The management of hernia in immunocompromised patients remains a distinct surgical challenge, characterized by complex risk profiles, heightened susceptibility to infectious complications, and ambiguous consensus on optimal mesh selection and perioperative protocols. As the prevalence of immunosuppression continues to rise due to increasing organ transplant rates, autoimmune diseases, oncological therapies, and advanced age, understanding the nuances of mesh repair in this population is of paramount importance. This review synthesizes current evidence on the safety, efficacy, and outcomes of hernia mesh repair in immunocompromised adults, traversing mesh materials, infection mitigation strategies, surgical techniques, recurrence and complication rates, patient-reported outcomes, cost-effectiveness, and future research imperatives. Advanced mesh materials-particularly long-acting resorbable meshes-show superior long-term durability but at elevated cost. The risk for mesh infection and recurrence is proportionate to immunosuppression burden, comorbidities, and operative field contamination. Notably, modern synthetic meshes, when coupled with stringent perioperative infection control and risk-mitigation strategies, offer durable repair with acceptable safety profiles, even in immunocompromised hosts. There is insufficient evidence to support routine use of biologic mesh, except in select contaminated fields. Patient-reported metrics are increasingly recognized as essential for outcome assessment, though standardization remains incomplete. Cost-effectiveness favors synthetics unless contamination risks predominate or patient preference dictates otherwise. Gaps include inconsistent immunocompromised patient definitions, limited long-term data, and lack of tailored guidelines. Prospective, multicenter studies integrating real-world patient-reported and economic data are needed.

Recent evidence supports the clinical and economic advantages of the Manchester procedure (MP) over sacrospinous hysteropexy (SSH) in women treated for mild to moderate uterine prolapse. However, its use remains inconsistent, resulting in a notable variation in current practice. This study explores gynecologists' barriers and facilitators to adoption of the MP, aiming to guide the development of a targeted implementation strategy. From March to June 2025, we conducted semi-structured interviews with gynecologists (n = 12) from the Netherlands in different stages of implementation to identify barriers and facilitators. The updated Consolidated Framework for Implementation Research (CFIR) guided data collection and analysis, ensuring a structured assessment of key domains. A total of 12 barriers and 20 facilitators were identified in 13 constructs across all CFIR domains. Key facilitators for implementation included strong regional collaboration networks, the low complexity of the surgical technique, peer-driven motivation to align with national trends, and overall trust in the evidence, although the latter varied between clinicians. Main barriers were the personal and organizational effort required for training and implementation, particularly in the absence of an experienced colleague, satisfaction with SSH results, and concerns about lower reimbursement for the MP. This study identified key barriers and facilitators influencing the adoption of the MP from the perspective of gynecologists, emphasizing the clinical, organizational, and financial factors involved. Addressing these barriers and leveraging facilitators could enhance adoption of the MP, potentially improving treatment outcomes and reducing healthcare costs.

Background: Non-puerperal uterine inversion (NPUI) is undoubtedly a rare phenomenon, in which, if an early diagnosis is to be made, a clinician must have a high index of suspicion. It is also important to be familiar with the different surgical techniques involved in its management. This report gives an account of a case of NPUI managed by a combined abdominal and vaginal approach. Case Presentation: The patient was a 39-year-old woman whose last childbirth was 7 years ago. She presented with heavy menstrual bleeding of a year duration and watery, copious, and foul-smelling vaginal discharge of 7 days duration. On examination, the inverted uterus was found to be protruding from the introitus with a solitary gangrenous fibroid mass attached to its fundal region. An excision of the mass was done via a vaginal approach with subsequent failed attempts to revert the uterus. Thus, the uterus was amputated per vagina, and its appendages approached per abdomen. The histology report revealed gangrenous leiomyoma with no evidence of malignancy. Conclusion: A high index of suspicion, appropriate history with astute pelvic examination and appropriate investigations are all important in the diagnosis and management of uterine inversion. Pelvic ultrasonography, especially those with Doppler enhancement, together with magnetic resonance imaging, have characteristic features. Definitive treatment involves reverting the uterus to its normal position and either preserving fertility or performing a hysterectomy if the family size is complete.

Introduction Virtual reality-based training tools have become increasingly incorporated into health education in recent years. In dentistry, three-dimensional (3D) haptic simulators are used in several undergraduate programs to support preclinical training in procedures such as caries removal, cavity preparation, coronal access, prosthodontic preparation, periodontal therapy, and surgical techniques. The aim of this study was to explore student performance in cavity preparation tasks using a virtual haptic simulation system across different academic years of the dentistry degree. Methods Second-, third-, and fourth-year dentistry students underwent prior training using 3D haptic simulators in the Virtual Haptic Simulation classroom at ADEMA University School (Universal Simulation, London, UK). Training consisted of completing five cavity preparation activities using preforms, followed by repetition of the same activities with and without the preform. Performance outcomes recorded by the simulator were analyzed and compared between academic years, including precision, surgery time, drilling time, activity progress, target volume, and external volume. Results Statistical analysis using ANOVA revealed no statistically significant differences in accuracy among the different academic years ( p = 0.09915). In contrast, significant differences were observed between groups for surgery time ( p = 9.059 × 10 − ⁷), drilling time ( p = 0.0001236), activity progress ( p = 4.26 × 10 − ⁸), target volume ( p = 1.244 × 10 − ⁹), and external volume ( p = 0.005844). No statistically significant differences were identified between cavities prepared with and without the preform in terms of surgery time, drilling time, or activity progress. Discussion Within the methodological limitations of this study, including the absence of clinical-transfer assessment, the use of non-equivalent tasks across academic levels, and reliance on simulator-derived metrics with limited sensitivity, the findings should be interpreted with caution. The observed performance patterns reflect students' interaction with the virtual haptic environment rather than definitive evidence of skill acquisition or progressive competence development. Non-significant differences in accuracy between academic years should not be interpreted as equivalence of operative competence. Overall, this study provides descriptive insight into the use of VR-haptic simulation as a supplementary preclinical training resource, highlighting areas for further methodological refinement and future controlled investigations.

Minimally invasive treatment for high-risk gastrointestinal stromal tumor (GIST) remains controversial for the concerns including intra-operative rupture and tumor spillage. This study aimed to compare the long-term oncological outcomes in the high-risk GIST patients receiving laparoscopic and open surgery. We conducted a retrospective study on patients with high-risk GISTs of the stomach undergoing curative resection by laparoscopic or open approach from 2002 to 2024 at a single medical center. Propensity score matching was applied to adjust for tumor size and tumor location between these two groups at a 1:1 ratio. We evaluated the peri-operative and long-term oncological outcomes. There were 184 patients with high-risk GISTs of the stomach recruited. The clinical demographics including age and gender were similar between the laparoscopic and open groups. The mean tumor size was significantly larger in the open group (13.4 ± 7.4cm versus 5.7 ± 3.5cm, p < 0.001). After matching, 34 patients in each group were analyzed with comparable tumor sizes and locations. The laparoscopic group was associated with a shorter hospital stay (9.7 ± 2.3days versus 12.4 ± 4.0days, p = 0.013). Otherwise, the operation time, blood loss, and the ratio of receiving adjuvant target therapy were similar between groups. Kaplan-Meier RFS analysis showed no difference between the open and laparoscopic groups either in 10-year RFS (82.7% versus 73.6%, p = 0.739) or 10-year OS (90.0% versus 96.9%, p = 0.588). Multivariate analysis showed the surgical approach was not a significant risk factor affecting RFS or OS. Laparoscopic resection is a safe and feasible surgical approach in selected gastric high-risk GIST patients, providing comparable oncologic outcomes to open surgery with a shorter hospital stay.

Management of chronic Achilles tendon ruptures (CATR) varies according to patient and injury characteristics, but clear guidelines regarding the evaluation and treatment options are still lacking. This study aims to identify tendencies regarding the evaluation and management of CATR among foot and ankle orthopaedic surgeons. The research question is if there is any tendency regarding evaluation, preoperative planning, choice of surgical approach and technique for management of CATR. A web-based questionnaire was distributed through 56 national and international foot and ankle orthopaedic societies. Replies were pooled and analysed. A 'main tendency' was considered when 75% of the participants chose the same treatment method, a 'tendency' for 50%-75%, and 'no tendency' when less than 50% choose the same method. A total of 667 orthopaedic surgeons from 60 countries participated. Most respondents were experienced, specialised foot and ankle surgeons; however, 68% managed fewer than five CATR annually. MRI was the predominant imaging modality selected for surgical planning (88%). Gap size (80%) is the principal determinant of technique selection, followed by time from injury (61%) and then patient age (57%). Open repair was the most common technique (66%). End-to-end repair for defects <2 cm was the only treatment tendency (68%). Rehabilitation strategies were heterogeneous, though plaster immobilisation in equinus (55%), walker boot use for partial weight-bearing (90%), and physiotherapy initiation at 4-6 weeks following surgery were common tendencies. Compared with acute ruptures, functional outcomes were perceived as slightly worse in CATR (54%). This study confirms significant variation in CATR management internationally. While end-to-end repair is a consistent choice for gaps smaller than 2 cm, the variability observed in responses reflects the lack of evidence and clear treatment algorithms. Level IV.

Venous thromboembolic (VTE) complications contribute substantially to perioperative morbidity and mortality. The decision for mechanical and/or chemo-prophylaxis is currently based on VTE risk assessment models since conventional laboratory assays of coagulation usually fail to detect changes indicating hypercoagulability. Rotational thromboelastometry is a novel assay of coagulation, that it could potentially be used in objectively selecting patients at risk for VTE, who should indisputably undergo prophylaxis. We evaluated the association of conventional and novel assays of coagulation and VTE risk. VTE risk was preoperatively assessed in 45 patients scheduled for endoscopic, open and laparoscopic urologic surgery, including transurethral resection of prostate, transurethral resection of bladder tumor, endoscopic vesical or ureteral stone lithotripsy, open prostatectomy, open cystectomy and urinary diversion, open or laparoscopic radical or partial nephrectomy, between March 2021 and October 2022, using three different risk assessment models (RAMs): the European Association of Urology (EAU) RAM, the American Urological Association (AUA) RAM, and the Caprini model. Patients under antiplatelet or anticoagulation agents were excluded. Patients' coagulation profile was determined by measuring PT, fibrinogen, aPTT, and rotational thromboelastometry analysis. For rotational thromboelastometry analysis, extrinsic rotational thromboelastometry and fibrinogen rotational thromboelastometry were examined in every patient. Statistical analysis was performed with ANOVA test and χ2 test. Mean values of all rotational thromboelastometry variables did not vary significantly among different EAU VTE categories. In extrinsic rotational thromboelastometry assessment, a significant difference was observed in the mean values of the Clotting time (CT) between the different risk groups based on AUA RAM. In the comparison between the risk groups defined based on the Caprini score, statistically significant differences were observed in the extrinsic rotational thromboelastometry clot formation time (CFT). In fibrinogen rotational thromboelastometry analysis, significant differences were identified in the clot amplitude after five minutes (A5) and maximum clot firmness (MCF) indices between the AUA risk groups, along with a significant difference in the mean clot formation rate (CFR) value between the risk groups defined based on the Caprini score. Rotational thromboelastometry can provide a detailed evaluation of the hemostatic status in patients undergoing urologic surgery that can be used as an adjunct to the VTE risk assessment models and thus, help to offer prophylaxis on a rather personalized basis. Future studies should assess the utility of thromboelastometry in identifying patients at high risk for VTE after major urological procedures.

Abstract Facial paralysis can cause profound functional and psychological impact. Management strategies have evolved significantly, with advances in understanding facial nerve anatomy, nerve physiology, and microsurgical techniques. This review provides a comprehensive overview of surgical strategies for both acute and chronic facial paralysis, highlighting contributions from Chang Gung Memorial Hospital that have shaped contemporary practice. Indications, timing, and selection of interventions—including nerve grafting, nerve transfers, and free functioning muscle transplantations—are examined with emphasis on techniques that restore facial symmetry. Recent developments in the management of acute facial paralysis following oncologic resection and in eyelid reanimation are also discussed. By integrating evidence from published research and institutional experience, this review aims to guide the selection of surgical strategies to enhance facial movement and symmetry.

Radical cystectomy (RC) with pelvic lymphadenectomy followed by urinary diversion is the standard treatment for muscle-invasive bladder cancer (MIBC). Perioperative systemic therapy can improve the oncological outcome of RC. Despite the use of modern surgical techniques, RC is still associated with ahigh rate of perioperative complications and reduced quality of life. As an alternative to RC, organ preserving trimodal therapy can be performed in selected patients. In light of newer and more effective systemic therapies and the associated higher response rates to neoadjuvant systemic therapy, interest in novel organ-preserving concepts for appropriate patients with MIBC has increased. These approaches aim to better preserve quality of life while achieving oncological outcomes that are at least comparable to those of RC. Clinical re-evaluation after initial systemic therapy requires establishment of robust surrogate parameters for complete pathological and systemic response. To this end, existing combined restaging methods (transurethral resection of bladder tumor [TUR-BT], urinary diagnostics, imaging techniques, liquid biopsies) need to be further developed and validated. This narrative review outlines current developments and challenges that must be considered for the successful implementation of organ-preserving approaches in MIBC and defines the prerequisites under which organ preservation may be feasible.

Purpose Extracranial-intracranial (EC-IC) bypass surgery remains controversial due to high complication rates reported in major trials. This study evaluates whether optimised perioperative protocols and surgical expertise can achieve substantially improved safety profiles in patients with symptomatic chronic internal carotid artery occlusion (CICAO) and chronic middle cerebral artery occlusion (CMCAO), addressing the critical gap between theoretical benefit and clinical reality. Materials and methods This retrospective single-centre study analysed 256 consecutive patients with symptomatic CICAO (n = 162) or CMCAO (n = 94) who underwent superficial temporal artery-middle cerebral artery bypass between October 2006 and February 2021. All procedures were performed by a single experienced surgeon using standardised protocols, including continuation of antiplatelet therapy throughout the perioperative period, maintaining baseline blood pressure levels, and strict postoperative blood pressure control below 140 mmHg. Patients underwent comprehensive evaluation with magnetic resonance imaging, digital subtraction angiography, and computed tomography perfusion. Primary outcomes included 30-day stroke or death and recurrent stroke during 24-month follow-up. Results The mean temporary intraoperative occlusion time was 23.5 minutes. Remarkably, the 30-day haemorrhagic stroke rate was 0.8% (2/256) with no ischaemic strokes, representing a dramatic improvement over historical controls. During 24-month follow-up, recurrent stroke occurred in 1.5% (4/256) of patients. Patients with CMCAO demonstrated superior outcomes compared to CICAO patients, with total stroke rates of 1.0% versus 3.1%, respectively. Conclusions Under expert surgical technique with optimised perioperative protocols, EC-IC bypass achieves exceptional safety profiles with complication rates substantially lower than previous major trials. The dramatic reduction from the historical 15% to 0.8% perioperative stroke rates demonstrates that surgical excellence and protocol optimisation can transform outcomes in cerebral revascularisation. These findings suggest that the poor results in previous trials may reflect technical and management factors rather than fundamental procedure limitations, warranting reconsideration of EC-IC bypass for carefully selected patients, particularly those with CMCAO.

Surgical site infections (SSIs) particularly periprosthetic joint infection (PJI, a deep/organ-space infection) remain devastating after total hip arthroplasty (THA). Because routine systemic perioperative antibiotics are standard of care, we focused on the added value of intrawound (local) prophylaxis. We evaluated whether intrawound antibiotics, used in addition to standard systemic prophylaxis, reduce infection after THA and explored effects across surgery type (primary vs. revision). We searched PubMed, Cochrane Library, ScienceDirect, EMBASE, CNKI, VIP, Wanfang, and CBM (January 2010 to final search) for cohort studies comparing intrawound antibiotic prophylaxis + standard systemic prophylaxis versus standard systemic prophylaxis alone. We systematically searched studies published since 2010 to include the most recent and relevant data, ensuring that the research included reflects modern surgical techniques, standardized reporting, and advancements in the use of intrawound antibiotics. Two reviewers independently screened, extracted data, and assessed risk of bias; meta-analysis used RevMan 5.3. Eight cohort studies (n = 16,939) met criteria. Heterogeneity for PJI was low (Chi² = 7.57, df = 7, P = 0.37; I² = 8%). Intrawound prophylaxis plus systemic prophylaxis was associated with lower PJI risk than systemic prophylaxis alone (OR = 0.42, 95% CI: 0.30-0.58, P < 0.00001). Subgroup analysis showed consistent benefit in both primary and revision THA (OR = 0.30, 95% CI: 0.20-0.47, P < 0.00001; I² = 0%). Superficial incisional SSI (skin/subcutaneous) showed no significant difference (OR = 0.41, 95% CI: 0.10-1.66, P = 0.92), and adverse events did not differ significantly (OR = 0.89, 95% CI: 0.45-1.78, P = 0.75). Funnel plots suggested possible publication bias. There is limited evidence, with a possible risk of publication bias, suggesting that intrawound (local) antibiotic prophylaxis, when added to standard systemic antibiotics, may be associated with reduced postoperative PJI after THA across primary and revision procedures. Evidence for superficial SSI and safety remains limited by few contributing studies. Standardized, head-to-head randomized trials are needed to define optimal regimens (agent, dose, timing) and long-term safety (including antimicrobial resistance).

Introduction: Plate fixation is an established procedure for proximal humeral fractures involving the greater tuberosity; however, concomitant glenohumeral dislocation increases the risk of secondary displacement of the greater tuberosity fragments. The suture bridge technique has produced satisfactory outcomes for greater tuberosity fractures; however, little is known about the outcomes of combining plate fixation with the suture bridge technique. We report the surgical technique and outcomes of plate fixation combined with the suture bridge technique for proximal humeral fracture-dislocations with displaced greater tuberosity. Presentation of case: We retrospectively identified six patients who underwent plate fixation combined with a suture bridge technique. Using the deltopectoral approach, we reduced the fractured fragments. We inserted medial anchors into the proximal margin of the humeral fracture surface and distal anchors into the shaft, and fixed the greater tuberosity fragments using the suture bridge technique. The fractured fragments were fixed using a locking plate. We evaluated postoperative shoulder functional scores and complications. The mean Constant score was 86, and the American Shoulder and Elbow Surgeons score was 85 at 1 year postoperatively. No major postoperative complications were observed. Discussion: The procedure yielded satisfactory functional and radiological outcomes. Plate fixation combined with the suture bridge technique allows for more secure fixation of greater tuberosity fragments than conventional procedures, potentially preventing greater tuberosity displacement postoperatively. Conclusion: This case series presents a new fixation procedure for proximal humeral fractures, which can be advantageous in patients with a high risk of postoperative greater tuberosity displacement.

Operative time-based learning curve and surgical outcomes of laparoscopic radical prostatectomy in a surgeon with limited open surgery experience.

Impact of bariatric surgery on the gut microbiota and metabolomic profile of the enterohepatic axis in an experimental model of obesity.

The anterolateral thigh free flap is widely utilized for reconstructing complex wounds. Despite considerable advances in free flap procedures, partial flap loss remains a challenge, particularly with larger perforator flaps. This study explored the outcomes of bipedicle anterolateral thigh free flap procedures by comparing single-pedicle free flaps in cases involving larger flaps. This retrospective study included 70 patients who underwent procedures (N = 72) involving extremely large anterolateral thigh free flaps (≥240 cm2 in area and >30 cm in length) at our hospital between January 2020 and December 2024. Patient characteristics and medical records were comprehensively reviewed, focusing on variables such as age, sex, flap size, surgical technique, perioperative characteristics, and postoperative outcomes. A comparison of patient demographics revealed no statistically significant differences across the entire group. A total of 8 bipedicle anterolateral thigh free flap reconstruction procedures were performed. No flap complications were observed in patients undergoing bipedicle free flap reconstruction; this outcome differed significantly from that noted in patients undergoing single-pedicle free flap reconstruction (P = 0.0215). Besides, no significant between-procedure difference was observed in ischemic time, operative time, or donor site complications. The bipedicle anterolateral thigh free flap procedure appears to be a reliable approach for reconstructing extensive soft tissue defects with a single, substantial flap.

Corynebacterium Periprosthetic Joint Infections: A Single-Institution's Experience with a Virulent Organism.

Cardiac structural complications (CSCs) have been recently established by the Valve Academic Research Consortium 3 consensus as a combined end point including multiple life-threatening periprocedural events following transcatheter aortic valve replacement. The objective was to assess the incidence, timing, management, and clinical impact of CSCs in the contemporary transcatheter aortic valve replacement era. Multicenter study including consecutive patients undergoing transcatheter aortic valve replacement in 18 European and Canadian centers from 2014 to 2024. According to the Valve Academic Research Consortium 3 criteria, CSCs included cardiac structure perforation, injury or compromise, new pericardial effusion, and coronary obstruction. Data was collected in a dedicated database, and patients were followed at 30 days, 1 year, and yearly thereafter. Among a total of 10 541 patients, CSCs occurred in 221 (2.1%), with 126 (1.2%) patients exhibiting >1 CSC: 146 (1.4%) cardiac structure compromise events (annular rupture: 41.1%, left ventricular perforation: 26.0%; right ventricular perforation: 24.0%, other injuries: 8.9%), 150 (1.4%) new pericardial effusions, and 59 (0.6%) coronary obstructions. Up to 75.6% of CSCs occurred intraprocedurally, and 61 (27.6%) patients had conversion to open heart surgery. The incidence of CSCs remained similar throughout the 10-year study period (from 1.3% to 3.2%, median annual rate of 2.3%). Thirty-day mortality was 35.3% (47.5% among patients requiring conversion to surgery), with annular rupture associated with the highest (41.0%) mortality rate. About 2% of contemporary transcatheter aortic valve replacement recipients presented CSCs, which did not decrease over time, required conversion to surgery in more than one-fourth of cases, and were associated with very high periprocedural mortality rates. Further research is needed regarding potential preventive strategies and optimal surgical bailout management.

Background: Achieving profound anesthesia in surgical procedures involving the mandibular angle region remains challenging due to overlapping sensory innervation from both the inferior alveolar nerve and branches of superficial cervical plexus. This study evaluates the effectiveness of superficial cervical plexus block (SCPB) as an adjunct to the inferior alveolar nerve block (IANB) in selective cases involving the angle of mandible. Methodology: A prospective clinical study was conducted on patients undergoing minor maxillofacial surgical procedures in mandibular angle region. Intraoperative pain scores, onset of anesthesia, need for supplemental anesthesia, operator satisfaction, and postoperative analgesia were assessed. Results: A total of 10 patients were included in the study. Patients in the superficial cervical plexus block demonstrated improved intraoperative analgesia, lower intraoperative pain scores and reduced requirement for supplemental anesthetic injections. The onset of anesthesia was clinically faster, and the duration of postoperative analgesia was longer, no major complications or adverse effects were recorded during the study period. Conclusions: Superficial cervical plexus block appears to provide sufficient anesthesia and increased patient comfort in surgeries involving the mandibular angle. SCPB may be considered as an effective and safe alternative for improved perioperative pain control.

Laparoscopic cholecystectomy is the gold standard for gallbladder disease, but the decision to switch to open surgery is still a critical one. The purpose of the study was to determine the conversion rate, to identify predictive risk factors and to analyze the results of the institution-wide conversion rate. A retrospective cohort study was conducted in the Department of Surgery, Community Based Medical College, Bangladesh (CBMC,B), Mymensingh, Bangladesh, between January 2020 and December of 2022, to assess factors leading to the change from laparoscopic to open cholecystectomy and analyze the impact of early change on patient safety and post-operative outcomes. Medical records of 320 patients, who had a laparoscopic cholecystectomy course for symptomatic gallbladder disease. Demographics, pre-operative findings, operative details and post-operative results were collected. Conversion from laparoscopic cholecystectomy to open cholecystectomy rate was 4.7% (n=15). Bivariate analysis revealed age at surgery (p=0.001), particularly age 50-59 years (20.8% change), gender (19.1% vs. 2.2%, p=0.002), and history of upper abdominal surgery (26.7% vs. 3.6%, p=0.008). A slight positive correlation between age (r=0.42) and gender (r=0.36) was confirmed by Pearson correlation. The main causes of change were thickened adhesions (40%) and acute inflammations (33.3%). The converted group had significantly more time to return to activity (92.5±18.3 vs. 54.2±12.5 minutes, p=0.001) and more hospital stays (5.8±1.6 vs 2.3±0.8 days, p=0.001). The patient profile for transfer from laparoscopic cholecystectomy to open cholecystectomy was clear for high-risk patients. We observed that time-oriented transformation guided by pre-operative risk factors and intra-operative challenges are key surgical judgement that reduces the risk of major complications and prioritises patient safety in favour of procedural rigour. CBMJ 2026 January: vol. 15 no. 01 P:127-133

Robotic-arm assisted systems are being increasingly used for primary total hip arthroplasties (THAs). However, their use in the surgically more complex revision THAs (rTHAs) has remained limited. This case series describes the surgical techniques used in 5 cases of robotic-arm assisted rTHA and discusses the advantages and disadvantages of robotic-arm assisted systems. 5 rTHAs were performed using a robotic-arm assisted system with CT-based planning and robotic-guided acetabular reconstruction. Clinical data, intraoperative details, and postoperative findings were retrospectively reviewed. Robotic-arm assisted rTHA offers detailed preoperative planning, including simulation of acetabular cup positioning, range of motion, and identification of osteophytic impingement risks. The flexibility of selecting reliable registration points is essential in cases with acetabular bone defects. Real-time calculations of hip length, offset, and bone void locations allow for tailored reconstruction without the need for intraoperative radiography. This case series demonstrates that robotic-arm assisted rTHA provides valuable surgical guidance, particularly in preoperative planning and intraoperative precision. Its use in complex revisions shows promise in optimising outcomes.