Journal of Robotic Surgery最新文献

Transoral robotic surgery (TORS) has rapidly expanded across oncologic and sleep surgery, yet its global evidence base remains fragmented. Prior bibliometric studies examined generic robotic surgery or TORS subsets without search-optimized, domain-specific mapping. Therefore, this study was designed to construct a comprehensive, data-driven bibliometric map of TORS research. A Scopus-based, multi-step search identified 938 English-language TORS articles. R-Based Bibliometrix and VOSviewer were used to analyze publication and citation trends, countries, institutions, sources, collaboration networks, co-citation structures, keyword co-occurrence, thematic evolution, Bradford's law, and emerging research fronts. From 2005 to 2025, TORS discourse across 197 sources showed 21.2% annual growth, with lower per-article citations recently. The United States dominated volume and citations, followed by Italy, the United Kingdom, South Korea, and Canada. Leading institutions included the University of Pennsylvania, Yonsei University, and North American cancer centers. Collaboration networks showed clustered, US-centered international partnerships and tightly connected author communities. Core journals (Laryngoscope, Head and Neck, European Archives of Oto-Rhino-Laryngology, Journal of Robotic Surgery) concentrated output, consistent with Bradford's Law. Keyword and trend analyses indicated transition from technique-focused terms to HPV-driven oropharyngeal cancer, functional outcomes, and de-escalation. Thematic maps and evolution analyses highlighted TORS and obstructive sleep apnea as motor themes, with niche domains such as base-of-tongue lesions and sialendoscopy. TORS research is rapidly expanding yet geographically concentrated, with evolving focus from technical feasibility toward oncologic, functional, and patient-centered themes, guiding multicenter trials, de-escalation strategies, and precision oncology integration.

Pull-through procedures remain the mainstay of treatment for Hirschsprung disease (HD). While laparoscopic-assisted procedures are widely performed, robotic-assisted Soave pull-through (RSPT) has emerged as a minimally invasive alternative with potential technical advantages. We systematically reviewed the available literature to evaluate the perioperative and functional outcomes of RSPT. PubMed, Embase, Scopus, Cochrane CENTRAL, and ClinicalTrials.gov were systematically searched through February 2025. Eligible studies included pediatric (< 18 years) patients undergoing RSPT. Data were pooled using random-effects models with two heterogeneity estimators to ensure robustness given the small number of included studies. Heterogeneity was assessed using I² and τ² statistics. Primary outcomes included operative time, console time, intraoperative blood loss, and length of stay (LOS). Secondary outcomes included constipation, enterocolitis, and soiling. Study quality was assessed using the National Institutes of Health (NIH) Quality Assessment Tool. Six retrospective studies comprising 282 patients were included. Pooled mean operative and console times were 192.2 min (95% CI: 95.2-388.0) and 105.6 min (95% CI: 34.7-321.5), respectively. Mean intraoperative blood loss was 9.8 mL (95% CI: 1.9-49.4), and pooled postoperative LOS was 6.5 days (95% CI: 4.6-9.1). No difference in estimates was observed by estimator models. Postoperative complications were typically mild, manageable conservatively, and improved over time. RSPT appears to be a feasible minimally invasive option for HD, demonstrating low blood loss, short hospital stay, and acceptable functional outcomes, albeit with longer operative times which reflect logistical rather than technical inefficiency. Future adequately powered, higher quality, multicenter trials with standardized outcomes are needed to better define its role relative to established laparoscopic approaches.

Evidence comparing urinary continence outcomes between robot-assisted radical prostatectomy (RARP) and laparoscopic radical prostatectomy (LRP) remains conflicting, largely due to heterogeneity in continence definitions and assessment methods. We compared continence recovery after RARP versus LRP using the 24-hour pad test (24 h-PT) and evaluated the impact of different continence definitions on reported outcomes. We analyzed a prospectively maintained database of consecutive patients undergoing RARP or LRP between 2008 and 2025 at a tertiary center. Urinary continence was assessed during the first postoperative year at predefined time points using pad-per-day (PPD) counts and the 24-hour pad test (24 h-PT). Continence recovery was analyzed using Kaplan-Meier methods, and adjusted hazard ratios were estimated using Cox proportional hazards models. A total of 1943 patients were included, of whom 42% underwent RARP. Median urinary loss was consistently lower after RARP at all follow-up intervals (p < 0.01). RARP was associated with a significantly higher cumulative probability of continence recovery (HR 1.47; 95% CI 1.28-1.70; p < 0.01). At 12 months, continence rates varied by definition, ranging from 69% to 88% after RARP and from 58% to 76% after LRP when comparing 24 h-PT and PPD-based definitions. In this large cohort assessed with the 24 h-PT, RARP was associated with superior continence recovery compared with LRP, with an absolute 11% advantage at 12 months and a 1.5-fold higher probability of continence recovery over time. These findings underscore the impact of continence definitions on reported outcomes and highlight the value of objective, volume-based measures when comparing functional outcomes between surgical techniques.

This study sought to compare the clinical outcomes of left total knee arthroplasty performed under robotic assistance by right-handed surgeons of differing experience levels, and to assess how such technology may improve operative precision and mitigate experience-related variations in results. A retrospective review was performed for 120 patients suffering from left knee osteoarthritis, all of whom received total knee arthroplasty from December 2020 to June 2025. Patients were divided into Group A (senior surgeons, > 10 years of experience) and Group B (junior surgeons, < 2 years of experience), each comprising 60 patients. Each group was further subdivided into robot-assisted total knee arthroplasty (RTKA) and conventional total knee arthroplasty (CTKA) subgroups, with 30 patients in each. Recorded parameters included operative time, incision length, intraoperative blood loss, postoperative hip-knee-ankle (HKA) angle, sagittal and coronal tibial and femoral component angles (LTC, FTC, LFC, FFC), as well as Knee Society Score (KSS), visual analogue scale (VAS) for pain, range of motion (ROM), and Western Ontario and McMaster Universities Osteoarthritis Index (WOMAC) scores on postoperative days 3 and 90. Complication rates were also compared. The results showed that while senior surgeons had shorter operative times and better early radiographic outcomes in conventional TKA, robotic assistance significantly improved component alignment and early clinical scores for junior surgeons, resulting in no statistically significant inter-group differences. in both radiographic and clinical outcomes. Notably, in the RTKA subgroups, there were no statistically significant disparities noted in operative outcomes when comparing procedures performed by senior and junior surgeons in any intraoperative, radiographic, or clinical parameters. Additionally, junior surgeons performing conventional left TKA had a higher incidence of femoral anterior cortical notching (NOTCH). In conclusion, robot-assisted left total knee arthroplasty enhances procedural consistency and reduces the performance gap between surgeons of different experience levels, particularly aiding junior right-handed surgeons in overcoming technical challenges associated with non-dominant side surgery, thereby showing potential to promote greater consistency in surgical outcomes and patient safety.

Transoral robotic surgery (TORS) with neck dissection has emerged as an organ-preserving treatment for hypopharyngeal squamous cell carcinoma (HPSCC), but long-term evidence remains limited. This retrospective study evaluated oncologic outcomes, prognostic factors, mortality patterns, and organ preservation in patients with T1-T3 HPSCC. From October 2010 to August 2023, 48 patients without prior upper aerodigestive tract malignancy or irradiation underwent TORS with neck dissection, with or without cisplatin-based neoadjuvant chemotherapy and adjuvant chemoradiation. Tumor stages included T1 (37.5%), T2 (45.8%), and T3 (16.7%), and en bloc resection was achieved in all cases. Pathologic analysis revealed lymph node metastasis in 46.8% and extranodal extension in 17%. Radiotherapy to the primary hypopharynx was omitted in 60% of patients; when administered, the mean dose was approximately 60 Gy. After a mean follow-up of 5.9 ± 3.5 years, 5- and 10-year recurrence-free survival rates were both 69%, while disease-specific survival rates were 77%. Overall survival at 5 and 10 years was 77% and 59%, respectively. Survival and recurrence were significantly associated with extranodal extension in multivariable analysis (p < 0.05). Of 15 deaths, distant metastases (46.7%) and second primary malignancies (33.3%) were predominant, whereas local recurrence accounted for only 13.3%. TORS with neck dissection provides durable disease control and excellent organ preservation for T1-T3 HPSCC, allowing radiotherapy omission in selected patients, although distant metastases and secondary cancers remain major causes of late mortality.