Surgical System Research Articles

Comparison of Surgical Times Between Manual and Robot-Assisted Epiretinal Membrane Peeling.

Epiretinal membranes (ERM) pose a common challenge in vitreoretinal pathology, often causing vision impairment in older adults. The Preceyes Surgical System (PSS) supports the surgical removal of ERM through robot-assisted membrane peeling (RA-MP). This study compares surgical times and iatrogenic hemorrhages between manual membrane peeling (MMP) and RA-MP using PSS. Nine patients underwent RA-MP with PSS, whereas 16 patients (18 eyes) underwent MMP for comparative analysis. Surgical durations were categorized into RA-MP, manual forceps utilization in PSS surgeries (mRA-MP), and traditional MMP. Cumulative manual manipulation duration (cMMP), instrument grasps, and intraoperative hemorrhages were statistically analyzed using the Mann-Whitney U test. RA-MP showed significantly longer peeling times compared to MMP (P < 0.001). Flap initiation grasps were similar between methods (P = 0.86), RA-MP demonstrated a significant reduction in peeling grasps (P = 0.01) and mean grasps per minute (P < 0.001). Although RA-MP resulted in fewer hemorrhages, the difference did not reach statistical significance relative to MMP (P = 0.08). Although RA-MP tended to extend surgical time, it offered advantages in reducing tissue trauma and intraoperative hemorrhages. Further research is needed to explore the learning curve for novice surgeons and evaluate the safety profile of RA-MP. RA-MP may offer potential advantages over manual surgery, particularly in terms of reduced tissue trauma and intraoperative hemorrhages. Despite its longer duration compared with manual techniques, RA-MP may lead to fewer grasping maneuvers and lower rates of hemorrhages, thereby enhancing the safety and precision of vitreoretinal surgeries.

Segmental Bowel Resection for Rectal Endometriosis Using the da Vinci SP

ObjectiveThe da Vinci SP Surgical System (SP) received regulatory approval for use in gynecological surgeries in Japan in 2023. Given the advantages of the precision of a robot, less pain, and the cosmesis of single-port surgery, the da Vinci SP is expected to be further used for minimally invasive surgeries. To the best of our knowledge, this is the first report of the use of SP for the treatment of rectal endometriosis with segmental bowel resection. SettingAn urban general hospital. Stepwise demonstration of the technique with narrated video footage. ParticipantsThe patient was a 46-year-old woman presented with chronic pelvic pain, pain on defecation, and constipation. Magnetic resonance imaging showed uterine large fibroid, left ovarian endometrioma, and 38 mm of rectal endometriosis, with complete cul-de-sac obliteration. InterventionsWe made a 30-mm vertical incision at the umbilicus, then placed the access port, and inserted three articulating instruments and a camera. An assistant port was placed in the right lower quadrant for using the linear stapler. The surgical steps were completely identical to conventional multiport laparoscopic robotic surgery. This suggests that conventional laparoscopic or robotic skills are highly transferrable to SP. SP offer several advantages, including high-resolution three-dimensional visualization, articulating instruments, and improved dexterity and range of motion. In addition, the umbilical access port was particularly useful for proximal bowel resection, specimen retrieval, and anvil positioning during bowel resection. The total operative time was 216 minutes. The estimated blood loss was 100 ml without any complications. The uterine weight was 800 g. The postoperative course was uneventful, with no perioperative complications, including no postoperative bladder dysfunction or low anterior resection syndrome [1,2]. ConclusionThe use of SP with the access port for segmental bowel resection for rectal endometriosis is technically safe and feasible, with good cosmesis and less pain.

Research and progress on the mechanism of lower urinary tract neuromodulation: a literature review.

The storage and periodic voiding of urine in the lower urinary tract are regulated by a complex neural control system that includes the brain, spinal cord, and peripheral autonomic ganglia. Investigating the neuromodulation mechanisms of the lower urinary tract helps to deepen our understanding of urine storage and voiding processes, reveal the mechanisms underlying lower urinary tract dysfunction, and provide new strategies and insights for the treatment and management of related diseases. However, the current understanding of the neuromodulation mechanisms of the lower urinary tract is still limited, and further research methods are needed to elucidate its mechanisms and potential pathological mechanisms. This article provides an overview of the research progress in the functional study of the lower urinary tract system, as well as the key neural regulatory mechanisms during the micturition process. In addition, the commonly used research methods for studying the regulatory mechanisms of the lower urinary tract and the methods for evaluating lower urinary tract function in rodents are discussed. Finally, the latest advances and prospects of artificial intelligence in the research of neuromodulation mechanisms of the lower urinary tract are discussed. This includes the potential roles of machine learning in the diagnosis of lower urinary tract diseases and intelligent-assisted surgical systems, as well as the application of data mining and pattern recognition techniques in advancing lower urinary tract research. Our aim is to provide researchers with novel strategies and insights for the treatment and management of lower urinary tract dysfunction by conducting in-depth research and gaining a comprehensive understanding of the latest advancements in the neural regulation mechanisms of the lower urinary tract.

Эффективность использования новой роботической системы Versius для выполнения операций у детей: результаты клинических испытаний

Authors represent the Russia’s first research demonstrating the results of the use of the Versius modular &amp; portable surgical robot by “CMR Surgical,” Ltd. (Cambridge, Cambridgeshire, United Kingdom) in surgical interventions on pediatric patients that they’ve obtained as part of the clinical trials complex approved by the Federal Service for Surveillance in Healthcare of Russia (“Roszdravnadzor”). The purpose of this research was to obtain practical evidence of the clinical safety and effectiveness of the use of the new Versius® Surgical Robotic System in minimally invasive surgical interventions on children. The criteria for the safety and effectiveness of the method were the absence of complications caused by the Surgical Robotic System (SRS) operation or the surgical technique as well as the absence of dropping into either laparoscopy or open surgery technique. Material and methods used: non-randomized single-center controlled trial had been carried out in children aged 1 to 18 y/o. Areas of application for surgical procedures included urology, abdominal and thoracic surgeries. Results: the number of patients who had undergone the robot-assisted surgeries had totaled 55 (27 (49%) m/28 (51%) f). The patient’s median age of the surgical intervention was 11.5 [7.0; 15.0] y/o; the median weight was 45.5 [27.0; 59.0] kilograms; the median surgical intervention duration was 140.0 [85.0; 175.0] minutes; patients’ stay in the intensive care unit had averaged for 23.0 [19.0; 24.0] hours; the average hospitalization duration was 8.0 [4.0; 14.0] days. Surgical interventions weren’t accompanied by any of the intraoperative complications such as bleeding, organ perforation and/or injury to adjacent anatomical structures. Conversions to either laparoscopic or open surgery technique also weren’t recorded. The equipment technical problems with SRS such as sudden system power-off, synchronous interaction of joysticks/manipulators interruption, robotic arms blocking, manipulators’ uncontrolled movement and/or traumatic effects on the tissues of the abdominal wall/chest weren’t recorded as well. Conclusion: the preliminary results obtained from the clinical trials complex affirm the potential ability of the Versius® Surgical Robotic System to performing robotic surgical interventions on pediatric patients aged 1 to 18 years old.

Accuracy of thoracic nerves recognition for surgical support system using artificial intelligence

We developed a surgical support system that visualises important microanatomies using artificial intelligence (AI). This study evaluated its accuracy in recognising the thoracic nerves during lung cancer surgery. Recognition models were created with deep learning using images precisely annotated for nerves. Computational evaluation was performed using the Dice index and the Jaccard index. Four general thoracic surgeons evaluated the accuracy of nerve recognition. Further, the differences in time lag, image quality and smoothness of movement between the AI system and surgical monitor were assessed. Ratings were made using a five-point scale. The computational evaluation was relatively favourable, with a Dice index of 0.56 and a Jaccard index of 0.39. The AI system was used for 10 thoracoscopic surgeries for lung cancer. The accuracy of thoracic nerve recognition was satisfactory, with a recall score of 4.5 ± 0.4 and a precision score of 4.0 ± 0.9. Though smoothness of motion (3.2 ± 0.4) differed slightly, nearly no difference in time lag (4.9 ± 0.3) and image quality (4.6 ± 0.5) between the AI system and the surgical monitor were observed. In conclusion, the AI surgical support system has a satisfactory accuracy in recognising the thoracic nerves.

Robot-assisted partial nephrectomy: Is it the future of kidney surgery? A comparison of nephron-sparing techniques in partial nephrectomy

Technological advancements are significantly transforming various medical fields, including urology. The increasing adoption of minimally invasive surgical techniques and robotic assistance is particularly impactful. Three partial nephrectomy techniques are investigated: open partial nephrectomy, laparoscopic partial nephrectomy, and robot-assisted partial nephrectomy. Among these, robot-assisted partial nephrectomy is considered to be superior due to shorter warm ischemia time, reduced blood loss, better early renal functional preservation, and shorter hospital stays. The zero-ischemia partial nephrectomy concept aims to improve postoperative kidney function outcomes. The integration of robotic technology and advancements in artificial intelligence and surgical training systems are expected to further enhance surgical techniques. Artificial intelligence, particularly when combined with computer vision algorithms, shows potential for creating precise and automated three-dimensional models for surgical planning in complex robot-assisted partial nephrectomy procedures, potentially leading to better patient outcomes. This review identifies the current capabilities and prospective advancements in the application of robotic technology in partial nephrectomy.

Comparison between DaVinci® and Hugo™-RAS Roux-en-Y Gastric Bypass in bariatric surgery

The application of a robotic platform in the bariatric surgical field is intended to enhance the already established advantages of minimally invasive surgery in terms of both technical and clinical outcomes. These advantages are especially relevant for technically challenging multiquadrant operations such as Roux-en-Y Gastric Bypass (RYGB). Consequently, robotic-assisted surgery has emerged as a possible application for bariatric surgeries. The study attempts to assess feasibility and safety of the Hugo™-Robotic-Assisted Surgery System (Hugo™-RAS) platform compared to the DaVinci® Surgical System (DaVinci®-SS) with a focus on complication rates and operative times. We retrospectively reviewed bariatric procedures performed from January 2013 until December 2023. We included all robotic RYGBs performed using Hugo™-RAS and DaVinci®-SS platforms. The study utilized Propensity Score Matching (PSM) analysis to address bias in selection, matching patients based on age, gender, body mass index, comorbidities and past abdominal operations. One hundred thirty-five patients were identified: 90 DaVinci®-SS and 45 Hugo™-RAS procedures. After PSM, each group consisted of 45 patients. There was no discernible disparity observed in relation to early (≤ 30 days) postoperative complications rate (p = 1), mean operative time (for docking time, console time and total operative time: p = 0.176, p = 0.678, p = 0.229, respectively) and postoperative hospital stay (p = 0.052) between DaVinci®-RSS and Hugo™-RAS procedures. Our results suggest that application of both Hugo™-RAS and DaVinci®-SS robotic platforms to RYGB is related to comparable safety profiles. Although DaVinci®-SS remains the most widely adopted platform in clinical practice, this study underscores the potential role of the Hugo™-RAS to provide effective solutions in robotic bariatric procedures.

The Evolution of Robotic Surgery through the Machine Design Innovation

To date, robotic surgery has gained much popularity, impacting deeply on surgical fields such as genitourinary system branches, general surgery, and cardiac surgery. We aim to outline the landscape of robotic surgery, focusing on design improvements, which have improved both the technical skills of surgeons and the outcomes of minimally invasive technique for patients. A thorough narrative literature review was conducted on PubMed/MEDLINE, employing keywords such as “robotic surgical system”, “robotic surgical device”, and “robotics AND urology”. Furthermore, the reference lists of the retrieved articles were scrutinized. The analysis focused on urological surgical systems from the 2000s to the present day. Beginning with the daVinci® Era in the 2000s, new robotic competitors, including Senhance®, Revo-I®, Versius®, Avatera®, Hi-notori®, and HugoTM RAS, have entered the medical market. While daVinci® has maintained a high competitiveness, even more new platforms are now emerging in the medical market with new intriguing features. The growing competition, driven by unique features and novel designs in emerging robotic technologies, has the potential to improve application fields, enhance diffusion, and ameliorate the cost effectiveness of procedures. Since the impact of these new surgical technologies on different specialties and healthcare systems remains unclear, more experience and research are required to define their evolving role.

Is It the Best Option? Robotic Surgery for Endometriosis.

Endometriosis is a chronic condition affecting approximately 10% of women of reproductive age, leading to significant physical and emotional stress. Treatments include medical management and surgical interventions, with laparoscopic surgery being the gold standard for removing endometrial tissue. The advent of robotic-assisted laparoscopic surgery (RALS) has enabled more complex procedures to be performed minimally invasively, increasing its use in high-difficulty surgeries. Developed in the late 20th century, systems like the Da Vinci Surgical System have revolutionized surgery by enhancing precision, dexterity, and visualization. The latest models, including the Da Vinci Xi and SP, offer advanced features such as enhanced arm mobility, fluorescence imaging, and single-port capabilities. Comparative studies of RALS and conventional laparoscopy (LPS) for endometriosis show mixed results. While some studies indicate no significant differences in complications or recovery outcomes, others highlight longer operative times and hospital stays for RALS. Despite these drawbacks, RALS is not inferior to LPS overall. The clinical benefits of RALS include greater precision and accuracy, reduced surgeon fatigue, and a faster learning curve, facilitated by advanced ergonomic and control systems. However, the high costs and extensive infrastructure requirements limit the accessibility and availability of robotic surgery, particularly in smaller or rural hospitals. The absence of tactile feedback remains a challenge, though upcoming advancements aim to address this. Continued research and development are essential to make robotic surgery more cost-effective and broadly accessible, ensuring its benefits can reach a wider patient population. This abstract encapsulates the key aspects of robotic surgery's development, comparative studies with conventional methods, and its clinical benefits and limitations, highlighting the need for ongoing improvements and research.

Randomized controlled trial on the efficacy of a custom-made, fully guided implant system for flapless crestal sinus floor elevation: Accuracy and patient-reported outcomes.

To compare fully guided flapless implant surgery using a light-cured surgical guide (FG group) with partially guided open flap surgery (PG group) in the posterior maxilla when performing simultaneous sinus floor elevation in terms of the accuracy, time requirements, and patient/clinician-reported outcomes (PROMs and CROMs). In this study, 56 tissue-level implants were placed with crestal sinus floor elevation in 56 patients at single-tooth sites, with 28 implants allocated to the PG group and 28 to the FG group. The deviations of the placed implants from the virtually planned positions were measured at the implant platform and apex and for the angular deviation. The presurgical preparation time and the duration of surgery were measured. PROMs and CROMs were made by administering questionnaires at multiple time points. Horizontal deviations at the platform and apex and the angular deviation were significantly smaller in the FG group than the PG group (p < .05). Presurgical preparation and surgery times were significantly shorter in the FG group (p < .001). Patient satisfaction and willingness to receive repeat treatment were significantly better in the FG group than in the PG group (p < .005 and .025, respectively). Clinicians were more satisfied in the FG group than the PG group (p < .05). When placing an implant with sinus floor elevation, the flapless approach using a fully guided surgical system can be more accurate, faster, and increase the satisfaction of both the clinician and patient compared to the partially guided surgery.

A scoping review of Enhanced Recovery After Surgery (ERAS), protocol implementation, and its impact on surgical outcomes and healthcare systems in Africa

BackgroundEnhanced Recovery After Surgery (ERAS) is a patient-centered approach to surgery designed to reduce stress responses and facilitate faster recovery. ERAS protocols have been widely adopted in high-income countries, supported by robust research demonstrating improved patient outcomes. However, in Africa, there is limited evidence regarding its implementation. This review aims to identify the existing literature on the implementation of ERAS principles in Africa, the reported clinical outcomes, and the challenges and recommendations for successful implementation.MethodsWe conducted a librarian-assisted literature search of electronic research databases between October and November 2023. Titles and abstracts were screened for eligibility, and duplicates were then removed, followed by full-text assessment of potentially eligible studies. We utilized the summative content analysis method to synthesize and group the data into fewer categories based on agreed-upon criteria. Descriptive statistics were used to describe the results.ResultsThe search identified 342 potential studies resulting in 15 eligible studies for inclusion in the review. The publication years ranged from 2016 to 2023. The studies originated from three countries: Egypt (n = 10), South Africa (n = 4), and Uganda (n = 1). Successful implementation was associated with reduced hospital length of stay (n = 12), lower mortality rates (n = 3), and improved pain outcomes (n = 7). Challenges included protocol adherence (n = 5) and limitations of the research design to generate strong evidence (n = 3). Recommendations included formal adoption of ERAS principles (n = 5), the need for sustained research commitment, and exploration of the applicability of ERAS in diverse surgical contexts (n = 8). Large-scale implementation beyond individual institutions was encouraged to further validate its impact on patient outcomes and healthcare costs (n = 1).ConclusionsDespite the limited number of studies on ERAS implementation in Africa, the available evidence suggests that it reduces the length of hospital stays and mortality rates. This is crucial for the region, given its higher mortality rates, necessitating more collaborative, methodically well-designed studies to establish stronger evidence for ERAS in lower-resource environments.

Artificial intelligence: revolutionizing robotic surgery: review.

Robotic surgery, known for its minimally invasive techniques and computer-controlled robotic arms, has revolutionized modern medicine by providing improved dexterity, visualization, and tremor reduction compared to traditional methods. The integration of artificial intelligence (AI) into robotic surgery has further advanced surgical precision, efficiency, and accessibility. This paper examines the current landscape of AI-driven robotic surgical systems, detailing their benefits, limitations, and future prospects. Initially, AI applications in robotic surgery focused on automating tasks like suturing and tissue dissection to enhance consistency and reduce surgeon workload. Present AI-driven systems incorporate functionalities such as image recognition, motion control, and haptic feedback, allowing real-time analysis of surgical field images and optimizing instrument movements for surgeons. The advantages of AI integration include enhanced precision, reduced surgeon fatigue, and improved safety. However, challenges such as high development costs, reliance on data quality, and ethical concerns about autonomy and liability hinder widespread adoption. Regulatory hurdles and workflow integration also present obstacles. Future directions for AI integration in robotic surgery include enhancing autonomy, personalizing surgical approaches, and refining surgical training through AI-powered simulations and virtual reality. Overall, AI integration holds promise for advancing surgical care, with potential benefits including improved patient outcomes and increased access to specialized expertise. Addressing challenges and promoting responsible adoption are essential for realizing the full potential of AI-driven robotic surgery.

Robotic urologic applications of the hinotori™ Surgical Robot System

ObjectiveTo assess the safety and effectiveness of urological tumor surgeries using the hinotori™ Surgical Robot System (hinotori) in a real-world clinical setting. MethodsAll surgeries including procedures of robot-assisted radical prostatectomy (RARP), robot-assisted partial nephrectomy (RAPN), robot-assisted radical nephrectomy (RARN), robot-assisted nephroureterectomy (RANU), robot-assisted adrenalectomy (RAA), and robot-assisted radical cystectomy with intracorporeal urinary diversion (RARC+ICUD) for urological tumors with hinotori and da Vinci surgical system (da Vinci) from January 2022 through September 2023 were enrolled. We evaluated the safety and effectiveness of surgery using hinotori compared using da Vinci. ResultsRobotic surgeries using hinotori were performed in a total of 91 cases, comprising 42 cases of RARP, 18 cases of RAPN, six cases of RARN, 10 cases of RANU, 13 cases of RAA, and two cases of RARC+ICUD. No major intraoperative complications were observed in any cases using hinotori. No major postoperative complications occurred in any of the cases. No case experienced unrecoverable equipment error during surgery. Meanwhile, robotic surgeries using da Vinci were performed in a total of 277 cases that included 126 cases of RARP, 94 cases of RAPN, 12 cases of RARN, 10 cases of RANU, 20 cases of RAA and 15 cases of RARC+ICUD. Major intraoperative complications occurred two cases. Major postoperative complications occurred in seven cases. Seven cases required transfusion. One case underwent conversion to open surgery. During the study period, no case experienced an unrecoverable equipment error. Surgical outcomes for cases with hinotori were comparable to those with da Vinci. ConclusionsThis study demonstrated that hinotori is a safe and feasible tool for robotic surgeries in the field of urology.

Investigating the accuracy of machine vision and augmented reality in percutaneous computed tomography-guided interventions: A phantom study.

This study aimed to evaluate the accuracy of percutaneous computed tomography (CT)-guided puncture based on machine vision and augmented reality in a phantom. The surgical space coordinate system was established, and accurate registration was ensured using the hierarchical optimization framework. Machine vision tracking and augmented reality display technologies were used for puncture navigation. CT was performed on a phantom, and puncture paths with three different lengths were planned from the surface of the phantom to the metal ball. Puncture accuracy was evaluated by measuring the target positioning error (TPE), lateral error (LE), angular error (AE), and first success rate (FSR) based on the obtained CT images. A highly qualified attending interventional physician performed a total of 30 punctures using puncture navigation. For the short distance (4.5-5.5 cm), the TPE, LE, AE, and FSR were 1.90 ± 0.62 mm, 1.23 ± 0.70 mm, 1.39 ± 0.86°, and 60%, respectively. For the medium distance (9.5-10.5 cm), the TPE, LE, AE, and FSR were 2.35 ± 0.95 mm, 2.00 ± 1.07 mm, 1.20 ± 0.62°, and 40%, respectively. For the long distance (14.5-15.5 cm), the TPE, LE, AE, and FSR were 2.81 ± 1.17 mm, 2.33 ± 1.34 mm, 0.99 ± 0.55°, and 30%, respectively. The augmented reality and machine vision-based CT-guided puncture navigation system allows for precise punctures in a phantom. Further studies are needed to explore its clinical applicability.

A Series-Parallel Hybrid Pelvic Fracture Reduction Surgical Robotic System Based on Novel 6-DOF Force Amplification Mechanism

A Series-Parallel Hybrid Pelvic Fracture Reduction Surgical Robotic System Based on Novel 6-DOF Force Amplification Mechanism

Developing novel non-assistant help operation in dual-portal robotic-assisted thoracic surgery (neoDRATS)

ObjectiveTo introduce and evaluate the non-assistant help operation in dual-portal robotic-assisted thoracic surgery (neoDRATS), a novel technique designed to eliminate the need for skilled assistants by using all 4 robotic arms independently during anatomical lung surgery. MethodsPatients were placed in the lateral decubitus position under general anesthesia with single-lung ventilation. The da Vinci Xi Surgical System was used, with specific configurations for right- and left-side operations. The neoDRATS technique used a 4-cm working port and a 1.8-cm secondary port, with detailed guidelines for optimal setup and robotic arm manipulation. ResultsThe neoDRATS approach demonstrated successful surgical outcomes without the need for a skilled assistant. The use of a 0° camera and careful placement of instruments minimized interference within the thoracic cavity. The technique provided smooth operability and minimized postoperative discomfort. Video demonstrations of right and left upper lobectomies are provided to illustrate the approach. ConclusionsNeoDRATS offers a practical, safe, and minimally invasive alternative to conventional multiportal and uniportal robotic-assisted thoracic surgeries. This technique simplifies the surgical process, particularly in settings with limited availability of skilled assistants, and represents a significant advancement in robotic thoracic surgery. Further refinement and clinical integration of neoDRATS are anticipated as robotic innovations continue to evolve.

Robotic-Assisted Surgery in Children Using the Senhance® Surgical System: An Observational Study.

Robotic-assisted surgery (RAS) holds many theoretical advantages, especially in pediatric surgical procedures. However, most robotic systems are dedicated to adult surgery and are less suitable for smaller children. The Senhance® Surgical System (SSS®), providing 3 mm and 5 mm instruments, focuses on making RAS technically feasible for smaller children. This prospective observational study aims to assess whether RAS in pediatric patients using the SSS® is safe and feasible. A total of 42 children (aged 0-17 years, weight ≥ 10 kg) underwent a RAS procedure on the abdominal area using the SSS® between 2020 and 2023. The study group consisted of 20 male and 22 female individuals. The mean age was 10.7 years (range 0.8 to 17.8 years), with a mean body weight of 40.7 kg (range 10.1 to 117.3 kg). The 3-mm-sized instruments of the SSS® were used in 12 of the 42 children who underwent RAS. The RAS procedures were successfully completed in 90% of cases. The conversion rate to conventional laparoscopy was low (10%), and there were no conversions to open surgery. One of the 42 cases (2%) experienced intraoperative complications, whereas six children (14%) suffered from a postoperative complication. Overall, 86% of the patients had an uncomplicated postoperative course. The results of the current observational study demonstrate the safety and feasibility of utilizing the SSS® for abdominal pediatric RAS procedures. The study provides new fundamental information supporting the implementation of the SSS® in clinical practice in pediatric surgery.

1000 Robotic-assisted lobectomies for primary lung cancer: 16 years single center experience

ObjectiveThis study aimed at describing our high-volume single center experience in robotic-assisted thoracic surgery (RATS) to evaluate short outcome and feasibility of the technique, the adequacy of oncological results, and the learning curve. MethodsWe retrospectively analyzed data from 1000 consecutive patients who underwent lobectomy and systematic lymphadenectomy for primary lung cancer using RATS approach between May 2007 and May 2023. ResultsNine-hundred ninety-seven patients (99.7 %) underwent lobectomy, whereas 3 (0.03 %) patients bilobectomy. Conversion rate to open surgery was 3.7 %. Minor complications occurred in 213 (21.3 %) patients, major complications in 29 patients (2.9 %). The 30-day and 90-day operative mortality was 0 % and 0.1 %, respectively. The median number of N1 + N2 stations resected was 5 (range 0–9), with a median number of 17 of N1 + N2 lymph nodes resected (range 0–55). The oncological outcome was evaluated only on the subgroup of patients (n = 895) with non-small cell lung cancer. Pathological lymph node upstaging from cN0 to pN1/pN2 was evident in 147 patients (17.3 %): 9 % from cN0 to pN1 and 7.1 % from cN0 to pN2. With a median follow-up of 3.9, 5-year OS and DFS were respectively 89.3 % and 83.6 % for stage I, 74 % and 66.5 % for stage II, and 61 % and 36.4 % for stage IIIA. ConclusionsBetter vision and excellent instrument maneuverability of the robotic surgical system allowed excellent results in terms of early, adequate oncological outcome comparable to open surgery literature data, and acceptable learning curve. Ultramini abstract1000 consecutive patients who underwent lobectomy and systematic lymphadenectomy for primary lung cancer using RATS approach have been analyzed with the aim to describe our high-volume single center experience, and to evaluate short outcome and feasibility of the technique, the adequacy of oncological results, and the learning curve.

Use of e-learning platforms to monitor surgical competencies in medical universities

The emergence of e-learning platforms as a potential means of advancement is not new, but their use has increased significantly during the COVID-19 epidemic. Distance learning presents users with not only problems but also user-centered solutions. The purpose of this study is to review the literature on e-learning platforms used in medical schools to formulate a research strategy to implement an e-learning platform for surgical competency control. To achieve the objective, a search was conducted for articles cited in PubMed, Research Gate, Google Scholar, Web of Science and Scopus databases from journals and conference proceedings published between 2015 and 2023. Literature in the study area was systematized to explore the experiences of users of e-learning platforms in medical schools to provide a basis for a methodological framework.The proposed structure or content analysis model can be used for further e-learning research and guide the successful implementation of e-learning and surgical competency monitoring systems in medical HEIs. An important area of focus is the study of the advantages and disadvantages of specific e-learning methods, as their benefits have not been fully explored and are mainly related to e-learning platforms. Here we consider various features of e-learning in the context of its implementation in the system of medical education in Kazakhstan and other foreign countries.

Practice guidelines on endoscopic surgery for qualified surgeons by the endoscopic surgical skill qualification system: Large intestine.

Practice guidelines on endoscopic surgery for qualified surgeons by the endoscopic surgical skill qualification system: Large intestine.