Journal of Robotic Surgery最新文献

Pelvic fractures, often caused by high-energy trauma, represent a significant challenge in orthopaedic practice. TiRobot-assisted minimally invasive surgery has emerged as a promising alternative, offering precise and navigated percutaneous fixation. However, robust evidence comparing its clinical efficacy with traditional methods is limited. This meta-analysis systematically reviewed studies comparing TiRobot-assisted surgery with conventional surgical techniques for pelvic fractures. Databases including PubMed, Web of Science, Embase, and the Cochrane Library were searched for studies published until December 1, 2025. Eleven studies, including randomized controlled trials (RCTs) and cohort studies, were included. Primary outcomes assessed were perioperative parameters, functional recovery, safety, and healthcare costs. Pooled analyses showed that TiRobot-assisted surgery was significantly associated with shorter operative times, lower intraoperative blood loss, fewer fluoroscopic exposures, and fewer drilling attempts compared with conventional surgery. Additionally, the TiRobot-assisted group demonstrated a lower screw malposition rate and reduced overall complication rates. Functional outcomes, measured by Majeed pelvic scores, were superior in the TiRobot-assisted group. However, direct medical costs were higher for TiRobot-assisted surgery. In conclusion, TiRobot-assisted surgery offers substantial advantages in managing pelvic fractures, optimizing perioperative efficiency, screw placement accuracy, and functional recovery, while reducing complications. Despite higher initial costs, TiRobot-assisted surgery presents a highly valuable minimally invasive option, particularly for complex and unstable pelvic fractures.

Robot-assisted total knee replacement has emerged as a promising technology in bone surgery, offering further precision and accuracy compared to manual methods. This advancement shows potential benefits for better patient outcomes. The PRISMA 2020 guidelines were followed to ensure a transparent, systematic, and reproducible evaluation of all included studies. This method helped review research properly. Comparative studies and controlled trials related to robot-assisted knee arthroplasty compared to conventional knee arthroplasty were found using multiple database searching (PubMed/MEDLINE, Embase, Cochrane Library, and Web of Science). The search strategy enabled identification of relevant studies. The study showed that robotic knee surgery had significantly better post-operative anatomical and mechanical restoration compared to the regular surgery methods. However, clinical and functional results were similar between both groups, and the complication rates themselves showed no further difference. Robot-assisted knee replacement surgery showed better accuracy and fewer alignment problems compared to conventional manual TKA. Regarding short-term results, patients had better outcomes with robot-assisted methods. Total Knee Arthroplasty itself became cost-effective when case volume was further increased beyond 49 cases per year. Although Robot-assisted knee surgery provides better accuracy in component positioning and alignment, the actual patient outcomes and knee function remain comparable to traditional surgery methods in short and medium-term follow-up. The technology shows promise; however, longer-term studies are required to determine whether these improvements translate into superior clinical outcomes. The cost-effectiveness only depends on how many cases the hospital manages and how well they organize their work processes.

The acetaminophen-nefopam combination has not been investigated as a preventive analgesic strategy for robot-assisted urological surgery. Here, we evaluated whether their administration could reduce postoperative pain and opioid consumption in such patients. This retrospective cohort study analyzed adults who underwent robot-assisted urological surgery from April 2023 to March 2025 at a single tertiary academic center. Patients received conventional anesthetic management (conventional group) or preventive acetaminophen (1000 mg) and nefopam (20 mg) at robotic system de-docking (preventive group). Propensity score matching (1:1) was performed using the ASA physical performance class, surgery type, surgeon, and procedure duration. Pain was assessed using an 11-point numeric rating scale. The primary outcome was pain severity distribution upon postanesthesia care unit (PACU) arrival. After matching, 340 patients (170 per group) were analyzed. The preventive group exhibited higher proportions of patients with no/mild pain (57.6% vs. 29.4%, P < 0.001) and lower proportions with moderate pain (20.0% vs. 40.6%, P < 0.001) compared to the conventional group. Opioid-free analgesia rates were higher in the preventive group during PACU stay (36.5% vs. 16.5%, P < 0.001) and in the first 24 h (30.6% vs. 13.5%, P < 0.001). Rescue opioid consumption was lower in the preventive group during the PACU (2.5 vs. 7.5 mg morphine equivalent, P < 0.001) and 24-h periods (5 vs. 10 mg, P < 0.001). Their PACU stay was also shorter (34 vs. 40.5 min, P < 0.001). Preventive acetaminophen-nefopam administration was associated with significantly lower postoperative pain severity and opioid requirements and faster recovery after robot-assisted urological surgery.

Robot-assisted adrenalectomy using the da Vinci platform offers theoretical advantages over conventional laparoscopy, including enhanced visualization, superior instrument articulation, and improved ergonomics. However, their comparative effectiveness remains controversial, with previous meta-analyses confounded by the inclusion of retrospective cohort studies. No systematic synthesis has exclusively evaluated prospective randomized controlled trials with formal GRADE certainty assessments. To compare the perioperative, postoperative, and economic outcomes of da Vinci robotic versus laparoscopic adrenalectomy for adrenal neoplasms through GRADE-assessed meta-analysis restricted to prospective randomized trials. This systematic review and meta-analysis was registered in PROSPERO (ID: CRD420251276037) on December 27, 2025. A systematic literature search (inception to December 2025) was performed to identify prospective randomized trials comparing robotic and laparoscopic adrenalectomy. Two independent reviewers performed the screening, extraction, and Cochrane RoB 2. Random-effects meta-analyses were used to pool operative time, blood loss, conversion, length of stay, complications, and cost. Heterogeneity was assessed using I² with pre-specified sensitivity and subgroup analyses. The GRADE system was used to evaluate the certainty of the evidence. Three randomized trials (n = 214 patients) met the inclusion criteria. Robotic adrenalectomy showed no statistically significant difference compared with laparoscopy in terms of operative time (MD 14.88 min, 95% CI - 25.18 to 54.95; P = 0.47; I²=94%; very low certainty), hospital stay (MD 0.04 days, 95% CI - 0.29 to 0.38; P = 0.80; I²=0%; low certainty), conversion rates (RR 0.72, 95% CI 0.05 to 10.58; P = 0.81; I²=60%; very low certainty), postoperative complications (RR 1.52, 95% CI 0.69 to 3.36; P = 0.30; I²=0%; low certainty), or total costs (MD $2444.02, 95% CI -$906.62 to 5794.66; P = 0.15; I²=99%; very low certainty). Estimated blood loss showed a statistically significant reduction with robotics (MD - 4.86 mL, 95% CI - 9.55 to - 0.18; P = 0.04; I²=0%; low certainty), but this 5 mL difference had no clinical relevance in procedures with typical blood loss under 50 mL. Sensitivity analysis identified Morino et al.2004 as the primary driver of heterogeneity in operative duration and conversion rates. Robotic adrenalectomy achieves perioperative and postoperative outcomes equivalent to laparoscopy for adrenal neoplasms, with low-to-very-low certainty evidence showing no meaningful differences in operative efficiency, recovery, complications or costs. Platform selection should prioritize surgeon expertise and case complexity rather than the expectation of universal benefit. Adequately powered trials in high-complexity populations are needed to identify the contexts in which robotic assistance provides measurable clinical value.

The global landscape of robotic-assisted surgery is undergoing rapid transformation as new platforms emerge to challenge the long-standing dominance of the da Vinci (DV) system. Although DV remains the most widely adopted robotic platform worldwide, its high acquisition and maintenance costs have limited diffusion, particularly in resource-constrained regions. Next-generation systems-including Hugo RAS, Versius, Senhance, Hinotori, KangDuo, Sentire, and Micro Hand S-aim to expand access through reduced capital expenditure, reusable instrumentation, alternative cost structures, and modular architectures. This narrative review synthesizes available studies comparing the economic performance of these new technologies - including da Vinci Single-Port - with the DV multiport. A systematic search across PubMed, Scopus, and Cochrane Library identified 14 comparative cost studies through October 2025. Radical prostatectomy was the most frequently evaluated procedure, with additional analyses focused on colorectal surgery, hysterectomy, sacrocolpopexy, total mesorectal excision, and pyeloplasty. Overall, emerging platforms demonstrate heterogeneous but promising economic profiles. Hugo RAS and KangDuo showed lower overall procedural expenses in some series, although early inefficiencies may increase initial non-surgical operative time until team proficiency improved. The da Vinci Single Port platform demonstrated possible cost increases relative to the multiport system, largely influenced by institutional discharge pathways and disposable pricing. Economic outcomes varied markedly across institutions, driven by local procurement policies, instrument pricing, operative workflows, and reimbursement models. Current evidence suggests that new robotic platforms can reduce specific cost components without compromising clinical outcomes, yet generalizability remains limited. Standardized, prospective cost evaluations incorporating acquisition models, non-surgical time, learning curves, and long-term outcomes are essential to determine true value across healthcare settings.

Early experiences with robotic-assisted esophagectomy showed disappointing anastomotic outcomes when techniques were directly translated from open or thoracoscopic surgery. Among intrathoracic anastomotic options in robot-assisted Ivor Lewis esophagectomy (RAMIE-IL), emerging data suggest lower complication rates with the linear stapled side-to-side technique. This method was adopted at our institution in 2018. Here, we present our outcomes and describe our standardized linear-stapled side-to-side anastomosis for RAMIE-IL. The primary objective of this study was to detail the surgical technique and evaluate postoperative outcomes of a linear-stapled side-to-side anastomosis in RAMIE-IL. This retrospective cohort study used prospectively collected registry data of all consecutive patients undergoing RAMIE-IL with an intrathoracic linear-stapled side-to-side anastomosis at ZGT Almelo, The Netherlands. All patients from inception (July 1st, 2018) until November 15th, 2025, were included. Data were obtained from the Dutch Upper GI Cancer Audit (DUCA) registry. 350 consecutive patients were included. Mean age was 66 years, 70% were male and 44% had an ASA-class of 3 or more. Length of ICU stay was median 1 days. Length of hospital stay was median 7 days. Overall anastomotic leak rate was 4%. Overall rate of all Clavien-Dindo ≥ 3 complications was 14%. Readmission rate within 30 days was 12.5%. 30-day mortality rate was 1.7%. The presented linear-stapled side-to-side anastomotic technique is feasible and associated with a low rate of anastomotic complications in the studied cohort.

We report the early outcomes of subcostal robot-assisted thoracic surgery (subRATS) for non-small cell lung cancer (NSCLC). We conducted a prospective, single-arm cohort study at Seoul National University Bundang Hospital beginning in June 2022 to evaluate the feasibility of subRATS for pulmonary resection in NSCLC. This interim analysis assessed outcomes in consecutive patients from June 2022 to June 2025. The operative times for a subgroup of patients who underwent lobectomy were also analyzed using cumulative sum (CUSUM) analysis to assess procedural reproducibility. A total of 102 patients were included, with a mean age of 63.3 years. Lobectomy was performed in 79 patients and segmentectomy in 21 patients. Systematic mediastinal lymph node (LN) dissection was completed in 47 patients. Nodal upstaging occurred in 11 cases, with eight patients upstaged to N2 disease. The mean console time was 106.6 min, and the average postoperative hospital stay was 3.6 days. Postoperative complications of Clavien-Dindo grade III or higher were observed in 4 patients: one 30-day mortality due to postoperative myocardial infarction, one conversion to thoracotomy due to bleeding, and two cases of transient recurrent laryngeal nerve injury. No postoperative diaphragmatic abnormalities were observed. CUSUM analysis identified the 31st case as the turning point on the learning curve, after which marked reductions in operative time, estimated blood loss, and length of hospital stay were achieved. SubRATS is feasible and reproducible for pulmonary resection and mediastinal LN dissection in patients with NSCLC, with the added advantage of sparing the intercostal nerve.