Journal of Robotic Surgery最新文献

Background: Robotic-assisted total knee arthroplasty (RA-TKA) has emerged as an advanced surgical technique. However, direct comparisons between Chinese and American robotic systems are limited.

Objective: Exploratory comparison of surgical accuracy and short-term clinical outcomes between Chinese HURWA and American MAKO robotic systems in total knee arthroplasty.

Methods: A prospective exploratory cohort study was conducted from September 2023 to January 2024. Eighty-five patients were assigned to undergo RA-TKA with either the HURWA system (n = 43) or the MAKO system (n = 42) based on the sequential clinical introduction of the systems. The primary outcomes were radiographic accuracy, including the restoration of the mechanical axis within ± 3°. Secondary outcomes encompassed surgical efficiency metrics and patient-reported clinical scores (WOMAC, HSS, VAS) assessed preoperatively and at one-year postoperatively.

Results: All included patients have completed surgery and follow-up.The two systems achieved a comparable and high proportion of mechanical axis restoration within ± 3° (HURWA: 86.05% vs. MAKO: 90.48%). The HURWA system demonstrated a significant advantage in osteotomy time (6.03 ± 2.35 vs. 8.06 ± 2.73 min, P < 0.001). Both groups exhibited substantial and comparable improvements in all clinical outcome scores at the one-year follow-up. The HURWA system, as an open-platform design, offered flexibility in prosthesis selection, while the MAKO system demonstrated a highly standardized workflow.

Conclusion: This exploratory comparison indicates that the HURWA system achieves favorable and comparable one-year clinical outcomes and radiographic alignment to the MAKO system in TKA, with distinct advantages in osteotomy efficiency and implant flexibility. These preliminary findings support the clinical potential of HURWA as a viable option, though definitive conclusions regarding its equivalence require validation through larger, long-term studies.

Robotic approach to hepatectomy has shown promise in recent times. The aim of our study was to identify the impact of various patient variables on outcomes from robotic major and minor hepatectomy. Data on 167 consecutive robotic hepatectomy procedures at our institution was retrospectively analyzed. Perioperative outcomes were analyzed for both minor and major hepatectomy. For major hepatectomy (n = 66), factors associated with increased operative time included cirrhosis (301 vs. 257 min) and obesity (310 vs. 261 min). Estimated blood loss (EBL) was worse in patients with underlying cirrhosis (242 vs. 161 mL), obesity (215 vs. 148mL) and tumor size ≥ 10 cm (232 vs. 136mL). Length of hospital stay (LOS) was also longer with age ≥ 70 years (5.9 vs. 4.5 days), cirrhosis (5.6 vs. 4.6 days) and malignant tumor pathology (5.1 vs. 3.8 days). Similarly, increased postoperative complications were seen with cirrhosis and tumor size ≥ 10 cm. For minor hepatectomy (n = 101), operative time was longer in patients with cirrhosis (139 vs. 105 min), obesity (141 vs. 115 min) and posterior-superior (PS) liver resection (168 vs. 104 min). Similarly, EBL was higher in cirrhotic patients (163 vs. 58mL) and those with PS resection (152 vs. 64mL). Longer LOS was observed in elderly patients (2.9 vs. 2.0 days), cirrhosis (2.9 vs. 2.1 days) and PS resection (2.8 vs. 2.1 days). Our study offers a comprehensive understanding of the impact of clinicopathologic factors on outcomes and can be utilized as a guide to appropriate patient selection, especially for surgeons starting a robotic hepatectomy practice.

To compare early and late complications rates after robot-assisted radical cystectomy for muscle invasive bladder tumors and certain high-risk non-muscle-invasive tumors according to the type of reconstruction. We conducted a single-center retrospective study including 109 patients who underwent robot-assisted radical cystectomy between 2008 and 2022. Patients were divided into two groups based on urinary diversion: extracorporeal Bricker ileal conduit (n = 74) or orthotopic neobladder (n = 35). Complications were graded by the Clavien-Dindo classification. Multivariate analysis identified independent risk factors for morbidity and mortality. Operative time was significantly longer for neobladder reconstruction (320 vs. 291 min, p = 0.047), as was hospital stay (14 vs. 10 days, p < 0.001). Early complications (< 30 days) occurred in 59.6% of patients, with a higher rate of minor complications in the neobladder group (57.1% vs. 28.4%, p = 0.006). There was no significant difference in major complications (Clavien III-V) or late complications (> 30 days), which affected 47.7% of patients. Operative time was an independent risk factor for major complications (OR = 1.15 per additional 15 min). Neobladder reconstruction was associated with increased early morbidity, mainly minor, without impact on late morbidity or mortality. Urinary diversion choice should be guided by patient profile and expected functional benefits.

To evaluate the effectiveness of a phased active warming protocol in preventing intraoperative hypothermia during Da Vinci robot-assisted radical resection for rectal cancer. A single-center retrospective cohort analysis examined patients undergoing Da Vinci robot-assisted rectal cancer resection from January 1, 2022, through December 31, 2024. Using 1:1 propensity score matching, patients receiving phased active warming protocol were matched with those under routine thermal care. Variables for matching encompassed age, sex, body mass index, American Society of Anesthesiologists classification, surgical duration, and anesthesia time. Primary outcome measured was intraoperative hypothermia incidence (core temperature below 36 °C). Secondary outcomes covered mean core temperature, postoperative shivering evaluated through Bedside Shivering Assessment Scale, surgical site infection rates, blood transfusion needs, hospital stay duration, and perioperative costs. Following propensity score matching, each group contained 144 patients (total n = 288). Hypothermia occurrence dropped markedly in the intervention cohort (26 cases [18.1%] versus 70 cases [48.6%], p < 0.001). End-of-surgery core temperature showed higher values in the intervention cohort (36.4 ± 0.5 °C compared to 35.8 ± 0.6 °C, p < 0.001). Shivering after surgery (BSAS score of 1 or greater) demonstrated reduced frequency in the intervention cohort (18 patients [12.5%] versus 50 patients [34.7%], p < 0.001). Wound infection rates decreased in the intervention cohort (6 cases [4.2%] versus 17 cases [11.8%], p = 0.022). Hospital stays shortened for the intervention cohort (8.2 ± 2.1 days compared to 10.5 ± 3.4 days, p < 0.001). The phased active warming approach substantially decreased hypothermia occurrence and enhanced perioperative outcomes in Da Vinci robot-assisted rectal cancer resection patients, demonstrating clinical value warranting widespread adoption.

This review summarizes radiographic, clinical and patient reported outcomes following robotic-arm assisted total hip arthroplasty (RAA-THA) in patients with developmental dysplasia of the hip (DDH), with comparisons to conventional (C-THA) and navigation (N-THA) techniques. MEDLINE, EMBASE and CENTRAL databases were searched for studies on DDH patients undergoing RAA-THA. Outcomes assessed included radiographic accuracy, patient-reported outcome-measures (PROMs), intraoperative outcomes, and complications. Eleven studies were included, analyzing 1150 hips (641 RAA-THA, 383 C-THA, 126 N-THA) with a median patient age of 60.5 years, and median BMI of 24.6. DDH severity was distributed as 59.6% Crowe I, 25.3% Crowe II/III hips, and 15.1% Crowe IV hips. Comparative studies among Crowe I-III hips showed significantly lower errors in cup inclination and anteversion with RAA-THA compared to both C-THA and N-THA. RAA-THA also achieved greater accuracy in restoring the center of rotation for Crowe I-III, but no difference was observed in Crowe IV hips. No significant differences were found in short-term PROMs, and intraoperative outcomes and complication rates were comparable between groups. RAA-THA may improve cup placement accuracy in Crowe I-III hips compared to C-THA and N-THA. However, the accuracy of Crowe IV hips remains unclear, with limited evidence available. Furthermore, radiographic benefits did not translate into significant differences in short-term PROMs, intraoperative outcomes, or complication rates. Future studies should include larger cohorts of patients with severe dysplasia and provide longer follow-up to better evaluate the efficacy and implant survivorship of RAA-THA in these complex cases. Level of Evidence: IV.

Background: Robotic-assisted laparoscopic hysterectomy has gained widespread adoption for benign gynecologic diseases despite its higher cost and ongoing debate over its clinical superiority compared to conventional laparoscopy. Although many comparative studies exist, no meta-analysis has exclusively synthesized randomized controlled trial evidence with a comprehensive GRADE certainty assessment of all clinically relevant, perioperative outcomes.

Methods: This systematic review and meta-analysis was prospectively registered (PROSPERO ID: CRD420251183072). We systematically searched major databases from inception through November 1, 2025, for randomized controlled trials comparing robotic total laparoscopic hysterectomy (R-TLH) with conventional total laparoscopic hysterectomy (C-TLH) for benign indications. Two independent reviewers screened the studies, extracted the data, and assessed the risk of bias using the RoB 2 tool. Random-effects meta-analyses were performed for operative duration, estimated blood loss, conversion to laparotomy, length of hospital stay, and perioperative complications. Heterogeneity was quantified using I² statistics, and comprehensive sensitivity analyses were conducted to assess the robustness of the results. The certainty of the evidence for each outcome was evaluated using the GRADE approach.

Results: Four trials (N = 375 patients) met the inclusion criteria, with 185 and 190 patients in the R-TLH and C-TLH groups, respectively. The total operative time did not differ significantly between the R-TLH and C-TLH groups (mean difference [MD] 11.79 min, 95% CI - 24.59 to 48.17; very low certainty). R-TLH was associated with a significantly shorter hospital stay (MD - 0.64 days, 95% CI - 1.10 to - 0.17; moderate certainty). No significant differences were observed in conversion to laparotomy (OR 0.50, 95% CI 0.10-2.46; low certainty), any postoperative complication (composite as defined by individual trials) (OR 0.58, 95% CI 0.21-1.58; moderate certainty), estimated blood loss (MD - 17.81 mL, 95% CI - 74.31 to 38.68; low certainty), or vaginal cuff hematoma (OR 0.28, 95% CI 0.05-1.62; low certainty). Sensitivity analyses yielded consistent results.

Conclusion: Based on the highest level of evidence exclusively from randomized trials, robotic and conventional laparoscopic hysterectomy demonstrate comparable operative outcomes for benign disease, with the robotic approach offering modestly shorter hospitalization. Given the substantial cost differences, conventional laparoscopy remains a clinically equivalent option for most patients requiring cholecystectomy.

This narrative review synthesizes global advances is paving the way for remote robotic surgery (telerobotic surgery), enabling surgeons to perform precise procedures over long distances with real-time responsiveness. This review synthesizes global advances in this field, outlining the system architecture and discussing reported clinical outcomes from early series-such as reduced intraoperative blood loss and shorter hospital stays, as illustrated by preliminary clinical series, such as 29 successful remote nephrectomies over 1,775 km reported in a selected patient cohort with no major complications in the short term. Key milestones are highlighted, from early transatlantic experiments to recent ultra-long-range procedures in China. The technology also demonstrates transformative potential for surgical training and optimized resource allocation via hub-and-spoke models. However, current applications remain largely experimental, constrained by small sample sizes, a scarcity of rigorous randomized controlled trials (RCTs), and limited long-term data. Significant challenges persist, including network latency and instability-especially beyond 200 ms, which can impair precision-cybersecurity vulnerabilities, a steep surgeon learning curve, high costs, and unresolved ethical-legal concerns regarding liability and cross-border practice. As a cornerstone of digital healthcare, 5G telerobotic surgery holds substantial promise for expanding global access to expert surgical care, provided these technical, economic, and regulatory barriers can be overcome through collaborative standardization and targeted innovation.

Computed tomography (CT) and ultrasound provide complementary strengths for image-guided interventions, yet single-modality guidance cannot deliver high spatial resolution, soft-tissue contrast, and real-time feedback simultaneously. This study introduces a multimodal image-guided robotic system designed for precision abdominal puncture based on CT-ultrasound fusion, which aligns preoperative three-dimensional CT images with intraoperative two-dimensional ultrasound images. Optical tracking is adopted to extract CT slices that spatially correspond to the live ultrasound plane, and the spatial alignment between them is achieved via a mutual information algorithm. A compact three-degree-of-freedom puncture actuator is designed, involving entry-point positioning, orientation adjustment, and needle advancement. The actuator rigidly integrates a probe clamping mechanism to preserve image-actuator co-registration. Phantom validation proved anatomically consistent fused displays and reliable guidance of the proposed system, and the puncture trials targeting renal calyces yielded a mean positional error of 1.17 mm and a mean angular error of 0.43°. The compact puncture actuator reduces footprint in the operating room and simplifies the calibration and clinical workflow. The proposed design provides a practical route toward safer and more reproducible minimally invasive abdominal interventions.