Robotic Platform Research Articles

Current trends of unicompartmental knee arthroplasty (UKA): choosing between robotic-assisted and conventional surgeries and timing of procedures

BackgroundWith robotic advancements in UKA technology, we sought to explore if robotic-assisted UKA could translate to clinical benefits such as reduced hospital stays and lowered emergency readmissions. Also, current utilization trends of UKA and choice of procedure timing (unilateral [uUKA] vs. one-staged bilateral UKA [biUKA]) could be explored.MethodsThis was a retrospective study utilizing the Clinical Data Analysis and Reporting System (CDARS) for data retrieval. All patients who had undergone primary UKA in all Hospital Authority (HA) hospitals in HK from 2021–2023 were included. Primary outcomes included utilization of UKA compared to TKA and percentage utilization of different UKA systems, namely, conventional, Mako, and Cori/Navio systems, from 2021–2023. Secondary outcomes involved: (1) patient demographics, (2) postoperative average length of stay (ALOS), (3) 30-day and 90-day postoperative Accident and Emergency Department (AED) attendance, (4) surgical times (skin-to-skin) and (5) 90-day mortality and reoperation. Differences in outcomes between uUKA and biUKA and between different robotic systems were examined. Regression analysis was performed to study if utilization of robotic-assisted systems could contribute to reduced hospital stays.ResultsUKA accounted for 15.2% of primary knee arthroplasties throughout 2021–2023. Robotic-assisted UKA (Mako and Navio/Cori) has shown an increasing utilization since 2022 in both unilateral (16.0% to 25.9%) and bilateral operations (17.8% to 29.0%). Mako had shorter ALOS than Navio/Cori (2.9 ± 1.6 vs. 3.6 ± 2.6 days; P = 0.006) and significantly shorter ALOS than conventional UKA (2.9 ± 1.6 vs. 3.6 ± 2.6 days; P = 0.004). Utilization of Mako was predictive of shortened ALOS on multi-linear regression (β = − 0.056; P = 0.049). Interestingly, biUKAs, especially conventional ones, showed a lower attendance rate than uUKAs at 30-day (2.9% VS 6.9%; P = 0.036) and 90-days (7.8% VS 15.7%; P = 0.004). Robotic-assisted surgery was associated with a prolonged surgical time of 16.4 min in uUKA and 29.1 min in biUKA compared to conventional operations.ConclusionUKA utilization has dropped since 2021 but the percentage of robotic-assisted UKA has risen. Mako yielded promising results in reducing hospital stays compared to conventional operations. Sub-group analysis (Mako versus Cori/Navio) highlighted the importance of distinguishing between different robotic platforms. For patients with bilateral unicompartmental OA, biUKA was shown to be a safe and effective alternative to unilateral operations.Trial RegistrationRegistered (HKU/ HA HKW IRB; Ref No: 24–373).

Smart Force Sensing in Robot Surgery Utilising the Back Electromotive Force

Since the introduction of robot-assisted laparoscopic surgery, efforts have been made to incorporate force sensing technologies to monitor critical components and to provide force feedback. The advanced laparoscopic robotic system (AdLap RS) is a robotic platform that aims to make robot technology more sustainable through the use of the fully reusable shaft-actuated tip-articulating (SATA) instruments. The SATA instrument driver features electronics and sensors exposed to the sterile environment, which complicate the sterilisation process. The aim of this study was to develop and validate smart sensing in stepper motors using the back electromotive force in a newly developed Smart SATA Driver (SSD), eliminating the need for sensors in the sterile environment. Methods: The stepper drivers were equipped with TMC2209 ICs featuring StallGuard technology to measure back EMF. The tip was actuated up until a set StallGuard threshold value was reached, at which the resulting tip force was measured. This cycle was repeated ten times for a range of threshold levels. A regression analysis with a power series model was used to determine the quality of the fit. Results: The SSD is capable of exerting tip forces between 2.4 and 8.2 N. The back EMF force test demonstrated a strong correlation between obtained StallGuard values and measured tip forces. The regression analysis showed an R-squared of 0.95 and a root Mean squared error of 0.4 N. Discussion: The back EMF force test shows promise for force feedback, but its accuracy limits real-time use due to back EMF fluctuations. Future improvements in motor stability and refining the back EMF model are needed to enable real-time feedback. Conclusion: The strong correlation during the back EMF force test shows its potential as a low-budget method for detecting motor stalls and estimating tool–tissue forces without the need for sensors in laparoscopic instruments.

Evaluating Postoperative Morbidity and Outcomes of Robotic-Assisted Esophagectomy in Esophageal Cancer Treatment—A Comprehensive Review on Behalf of TROGSS (The Robotic Global Surgical Society) and EFISDS (European Federation International Society for Digestive Surgery) Joint Working Group

Background: Esophageal cancer, the seventh most common malignancy globally, requires esophagectomy for curative treatment. However, esophagectomy is associated with high postoperative morbidity and mortality, highlighting the need for minimally invasive approaches. Robotic-assisted surgery has emerged as a promising alternative to traditional open and minimally invasive esophagectomy (MIE), offering potential benefits in improving clinical and oncological outcomes. This review aims to assess the postoperative morbidity and outcomes of robotic surgery. Methods: A comprehensive review of the current literature was conducted, focusing on studies evaluating the role of robotic-assisted surgery in esophagectomy. Data were synthesized on the clinical outcomes, including postoperative complications, survival rates, and recovery time, as well as technological advancements in robotic surgery platforms. Studies comparing robotic-assisted esophagectomy with traditional approaches were analyzed to determine the potential advantages of robotic systems in improving surgical precision and patient outcomes. Results: Robotic-assisted esophagectomy (RAMIE) has shown significant improvements in clinical outcomes compared to open surgery and MIE, including reduced postoperative pain, less blood loss, and faster recovery. RAMIE offers enhanced thoracic access, with fewer complications than thoracotomy. The RACE technique has improved patient recovery and reduced morbidity. Fluorescence-guided technologies, including near-infrared fluorescence (NIRF), have proven valuable for sentinel node biopsy, lymphatic mapping, and angiography, helping identify critical structures and minimizing complications like anastomotic leakage and chylothorax. Despite these benefits, challenges such as the high cost of robotic systems and limited long-term data hinder broader adoption. Hybrid approaches, combining robotic and open techniques, remain common in clinical practice. Conclusions: Robotic-assisted esophagectomy offers promising advantages, including enhanced precision, reduced complications, and faster recovery, but challenges related to cost, accessibility, and evidence gaps must be addressed. The hybrid approach remains a valuable option in select clinical scenarios. Continued research, including large-scale randomized controlled trials, is necessary to further establish the role of robotic surgery as the standard treatment for resectable esophageal cancer.

Robot‐Assisted Measurement of the Critical Micelle Concentration

The critical micelle concentration (CMC) is the key characterization of surfactants. To date, no method can yield sequential CMC measurements in an automated fashion. This work introduces SIMO (smart integrator for manual operations), a novel robotic platform for automating the determination of CMC for surfactants. It highlights the precision and reproducibility of SIMO, with an 80% reduction in standard deviation compared to a manual method. The article discusses the robotic protocol and data postprocessing, highlighting the challenges behind integrating automation and robotics in laboratories. SIMO's reliability is tested against a challenging experiment, that of determining the effect of various cations on the CMC of polymeric surfactants. The work presented showcases the potential of robotics in scientific experimentation, promising enhanced accuracy and efficiency.

Evaluation of PID-Based Algorithms for UGVs

The autonomous navigation of unmanned ground vehicles (UGVs) in unstructured environments, such as agricultural or forestry settings, has been the subject of extensive research by various investigators. The navigation capability of a UGV in unstructured environments requires considering numerous factors, including the quality of data reception that allows reliable interpretation of what the UGV perceives in a given environment, as well as the use these data to control the UGV’s navigation. This article aims to study different PID control algorithms to enable autonomous navigation on a robotic platform. The robotic platform consists of a forestry tractor, used for forest cleaning tasks, which was converted into a UGV through the integration of sensors. Using sensor data, the UGV’s position and orientation are obtained and utilized for navigation by inputting these data into a PID control algorithm. The correct choice of PID control algorithm involved the study, analysis, and implementation of different controllers, leading to the conclusion that the Vector Field control algorithm demonstrated better performance compared to the others studied and implemented in this paper.

Optimization of manipulator inverse kinematics using improved particle swarm algorithm for enhanced manufacturing efficiency

In the context of digital manufacturing and intelligent manufacturing systems, optimizing the inverse kinematics (IK) of manipulators is crucial for improving manufacturing efficiency and productivity. The authors propose an improved particle swarm optimizer (IPSO) with adaptive inertia weight and asynchronous learning factors to enhance the optimization performance. The proposed algorithm introduces a novel mutation strategy where selected initial particles undergo mutation to generate new particles, thereby increasing swarm diversity. The best-performing particles after mutation replace the initial ones to improve global optimization capability. The effectiveness of the IPSO algorithm is evaluated through thirteen classical benchmark functions and compared with genetic algorithms (GA), standard particle swarm optimization (PSO), linear decreasing weight PSO (LDWPSO), and biogeography-based PSO (BLPSO), quantum-behaved particle swarm optimization (QPSO), Levy Flight quantum-behaved particle swarm optimization (LQPSO), Gaussian quantum-behaved particle swarm optimization approaches (GQPSO). Experimental mean results demonstrate that the IPSO algorithm outperforms these algorithms. The IPSO algorithm and the other algorithms subsequently were employed to estimate the performance for tackling the IK problem of a manipulator and the comparison results demonstrate the superior performance of IPSO algorithm in terms of accuracy and convergence rate. Finally, the practical efficacy of the IPSO algorithm was validated through experimental trials conducted on a custom-designed six-degree-of-freedom (6-DOF) collaborative robotic manipulator platform, which demonstrated the viability of IPSO algorithm in real-world manufacturing applications. The findings suggest that the proposed IPSO algorithm offers a promising solution for enhancing manipulator control efficiency in digital manufacturing systems. The IPSO code is available at: https://10.6084/m9.figshare.27753549 .

Closing the loop: establishing an autonomous test-learn cycle to optimize induction of bacterial systems using a robotic platform

One goal of synthetic biology is to provide well-characterised biological parts that behave predictably in genetic assemblies. To achieve this, each part must be characterised in a time-resolved manner under relevant conditions. Robotic platforms can be used to automate this task and provide sufficiently large and reproducible data sets including provenance. Although robotics can significantly speed up the data collection process, the collation and analysis of the resulting data, needed to reprogram and refine workflows for future iterations, is often a manual process. As a result, even in times of rapidly advancing artificial intelligence, the common design-build-test-learn (DBTL) cycle is still not circular without human intervention. To move towards fully automated DBTL cycles, we developed a software framework to enable a robotic platform to autonomously adjust test parameters. This interdisciplinary work between computer science and biology thus transforms a static robotic platform into a dynamic one. The software framework includes software components such as an importer that retrieves measurement data from the platform’s devices and writes it to a database. This is followed by an optimizer that selects the next measurement points based on a balance between exploration and exploitation. The platform is shown to be able to automatically and autonomously optimize the inducer concentration for a Bacillus subtilis system and the combination of inducer and feed release for a Escherichia coli system. As a target product the readily measurable green fluorescent reporter protein (GFP) is produced over multiple, consecutive iterations of testing. An evaluation of chosen (learning) algorithms for single and dual factor optimization was performed. In this article, we share the lessons learned from the development, implementation and execution of this automated design-build-test-learn cycles on a robotic platform.

Digital Twin-Based Management of Sewer Systems: Research Strategy for KaSyTwin Project

Sewer infrastructure is vital for flood prevention, environmental protection, and public health. As part of sewer infrastructure, sewer systems are prone to degradation. Traditional maintenance methods for sewer systems are largely manual and reactive and rely on inconsistent data, leading to inefficient maintenance. The KaSyTwin research project addresses the urgent need for efficient and resilient sewer system management methods in Germany, aiming to develop a methodology for the semi-automated development and utilization of digital twins of sewer systems to enhance data availability and operational resilience. Using advanced multi-sensor robotic platforms equipped with scanning and imaging systems, i.e., laser scanners and cameras, as well as artificial intelligence (AI), the KaSyTwin research project focuses on generating digital twin-enabled representations of sewer systems in real time. As a project report, this work outlines the research framework and proposed methodologies in the KaSyTwin research project. Digital twins of sewer systems integrated with AI technologies are expected to facilitate proactive maintenance, resilience forecasting against extreme weather events, and real-time damage detection. Furthermore, the KaSyTwin research project aspires to advance the digital management of sewer systems, ensuring long-term functionality and public welfare via on-demand structural health monitoring and non-destructive testing.

Advancing Pediatric Robotic Colorectal Surgery: Trends, Outcomes, and Future Directions-A Comprehensive Review.

Pediatric robotic colorectal surgery has rapidly evolved, offering enhanced precision and safety for treating complex conditions such as Hirschsprung disease (HSCR), anorectal malformations (ARMs), and inflammatory bowel disease (IBD). This review analyzes recent trends, outcomes, and complications in robotic colorectal procedures for pediatric patients. A systematic review was performed using PubMed, yielding 1,112 articles related to pediatric robotic colorectal surgery. After applying exclusion criteria, 35 papers were analyzed, focusing on patient characteristics, procedure types, and clinical outcomes. Since 2001, approximately 700 pediatric patients have undergone robotic colorectal procedures, with HSCR being the most commonly treated condition (n = 421). The review highlights that 1.7% of patients experienced Clavien-Dindo grade III complications, while 11.5% had grade I to II complications, indicating a favorable safety profile. The use of robotic platforms facilitated improved precision during perirectal dissection and reduced the risk of damage to adjacent structures, particularly in cases requiring complex pelvic dissections. Despite promising outcomes, the uptake of robotic colorectal surgery remains lower than that for urologic procedures due to challenges such as cost, instrument size, and specialized training. Robotic colorectal surgery in children is a safe and effective approach, particularly for complex conditions like HSCR, IBDs, and ARMs. While adoption is currently limited by cost and training requirements, ongoing advancements in technology and techniques promise to broaden its application and improve outcomes in pediatric surgery.

Further Validating the Robotic Microsurgery Platform through Preclinical Studies on Rat Femoral Artery and Vein.

This research aims to validate the proficiency and accuracy of the robotic microsurgery platform using rat femoral vessel model. A total of 256 rat femoral vessels were performed, half using robotic and the other by manual microanastomosis by eight microsurgeons with less than 5 years of experience given eight trials (rats) each. Vessel demographics, proficiency (duration of suture and Structured Assessment of Robotic Microsurgical Skills [SARMS]), and accuracy (patency and scanning electron microscopic [SEM]) were analyzed between the two groups. Using the robot, an average of four trials was needed to reach a plateau in total anastomosis time and patency. Significant more time was required for each vessel anastomosis (34.33 vs. 21.63 minutes on the eighth trial, p < 0.001) one factor being a higher number of sutures compared with the handsewn group (artery: 7.86 ± 0.51 vs. 5.86 ± 0.67, p = 0.035, vein: 12.63 ± 0.49 vs. 9.57 ± 0.99, p = 0.055). The SARMS scores became nonsignificant between the two groups on the fourth trial. The SEM showed a higher tendency of unevenly spaced sutures, infolding, and tears in the vessel wall for the handsewn group. Using the robot, similar patency, accuracy, and proficiency can be reached through a fast but steep learning process within four trials (anastomosis of eight vessels) as the handsewn group. The robotic anastomosis may take longer time, but this is due to the increased number of sutures reflecting higher precision and accuracy. Further insight of precision and accuracy was found through the SEM demonstrating the possibility of the robot to prevent unexpected and unwanted complications.

Laparoscopic robotic-assisted ileo-caecal resection with intracorporeal anastomosis in children with Crohn disease: initial experience of a paediatric center and surgical feasibility

PurposePediatric-onset Crohn's disease (CD) presents with a more aggressive course than adults. Surgical treatment is still necessary in many patients. The laparoscopic technique for treating terminal ileal CD is deemed safe and feasible, with the advantage to perform an intra-corporeal anastomosis (ICA). The robotic platform facilitates ICA creation thanks to 3D-visualization, tenfold magnification and better dexterity. The aim of this study was to report our initial experience of robotic ileocecal resection (RICR) with ICA in children with CD.MethodsSix patients underwent RICR for CD. Patient characteristics, intraoperative details, and postoperative outcomes were collected. The surgical technique consisted in an intra-corporeal ICR with a stapled side-to-side ileo-colic anastomosis.ResultsThe mean age at surgery was 14.8 years. The mean operative time was 210.8 min. No intraoperative complications or conversions were recorded. Bowel function returned on postoperative day 3 and the mean hospital stay was 8 days. Two minor complications were treated conservatively and 1 major (anastomotic dehiscence) required reoperation.ConclusionRICR is a safe and feasible technique in pediatric CD of terminal ileum. The robot offers advantages over other techniques for the precision of the suture, avoiding extracorporeal anastomosis. However, larger studies are needed to confirm these preliminary results.

Ambiguity in robotic surgical instruction: lessons from remote and in-person simulation.

The rise of robotic surgery has been accompanied by numerous educational challenges as surgeons and trainees learn skills unique to the robotic platform. Remote instruction is a solution to provide surgeons ongoing education when in-person teaching is not feasible. However, surgical instruction faces challenges from unclear communication. We aimed to describe, examine, and compare ambiguities in remote and in-person robotic instruction. We designed a simulation scenario in which a standardized learner performed tasks in robotic surgery while making pre-scripted errors. Instructors provided remote or in-person instruction to the standardized learner. We applied tools from discourse analysis to transcribe sessions, identify instructional instances, classify ambiguities, and select passages for further review. We used tests of proportions to compare ambiguities between the settings. We conducted four simulation sessions, including two remote and two in-person sessions, and identified 206 instructional instances. Within these, we found 964 occurrences of three common semantic ambiguities, or ambiguities arising from words alone. Instructors used visual tools - thus employing multimodality - to clarify semantic ambiguities in 32% of instructional instances. We identified a similar degree of referential ambiguity, or ambiguity for which context from multimodality did not provide clarifying information, during remote (60%) and in-person (48%) instructional instances (p = 0.08). We described, examined, and compared ambiguities in remote and in-person instruction for simulated robotic surgery. Based on the high prevalence of ambiguity in both settings, we recommend that robotic instructors decrease referential ambiguity. To do so, instructors can reduce semantic ambiguity, harness multimodality, or both.

Exploring Dance as a Therapeutic Approach for Parkinson Disease Through the Social Robotics for Active and Healthy Ageing (SI-Robotics): Results From a Technical Feasibility Study.

Parkinson disease (PD) is a progressive neurodegenerative disorder characterized by motor symptoms. Recently, dance has started to be considered an effective intervention for people with PD. Several findings in the literature emphasize the necessity for deeper exploration into the synergistic impacts of dance therapy and exergaming for PD management. Moreover, socially engaging robotic platforms equipped with advanced interaction and perception features offer potential for monitoring patients' posture and enhancing workout routines with tailored cues. This paper presents the results of the Social Robotics for Active and Healthy Ageing (SI-Robotics) project, aimed at designing an innovative rehabilitation program targeted at seniors affected by (early-stage) PD. This study therefore aims to assess the usefulness of a dance-based rehabilitation program enriched by artificial intelligence-based exergames and contextual robotic assistance in improving motor function, balance, gait, and quality of life in patients with PD. The acceptability of the system is also investigated. The study is designed as a technical feasibility pilot to test the SI-Robotics system. For this study, 20 patients with PD were recruited. A total of 16 Irish dance-based rehabilitation sessions of 50 minutes were conducted (2 sessions per week, for 8 wks), involving 2 patients at a time. The designed rehabilitation session involves three main actors: (1) a therapist, (2) a patient, and (3) a socially interacting robot. To stimulate engagement, sessions were organized in the shape of exergames where an avatar shows patients the movements they should perform to correctly carry out a dance-based rehabilitation exercise. Statistical analysis reveals a significant difference on the Performance-Oriented Mobility Assessment scale, both on balance and gait aspects, together with improvements in Short Physical Performance Battery, Unified Parkinson Disease Rating Scale-III, and Timed Up and Go test, underlying the usefulness of the rehabilitation intervention on the motor symptoms of PD. The analysis of the Unified Theory of Acceptance and Use of Technology subscales provided valuable insights into users' perceptions and interactions with the system. This research underscores the promise of merging dance therapy with interactive exergaming on a robotic platform as an innovative strategy to enhance motor function, balance, gait, and overall quality of life for patients grappling with PD.

Single-docking robot-assisted radical antegrade modular pancreatosplenectomy with partial left nephrectomy in a patient with synchronous pancreatic neuroendocrine neoplasm and clear cell renal cell carcinoma.

The synchronous occurrence of pancreatic neuroendocrine neoplasm (PNEN) and clear cell renal cell carcinoma (ccRCC) in one patient is extremely rare. Synchronous resection of both tumours is preferred over a two-stage procedure if possible. The robotic da Vinci Xi platform allows for multi-quadrant surgery with oncological outcomes comparable to those of laparoscopic or open surgery. We present the case report of an 80-year-old male who underwent synchronous resection of a PNEN in the tail of the pancreas and ccRCC in the left kidney. To the best of our knowledge, this is the first case report on this topic.

High-Bandwidth Contact State Estimation with only Joint Angle Feedback for Legged Robots

Considering the contact between robot feet and the ground is unpredictable in unstructured terrains, robots require fast and accurate contact detection capability. This paper presents a contact detection method through estimating external force that benefits from compensating friction torque and driving torque effectively. For estimating external force, a new estimation method for joint angular velocity/acceleration is proposed. Furthermore, filter parameters are selected theoretically based on the leg control model, which achieves the optimal solution of the parameters. A control compensation strategy of the low-velocity zone of the motor is also implemented for optimizing the estimation of contact force. In contrast to the classic generalized momentum method, the proposed method allows high bandwidth estimation. The proposed contact detection method and the angular velocity/acceleration estimation method using only discrete position feedback information are verified on the developed quadruped robot platform SCIT Dog.

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.

Real-Time Deployment of Ultrasound Image Interpretation AI Models for Emergency Medicine Triage Using a Swine Model

Ultrasound imaging is commonly used for medical triage in both civilian and military emergency medicine sectors. One specific application is the eFAST, or the extended focused assessment with sonography in trauma exam, where pneumothorax, hemothorax, or abdominal hemorrhage injuries are identified. However, the diagnostic accuracy of an eFAST exam depends on obtaining proper scans and making quick interpretation decisions to evacuate casualties or administer necessary interventions. To improve ultrasound interpretation, we developed AI models to identify key anatomical structures at eFAST scan sites, simplifying image acquisition by assisting with proper probe placement. These models plus image interpretation diagnostic models were paired with two real-time eFAST implementations. The first implementation was a manual AI-driven ultrasound eFAST tool that used guidance models to select correct frames prior to making any diagnostic predictions. The second implementation was a robotic imaging platform capable of providing semi-autonomous image acquisition combined with diagnostic image interpretation. We highlight the use of both real-time approaches in a swine injury model and compare their performance of this emergency medicine application. In conclusion, AI can be deployed in real time to provide rapid triage decisions, lowering the skill threshold for ultrasound imaging at or near the point of injury.

Robotic Versus Laparoscopic Adrenalectomy for Adrenal Tumors: An Up-to-Date Meta-Analysis on Perioperative Outcomes.

Background: Minimally invasive surgery (MIS) for adrenal glands is becoming increasingly developed worldwide and robotic surgery has advanced significantly. Although there are still concerns about the generalization of outcomes and the cost burden, the robotic platform shows several advantages in overcoming some laparoscopic shortcomings. Materials and Methods: A systematic review and meta-analysis were conducted using the PubMed, MEDLINE and Cochrane library databases of published articles comparing RA and LA up to January 2024. The evaluated endpoints were technical and post-operative outcomes. Dichotomous data were calculated using the odds ratio (OR), while continuous data were analyzed usingmean difference (MD) with a 95% confidence interval (95% CI). A random-effects model (REM) was applied. Results: By the inclusion of 28 studies, the meta-analysis revealed no statistically significant difference in the rates of intraoperative RBC transfusion, 30-day mortality, intraoperative and overall postoperative complications, re-admission, R1 resection margin and operating time in the RA group compared with the LA. However, the overall cost of hospitalization was significantly higher in the RA group than in the LA group, [MD USD 4101.32, (95% CI 3894.85, 4307.79) p < 0.00001]. With respect to the mean intraoperative blood loss, conversion to open surgery rate, time to first flatus and length of hospital stay, the RA group showed slightly statistically significant lower rates than the laparoscopic approach. Conclusions: To our knowledge, this is the largest and most recent meta-analysis that makes these comparisons. RA can be considered safe, feasible and comparable to LA in terms of the intraoperative and post-operative outcomes. In the near future, RA could represent a promising complementary approachto LA for benign and small malignant adrenal masses, particularly in high-volume referral centers specializing in robotic surgery. However, further studies are needed to confirm these findings.

Two-DoF turret mechanism for a rope-driven wheel-legged climbing robot on a 3D façade

Current climbing robots for building cleaning and inspection are typically designed for vertical walls. In this study, a novel robot platform is developed to navigate complex 3D building façades with obstacles and slopes. This platform uses an Ascender, equipped with a winch for climbing, and a wheel-legged mechanism for versatile movement. A linear sliding turret (LST) mechanism is introduced to address challenges encountered with Ascender and wheel-legged mechanisms on three-dimensional façades. By controlling the robot’s center of gravity, the LST mechanism distributes ground reaction forces (GRFs) across four legs, minimizing damage to the building. It also controls the zero-moment point (ZMP) and tension to stably overcome obstacles. Experimental validation confirmed the robot’s stability on various slopes, obstacle negotiation, and balanced GRF distribution. This rope-driven, wheel-legged climbing robot with an LST mechanism demonstrates strong potential for overcoming challenges in diverse, sloped environments.

Achieving Textbook Outcomes with Robotic Assisted Ivor Lewis Esophagectomy: A Single Center Experience with 150 Consecutive Patients.

With published randomized data, minimally invasive esophagectomy (MIE) is becoming more popular, however a sizable variability in techniques and outcomes still exist. This is a retrospective analysis of 150 consecutive robotic assisted minimally invasive esophagectomies (RAMIE) from a prospectively maintained database from 2020-2024, at a single comprehensive cancer center. We aim to evaluate the textbook outcome rate after RAMIE. 150 consecutive patients underwent RAMIE from 2020 -2024. Tumor location included esophagus in 18, type 1 GE junction in 52, type 2 in 71, and type 3 in 9 patients. Majority of patients had clinical stage T3 tumors. Neoadjuvant therapy was utilized in 85%. Complete pathologic response was seen in 27%. Median number of lymph nodes retrieved were 21. Anastomotic leak occurred in 2 patients, none requiring a reoperation. Median hospital stay was 7 days. Thirty day and 90-day mortality were 0.7% and 1.3% respectively. 90-day stricture with endoscopic dilation was also 0.7%. 90% patients had a textbook outcome. This single center experience highlights that a combination of robotic platform and a side-to-side stapled anastomotic technique helps achieve exceptional postoperative outcomes for MIE with a textbook outcome rate of 90%. With increasing worldwide adoption of MIE, this seems to be an appropriate time to standardize operative technique to optimize postoperative outcomes.