no readmission, no mortality, and no severe morbidity. 27 participating centers performed 200 MIPE located in head/uncus (n = 65, 33%), neck (n = 26, 13%) and body/tail (n = 109, 55%), 8% of them performed by robotic approach. Mortality reached 1.5% (n = 3). Head/uncus lesions were larger (p = 0.03), frequently BD-IPMN (p = 0.04), with significant longer operative time (p = 0.002). TBO achievement was high across all tumor locations (52 vs. 73 vs. 67%, p = 0.09) with higher PPH (p = 0.03) or bile leaks (p = 0.03) for head/uncus lesions. In multivariate analysis, overweight (OR 0.49), preoperative biopsy (OR 0.41) and head/uncus lesion (OR 0.34) were independently associated with lower TBO. No independent risk factor was found for POPF or severe morbidity. While expertise level influenced indications, with more cystic lesions (p = 0.002), larger tumors (p = 0.003), 3D use (p = 0.001), and head/uncus lesions (p = 0.04) in high volume centers, TBO was not significantly different (p = 0.45). MIPE is feasible with 1.5% mortality whatever its localization with higher morbidity for head/uncus lesions, justified by the will to avoid pancreaticoduodenectomy. High volume centers push the limits of MIPE without increasing morbidity.

The feasibility and short-term safety of single-site hysterectomy: a retrospective cohort study of a novel robotic platform.

Robotic-assisted laparoscopic single-site hysterectomy is popular among patients and surgeons due to good cosmetic outcomes and fast recovery. However, questions remain such as loss of triangulation and instrument collision. Our aim is to test the feasibility and safety of a purpose-designed single-site robotic surgical platform mainly in hysterectomies. We retrospectively collected patients who had undergone hysterectomy by SHURUI (SR-ENS-600) robotic surgical system in the First Affiliated Hospital of Xi'an Jiaotong University. Initial cases as control were also collected including da Vinci single-site (IS4000) and multi-port (IS3000 and IS4000) hysterectomies performed by the same surgical team. The main outcome was surgical feasibility rate (valid surgeries/total cases × 100%). Short-term post-operative outcomes and complications were recorded and compared between three groups. From Dec, 2nd, 2023 to Mar, 1st, 2024, 19 cases of hysterectomies were enrolled, including 6 myomas, 2 adenomyosis, 9 cervical high-grade squamous intraepithelial lesion/stage Ia1 cancers, and 2 stage Ia endometrial cancers. Seventeen cases of da Vinci single-site surgeries and 20 cases of multi-ports surgeries were also included for comparation. Intra-operative bleeding volume was significantly lower in SHURUI group compared with da Vinci single-site and multi-ports groups (40.5mL vs 47.4mL vs 58.5mL, P = 0.046 and 0.028). Post-operative time to flatus was also shorter in SHURUI group compared with da Vinci single-site and multi-port surgeries (22.9h vs. 33.5h vs. 28.6h, P = 0.054 and 0.001). Follow-up for SHURUI group lasted for 3months with no complications. SHURUI robotic surgery was feasible and safe in hysterectomies. It also had comparable outcomes with da Vinci robotic platform and approaches.

A Novel Technique for Nasopharyngeal Stenosis Repair: Combined Transoral Robotic and Endonasal Approaches for Enhanced Visualization and Surgical Precision

Nasopharyngeal stenosis is a challenging condition characterized by a narrowed nasopharynx, leading to nasal congestion, impaired breathing, and recurrent sinus issues. In this report, we present a unique surgical approach that combines the use of both the Da Vinci Xi robot and a 70-degree nasal endoscope in a patient with a Type II stenosis of the nasopharynx. The benefits of improved visualization, maneuverability, and precision of this novel combined approach are highlighted. It also highlights the benefit of using Mitomycin C in minimizing the risk of re-stenosis. This previously undescribed technique can not only improve patient outcomes, but it also paves the way for future advancements and broader applications in robotically assisted procedures involving the skull base and oropharynx.

Reprogrammable Flexible Piezoelectric Actuator Arrays with a High Degree of Freedom for Shape Morphing and Locomotion.

The high degree of freedom (DoF) shape morphing widely exists in biology for mimicry, camouflage, and locomotion. Currently, a lot of bionic soft/flexible actuators and robots with shape-morphing functions have been developed to realize conformity, grasp, and movement. Among these solutions, two-dimensional responsive materials and structures that can shape morph into different three-dimensional configurations are valuable for creating reversible high DoF shape morphing. However, most existing methods are predetermined through the fabrication process and cannot reprogram their shape, facing limitations on multifunction. Besides, the achievable geometries are very limited due to the device's low integrated level of actuator elements. Here, we develop a polyvinylidene fluoride flexible piezoelectric actuator array based on a row/column addressing (RCA) scheme for reprogrammable high DoF shape morphing and locomotion. The specially designed row/column electrodes form a 6 × 6 array, which contains 36 actuator elements. By developing a high-voltage RCA control system, we can individually control all the elements in the array, leading to a highly reprogrammable array with various sophisticated high DoF shape morphing. We also demonstrate that the array is capable of propelling a robotic fish with various locomotions. This research provides a new method and approach for biomimetic robotics with better mimicry, aero/hydrodynamic efficiency, and maneuverability, as well as haptic display and object manipulation.

Robot-assisted Kidney Transplantation: The 8-year European Experience.

Evidence regarding perioperative results and long-term functional outcomes of robotic-assisted kidney transplantation (RAKT) is limited. We evaluated perioperative surgical results and long-term functional outcomes of RAKT in patients receiving kidney transplants from living donors. This retrospective analysis is based on a prospective multicenter cohort study conducted from July 2015 to October 2023 across ten European centers. A total of 624 patients who underwent heterotopic RAKT from living donors were included, excluding those who received orthotopic RAKT. The primary outcomes measured were long-term renal function, perioperative complications, and survival rates. Renal function was assessed with the estimated glomerular filtration rate (eGFR). The Clavien-Dindo classification (CDC) was used to describe early (within 30d) and late (from 31 to 90d) postoperative complications. The probabilities of dialysis, graft nephrectomies, and any-cause mortality during follow-up were reported in terms of the 5-yr cumulative incidence. A total of 624 patients with a median age of 35yr (interquartile range [IQR]: 26-52) underwent RAKT. Preemptive RAKT was performed in 52% of cases, and the majority (84%) had the transplant in the right iliac fossa. The median operative time was 210 min (IQR: 180-262), with a rewarming time of 43 min (IQR: 38-50). Intraoperative complications were rare (1.1%), and postoperative graft nephrectomy occurred in 1.9% of patients. High-grade (CDC grade ≥3) early and late postoperative complications were observed in 7.7% and 2.3% of patients, respectively. Rates of incisional hernias, ureteral stenosis, and arterial stenosis were 1.4%, 1.1%, and 0.2%, respectively. The median eGFR values were 19, 52, and 53 ml/min/1.73m2 on the 1st postoperative day, on the 7th postoperative day, and at 6 mo, respectively. Over a median follow-up of 23mo (IQR: 6-49), 17 patients received dialysis, 11 patients underwent graft nephrectomy, and four patients died. None of the deaths were due to RAKT. The main limitation is the absence of a comparator group. With the largest experience worldwide on RAKT, we confirm the perioperative safety and excellent long-term functional outcomes of this procedure. Given the benefits of a minimally invasive robotic approach, these findings support the broader adoption of RAKT as a viable option for kidney transplantation.

Rise in Minimally Invasive Surgery for Colorectal Cancer Is Associated With Adoption of Robotic Surgery.

Minimally invasive surgery is associated with improved short-term outcomes and similar long-term oncologic outcomes for colorectal cancer patients compared with open surgery. Although the robotic approach has ergonomic and technical benefits, how it has impacted utilization of traditional laparoscopic surgery and minimally invasive surgery overall is unclear. Describe trends in open, robotic, and laparoscopic approaches for colorectal cancer resections and examine factors associated with minimally invasive surgery. Retrospective cohort study using data from the National Cancer Database from 2010 through 2020. Commission on Cancer-accredited U.S. facilities. Patients diagnosed with nonmetastatic colon or rectal adenocarcinoma. Surgical approach rates (open, robotic, laparoscopic). We identified 475,001 patients diagnosed with nonmetastatic colorectal adenocarcinoma, of whom 192,237 (40.5%) underwent open surgery, 64,945 (13.7%) underwent robotic surgery, and 217,819 (45.9%) underwent laparoscopic surgery. For colon cancer, laparoscopic minimally invasive surgery use steadily increased, with a peak prevalence of 54.0% in 2016, and total minimally invasive surgery (robotic + laparoscopic) was performed more often than open surgery from 2013 through 2020. For rectal cancer, laparoscopic minimally invasive surgery had a peak prevalence of 37.2% in 2014 and declined from 2014 through 2020; robotic surgery prevalence increased throughout the study period (5.5% in 2010, 24.7% in 2015, 48.8% in 2020). Minimally invasive surgery use increased in facilities performing robotic surgery every year during the study period. For both colon and rectal cancer, use of open surgery decreased across all facilities throughout the study period. Utilized National Cancer Database which may not be generalizable to non-Commission on Cancer institutions. Minimally invasive surgery steadily increased across all facilities from 2010 through 2020. Open resections declined, laparoscopic resections plateaued, and robotic resections increased for colon and rectal cancer. Minimally invasive surgery increases may be driven by increases in robot-assisted surgery. See Video Abstract.

European multicentre analysis of the implementation of robotic complete mesocolic excision for right-sided colon tumours.

Complete mesocolic excision (CME) is an oncologically driven technique for treating right colon cancer. While laparoscopic CME is technically demanding and has been associated with more complications, the robotic approach might reduce morbidity. The aim of this study was to assess the safety of stepwise implementation of robotic CME. A multicentre retrospective analysis of prospectively collected data on robotic right colectomy was performed at five European tertiary centres. Patients were classified for type of surgery: R-RHC (standard right colectomy), R-impCME (learning cases towards robotic CME defined as R-RHC with one but not all the hallmarks of CME) or R-CME (robotic CME). Primary outcomes were overall and severe 30-day complication rates before and after propensity score matching (PSM) analysis. Five hundred and fifty-one consecutive patients undergoing robotic surgery for (pre)malignant lesions of the right colon between 2010 and 2020 were included: R-RHC (n = 101), R-impCME (n = 135) and R-CME (n = 315). Baseline characteristics differed for American Society of Anesthesiologists score (p = 0.0012) and preoperative diagnosis of adenocarcinoma (p < 0.001). Procedure time increased by surgical complexity (p < 0.001). Vascular event rates did not differ, with no superior mesenteric vein injuries. Conversion, complication and anastomotic leak rates, time to flatus/soft diet and length of stay (LOS) did not differ. While R-RHC was performed for a lower rate of malignancies (p < 0.001), lymph node yield was significantly higher in R-CME (p < 0.001). After PSM, analyses on 186 patients documented no differences in overall and severe 30-day complication rate, conversion rate, LOS or 30-day mortality. R-CME can be implemented without increasing the overall or 30-day severe complication rate.

Transcervical resection of myoma (TCRM): Part I.

Uterine fibroids occur frequently in women during the reproductive age, and they are rarely associated with clinical meaning because of their benign characteristics and asymptomatic clinical presentation. Sometimes, uterine fibroids are symptomatic and associated with compression syndrome, infertility, chronic pelvic pain and heavy menstrual bleeding. All need further intervention and treatment. Medication is often preferred and frequently applied but symptom-control rate is varied, resulting the need of further active treatment. An effective but minimally invasive procedure such as surgery is sometimes used as back up strategy in the management of women with no response to medical treatment. Additionally, fertility-sparing or uterus-preservation is the main goal and becomes very popular in both physicians and patients. Conservative surgical treatment can be made according to myoma location. Simply, myoma is classified as submucosal, intramural and subserous types. However, to offer a practical standardized consensus for the description and categorization of myomas, the International Federation of Gynaecology & Obstetrics (FIGO) classification system from type 0 to type 8 is established, which is often used for guiding patient management and offering prognostic information, because submucosal myoma (FIGO type 0, 1, probable 2, and possible 3) is frequently associated with symptoms or signs, needing a further intervention. Transcervical resection of myoma (TCRM, also called as hysteroscopic myomectomy: HM) is the treatment of choice for submucosal myoma, and this increased trend is secondary to its nearly non-trauma in nature, even compared to other MIS, such as mini-laparotomy and laparoscopic or robotic approach. Although TCRM is becoming more and more popular in modern clinical practice, the risks and limitations of TCRM are often overlooked. In this review as part I, we will focus on the rationale, efficacy, complication, and limitation of using TCRM in the management of women with symptomatic uterine fibroids. Under the well-training and carefully performing TCRM, TCRM not only provides the less traumatic injury to the uterus, but also offers an effective and safe strategy in dealing with symptomatic submucosal myoma.

Impact of Centralisation of Radical Prostatectomy Driven by the Introduction of Robotic Systems on Positive Surgical Margin and Biochemical Recurrence in pT2 Prostate Cancer.

To assess how centralisation of cancer services via robotic surgery influenced positive surgical margin (PSM) occurrence and its associated risk of biochemical recurrence (BCR) in cases of pT2 prostate cancer (PC). Retrospective analysis of all radical prostatectomy (RP) cases performed in the West of Scotland during the period from January 2013 to June 2022. Primary outcomes were PSM and BCR. The secondary outcomes compared the impact of centralisation and surgical approach on PSM and BCR; and margin length and location on BCR. Propensity score matching and Cox regression models were performed using R. A total of, 907 patients were included; 662 robot assisted radical prostatectomy (RARP), 245 open RP. PSM rate was 17.7% (161/907), similar in RARP and open cohorts. Patients with PSM had higher rates of BCR; 26.7%, compared to 8.7% in patients with no PSM. Patients with margins of ≥ 1 mm had higher risk of developing BCR. Patients who underwent open RP had increased incidence of PSM ≥ 1 mm; 40/43 (93%) compared to 83/117 (71%) in robotic approach (p = 0.003). Limitations include the study being retrospective, introduction of centralisation and robot concurrently, and evolution of practice. PSMs in pT2 PC are associated with higher rates of BCR. Introduction of centralisation via the robot had no impact on PSM occurrence or BCR, although did demonstrate a reduction in PSM length.

The Therapeutic Potential of Different Surgical Approaches in the Management of Cardiac Myxoma: A Systematic Review.

Background: Cardiac myxomas are benign tumors of the heart. They occur mostly in the left atrium. The preferred treatment is surgical resection, which can be performed via conventional median sternotomy, minimally invasive, or robotic-assisted approaches. This study aimed to evaluate the outcomes, advantages, and limitations of these surgical methods, with a focus on their safety, efficacy, and impact on patient recovery. Methods: This systemic review was conducted according to PRISMA guidelines. The chosen databases were systematically searched using the keywords "cardiac myxoma", "resection", "approach", "minimally invasive", and "robotic surgery". The comparison between the surgical strategies was based on thirteen articles, which met the inclusion criteria. Results: Median sternotomy remains the standard technique, providing excellent surgical access but is associated with longer hospital stays, higher blood loss, and increased risk of complications such as stroke. Minimally invasive approaches demonstrated comparable safety with shorter ICU stays, reduced blood loss, and lower postoperative pain but presented challenges, including limited exposure and longer procedure times. Robotic-assisted surgery showed potential as a safe alternative but was limited by high costs and technical demands. However, the data on minimally invasive and robotic methods are limited due to the rarity of cardiac myxomas. Conclusions: The choice of surgical technique should be individualised by considering the tumour size, location, patient condition, and surgeon expertise. Routine postoperative echocardiographic monitoring is essential to detect residual or recurrent tumours. Further studies are needed to validate the long-term efficacy of minimally invasive and robotic approaches.

Comparison of robotic and laparoscopic approaches in short- and long-term outcomes of lateral pelvic lymph node dissection for advanced rectal cancer: a Japanese multicenter study.

Lateral pelvic lymph node dissection (LPND) is a challenging surgical technique with complex anatomy and narrow pelvic manipulation. The outcomes of robotic and laparoscopic surgery for LPND are still unclear. We retrospectively reviewed 169 consecutive patients who underwent rectal cancer surgery with LPND between 2016 and 2023. Patients were divided into two groups according to whether LPND was performed by robotic surgery (R group, n = 40) or laparoscopic surgery (L group, n = 129). Clinicopathological feature and outcomes were compared between groups. Frequency of surgery with combined resection of adjacent structures (5.0% vs. 19.4%, p = 0.023), frequency of patients with distant metastasis (5.0% vs. 19.4%, p = 0.028), and estimated blood loss from bilateral LPND (74 mL vs. 132 mL, p = 0.013) were all lower in the R group than in the L group. Type of surgical approach did not correlate with postoperative complications. Median follow-up was 31.0 months (range, 1.0-69.0 months). No patients in the R group experienced local recurrence, compared to 4.6% in the L group. Multivariate analysis revealed laparoscopic surgery (odds ratio 3.687, 95% confidence interval 1.505-6.033; p = 0.004) as an independent predictor of poor relapse-free survival. Robotic surgery for LPND appears to have good prognostic value in some, but not all, oncologic cases. However, large prospective studies are desirable to validate these findings.

Robotic pancreaticoduodenectomy for portal annular pancreas: how to do it.

Portal annular pancreas (PAP) is an uncommon anomaly in which the pancreatic parenchyma surrounds the portal or superior mesenteric vein. An adequate operative approach is necessary to prevent clinically relevant postoperative pancreatic fistula after pancreaticoduodenectomy for PAP. We herein report a case of robotic pancreaticoduodenectomy for PAP. In PAP, dissection of the retroportal parenchyma is the most important aspect of surgery. Adequate retraction of the portal system using vessel loops allows for a safe dissection and transection of the retroportal parenchyma. The robotic approach has some advantages for dissecting the retroportal parenchyma. The magnified three-dimensional view helps the surgeon distinguish the nerve plexus from the pancreatic parenchyma. The caudal view allows for direct dissection of the retroportal parenchyma from the superior mesenteric artery. Dissection can easily be performed using articulated forceps. Owing to these advantages, robotic pancreaticoduodenectomy can be safely performed for PAP.

Robotic Pancreaticoduodenectomy for Pancreatic Head Tumour: A Single-Centre Analysis.

Background: The robotic approach is an appealing way to perform minimally invasive pancreaticoduodenectomy. We compare robotic cases' short-term and oncological outcomes to a historical cohort of open cases. Methods: Data were collected in a prospective database between 2016 and 2024; complications were graded using the ISGPS definition for the specific pancreas-related complications and the Clavien-Dindo classification for overall complications. Furthermore, the Comprehensive Complication Index was calculated. All patients undergoing pancreaticoduodenectomy were included, except those with acute or chronic pancreatitis, vascular tumour involvement or multi-visceral resections. Only the subset of patients with malignancy was regarded for the oncologic outcome. Results: In total, 100 robotic and 102 open pancreaticoduodenectomy cases are included. Equal proportions of patients have a main pancreatic duct ≤3 mm (p = 1.00) and soft consistency of the pancreatic remnant (p = 0.78). Surgical time is longer for robotic pancreaticoduodenectomy (p < 0.01), and more patients have delayed gastric emptying (44% and 28.4%, p = 0.03). In the robotic group, the number of patients without any postoperative complications is higher (p = 0.02), and there is less chyle leak (p < 0.01). Ninety-day mortality, postoperative pancreatic fistula, and postpancreatectomy haemorrhage are similar. The lymph node retrieval and R0 resection rates are comparable. Conclusions: In conclusion, after robotic pancreaticoduodenectomy, remembering all cases during the learning curve are included, less chyle leak is observed, the proportion of patients without any complication is significantly larger, the surgical duration is longer, and more patients have delayed gastric emptying. Oncological results, i.e., lymph node yield and R0 resection rate, are comparable to open pancreaticoduodenectomy.

Comparison of surgical results and technical performance between robotic and laparoscopic approaches for Kasai portoenterostomy in biliary atresia: a multicenter retrospective study.

Many variables, including age at surgery, disease type, surgical approaches and perioperative management factors have been demonstrated to influence efficacy in BA infants, however, the effect of surgical performance remains unclear. The objective of this retrospective study was to compare the postoperative efficacy and surgical performance of robotic (RKPE) versus laparoscopic Kasai portoenterostomy (LKPE) for BA. Between October 2018 and June 2023, 158 type III BA patients undergoing minimally invasive surgery (RKPE = 66, LKPE = 92) were included in this multicenter retrospective study. All procedures were performed by surgical teams experienced in Kasai portoenterostomy techniques. Technical performance was quantified and analyzed using the Objective Structured Assessments of Technical Skills (OSATS) and Generic Error Rating Tool instruments (GERT). Postoperative outcomes and surgical performance were compared. Compared with LKPE group, RKPE group had shorter fibrous cone transection time (48.92 ± 6.98 vs. 61.45 ± 8.98min; p < 0.001), shorter hepaticojejunostomy time (47.55 ± 6.57 vs. 59.93 ± 7.88min; p < 0.001) and less estimated intraoperative bleeding [7.00 (5.00-10.00) vs. 13.50 (10.50-16.50) mL; p < 0.001]. More importantly, RKPE group showed a superior OSATS score [30.50 (29.00-31.00) vs. 28.00 (28.00-29.00); p < 0.001], number of errors (46.62 ± 6.32 vs. 56.40 ± 6.82 times/case; p < 0.001), and number of events [9.40 (8.40-10.40) vs. 16.00 (14.00-17.80) times/case; p < 0.001]. On postoperative days 1 and 3, RKPE group had lower C-reactive protein levels (19.87 ± 12.28 vs. 27.05 ± 11.16mg/L, p < 0.001; 14.88 ± 7.11 vs. 20.73 ± 9.09mg/L, p < 0.001). During follow-up, RKPE group had higher jaundice clearance rate at 3 (68.18% vs. 51.09%; p = 0.032) and 6months (78.79% vs. 64.13%; p = 0.047) postoperatively. However, the cholangitis rate within 1year postoperatively (46.97% vs. 50.00%; p = 0.707), as well as one-year (75.76% vs. 72.83%; p = 0.678) and two-year survival with native liver rates (68.42% vs. 66.67%; p = 0.857), were comparable between two groups. RKPE provided superior technical skill performance and a higher jaundice clearance rate than LKPE, indicating that it may be a better minimally invasive option for BA. In addition, the survival with native liver rate showed no significant difference between the two cohorts, which needs to be confirmed by further study.

Robot-Assisted Pyelolithotomy in Pelvic Kidney.

Background/Objectives: Pelvic kidney is a congenital anomaly characterized by the kidney's failure to ascend to its normal anatomical location during early embryonic development. This anomaly complicates traditional surgical approaches for renal calculi due to the kidney's atypical positioning and associated anatomical challenges. We sought to summarize our experience with robotic-assisted pyelolithotomy (RPPK) for pelvic kidney stones. Methods: A retrospective review of patients who underwent RPPK was conducted between 2014 and 2023. Demographic data on stone characteristics, operative details, and postoperative outcomes were analyzed. Results: Four patients (three male; mean age-51.2 years with a range of 45-54; mean BMI-26.6 with a range of 22.3-32.2) underwent RPPK. All had a right-sided pelvic kidney; two had prior failed ureteroscopy. The mean stone diameter was 27.7 mm (range: 17-35); the mean density was 1207.5 HU (range: 905-1500). The mean operative time was 265 min (range: 200-323); the time from incision to closure was 142.2 min (range: 95-225). No ureteral stents or drains were used. Blood loss was negligible. The mean hospital stay was 2.2 days. No immediate complications were recorded. The mean follow-up was 11.75 months (range: 3-30). Conclusions: RPPK is safe and effective for managing pelvic kidney stones. Challenging renal anatomy stone size and density are not obstacles to the robotic approach unlike other fragmentation methods.

Computer-Integrated Surface Image Processing of Hydrogen-Saturated Steel Wear Products

This paper briefly describes the conceptual direction of the application of computer vision (CV) methods that involve controlling the morphology of hydrogenated wear particles (WPs). During long-term operation, in the surface and subsurface layers of the materials of parts in the tribo-joint, changes in the micromechanisms of fracture occur, which change the morphology of WPs. It has been shown that the developed computer program (CP) can be used to monitor the fractography of the surface of wear particles, and, accordingly, it is possible to control changes in the surface morphology. Therefore, it is possible to predict the operational stability and durability of the tribo-joint. A conceptual scheme for determining the performance of a tribotechnical assembly depending on the determined parameters of WPs is presented. The modes marked on it, including normal operation, transient, run-in, and catastrophic failure, can be evaluated by robotics approaches.

Transbronchial Approach to Peripheral Lung Lesions- How Good are the Robotic and Non-Robotic Approaches Compared with CT Guided Biopsy?

Transbronchial Approach to Peripheral Lung Lesions- How Good are the Robotic and Non-Robotic Approaches Compared with CT Guided Biopsy?

Robotic trans-abdominal retromuscular hernia repair for medium-sized midline hernias: midterm outcomes and surgical site occurrence (SSO) analysis in 120 patients.

Robotic surgery has become a popular method for treating ventral hernias due to its promising peri-operative outcomes. However, the long-term results of this approach are still unclear. In this study, 120 patients underwent robotic trans-abdominal retromuscular mesh placement (r-TARM) with a mean follow-up period of 18.1months. This study aims to evaluate the feasibility of the robotic approach reporting peri-operative and midterm outcomes. Additionally, we examined possible risk factors that may contribute to the development of surgical site occurrences (SSOs). Between January 2021 and September 2023, 120 patients underwent r-TARM for midline hernias, including 39 primary, 71 incisional, and 10 recurrent cases. A retrospective analysis was performed. A logistic regression model was used to identify possible patient risk factors for SSO development. The average operative time was 153.5 ± 47.2min, and there were no open or laparoscopic approach conversions. The mean length of hospital stay was 1.9 ± 0.9 days. We observed SSO in 16 patients (13.3%). One patient (0.8%) required angiographic embolization due to post-operative parietal bleeding. The mean follow-up time was 18.1 ± 7.8months, and we observed hernia recurrence in only one (0.8%) patient. The logistic regression model did not identify any possible risk factors for SSO. r-TARM is a safe and effective method for treating ventral hernias not requiring posterior component separation. Our results indicate that patient and hernia characteristics were not predictive of SSO. Midterm outcomes are encouraging, though longer follow-up is needed.