Journal of Robotic Surgery最新文献

Robotic surgical systems have revolutionized minimally invasive procedures, offering enhanced three-dimensional visualization, high precision, and stable operation, particularly beneficial for radical prostatectomy. However, high costs have hindered the adoption of robot-assisted radical prostatectomy (RARP) in grassroots hospitals in China. This retrospective study aimed to evaluate the efficacy and safety of the EDGE Surgical Robotic System in performing RARP. A total of 129 patients who underwent RARP at our center between November 2023 and March 2025 were analyzed, with outcomes assessed including port placement to docking time, operative time, estimated blood loss, complications, pathological results, safety indicators, length of hospital stay, catheterization duration, postoperative PSA level, and early urinary continence recovery rate. All surgeries were completed successfully without conversion to laparoscopic or open procedures, with a mean setup time of 36.9 min, operative time of 176.3 min, and estimated blood loss of 128.1 mL. The positive surgical margin (PSM) rate was documented at 31.0%, with an average hospital stay of seven days and catheterization duration of 15.4 days. Importantly, no safety incidents were reported, and the average total cost of hospitalization and operative cost was CNY ¥59854.8 (USD $8287.8) and ¥36,249.2 (USD $5,019.26), respectively, indicating a cost-effective approach. While the study's retrospective design is a limitation, the findings provide preliminary evidence that the EDGE Surgical Robotic System is a safe and economically viable alternative for RARP, paving the way for broader implementation in similar healthcare settings.

Introduction: Robot-assisted radical prostatectomy (RARP) is a widely used treatment for clinically localised prostate cancer. Preserving neurovascular bundles (NVB), are crucial for erectile function and urinary continence. However, it remains challenging due to accurate identification of the NVB. Branches of the prostatic artery can act as a reference for nerve-sparing (NS) prostatectomy surgery. Due to anatomical variations, vascular mapping utilising CT prostate angiography (CTPA) could assist in prostate artery localisation during RARP, to impact surgical outcomes.

Aims:  This is a hypothesis-generating narrative review in which the anatomy of the prostate, NVB and vasculature is described in addition to the current scope of RARP. CTPA in preoperative planning for RARP is evaluated, with a focus on its potential to enhance preservation of erectile function through improved identification of prostatic vasculature.

Discussion: CTPA is used for pre-procedure planning in prostate artery embolization (PAE) to manage symptomatic benign prostatic hyperplasia (BPH). Currently, pre-procedure planning for NS RARP includes prostate biopsy and MRI for staging. The mainstay of research on RARP is primarily focused on techniques to preserve the NVB, but the role of arterial anatomy warrants additional exploration. Factors such as cost, time and radiation exposure must be considered before CTPA could be included in routine preoperative assessment.

Conclusion: By enabling precise identification of critical prostate arterial anatomy, CTPA could facilitate easier localization of the NVB intraoperatively, contributing to improved surgical outcomes. Further investigations are required to ascertain if preoperative CTPA can be a standard to improve functional outcomes and recovery after RARP.

Background: The rapid adoption of robotic abdominal surgery has necessitated structured training programs to ensure surgeon competence and patient safety. The da Vinci TR 100-200-300-400-500 training system represents a comprehensive pathway for developing robotic surgical skills, yet its effectiveness on learning curves remains incompletely characterized.

Methods: A systematic review was conducted following PRISMA guidelines, searching PubMed, Embase, and Cochrane databases from inception to October 2025. Studies evaluating learning curves associated with the TR training system in robotic abdominal surgery were included. Data extraction focused on training methodologies, assessment parameters, learning curve patterns, and clinical outcomes.

Results: The search identified 1,591 records, with 17 studies meeting inclusion criteria. The TR training system demonstrates a progressive learning curve across its modules: TR 100 (technical skills foundation), TR 200 (technical-clinical integration), TR 300 (procedure application), TR 400 (procedure refinement), and TR 500 (mastery). Significant learning occurs within 5-10 repetitions for basic skills, with 90% expert-level performance achieved by 53% of novices after 10 repetitions. Key parameters showing improvement include overall score, time to completion, instrument collision, and critical errors.

Conclusion: The TR 100-200-300-400-500 training system provides an effective structured pathway for developing robotic abdominal surgery skills. However, standardization of assessment methods and validation of skill transfer to clinical performance require further investigation.

To clarify and statistically analyze the long-term transition of urinary condition and quality of life (QOL) after robot-assisted radical prostatectomy (RARP) using some self-report questionnaires. From May 2017 to June 2021, 243 patients who underwent RARP for prostate cancer at Chiba Tokushukai Hospital were investigated retrospectively. The urinary status was observed for 5 years after surgery using the Core Lower Urinary Tract Symptom Score (CLSS), International Prostate Symptom Score (IPSS), Overactive Bladder Symptom Score (OABSS), and International Continence Control Questionnaire-Short Form (ICIQ-SF). We used storage (IPSS-S) and voiding (IPSS-V) items separately for analysis. IPSS-S included "frequency", "urgency", and "nocturia", and IPSS-V included "incomplete emptying", "intermittency", "weak stream", and "straining". The association between the results of the questionnaire and postoperative urinary continence and QOL was examined by statistical analysis. Median values of follow-up duration were 65.5 months. Items in almost all questionnaires showed the worst points 1 month after surgery and recovered thereafter. All items showed recovery to the baseline level except for "urgency incontinence" and "stress incontinence". Preoperative IPSS-S > 7 was significantly associated with "pad-free" and "1 pad per day" status in multivariate analysis (Hazard ratio = 0.50 and 0.60, P < 0.01 and < 0.01, respectively). Urinary problems other than urinary incontinence can be restored to the baseline level after RARP. QOL differed between patients who showed a "pad-free" status and "1 pad per day" status. Additionally, preoperative IPSS-S was suggested to be a predictor of both "pad-free" status and "1 pad per day" status after surgery.

Background: The emergence of new multi-modular robotic surgical systems, such as Hugo RAS and Versius, introduces architectural and ergonomic variations compared with the established Da Vinci platform. While their surgical performance has been widely investigated, limited data exist regarding anesthesiological outcomes. This study aimed to compare intraoperative anesthetic parameters across three robotic platforms in a tertiary academic center.

Methods: A retrospective observational analysis was conducted on 258 consecutive patients who underwent robotic abdominal, urological, or gynecological surgery between January 2024 and June 2025. Patients were stratified according to the robotic platform used-Da Vinci, Hugo RAS, or Versius. Intraoperative variables, including Trendelenburg angle, anesthesia duration, pneumoperitoneum time, urine output, and fluid balance, were compared among groups.

Results: The Da Vinci system was used in 68.6% of cases, followed by Versius (15.9%) and Hugo RAS (15.5%). No major differences were observed in anesthesiological or postoperative outcomes across platforms, except for a higher intraoperative urine output with Versius in gynecological surgery. Minor variations included a steeper Trendelenburg position in colorectal surgeries performed with Da Vinci and shorter operative and pneumoperitoneum times with Versius in abdominal wall procedures.

Conclusion: Despite structural and ergonomic differences, the Hugo RAS and Versius systems demonstrated anesthesiological safety and intraoperative performance comparable to the Da Vinci platform, supporting their safe integration into clinical practice.

The detection of incidentally identified small renal masses has increased, prompting greater use of nephron-sparing procedures. Robot-assisted partial nephrectomy (RAPN) is established for tumors ≤ 4 cm; however, evidence directly comparing its use for very small tumors (≤ 2 cm) and slightly larger lesions (> 2-4 cm) is limited, particularly in Asian populations. We evaluated how tumor size affects perioperative outcomes, renal function preservation, and oncological safety in RAPN. The data of 649 Japanese patients who underwent RAPN for clinically localized renal cell carcinoma were retrospectively analyzed. Patients were grouped according to maximal tumor diameter (≤ 2 cm or > 2-4 cm). Propensity score matching was performed to mitigate disparities in patient backgrounds including tumor complexity and location. Outcomes assessed included operative and console times, warm ischemia time, estimated blood loss (EBL), postoperative complications, trifecta and pentafecta achievement, renal functional preservation, and recurrence-free survival (RFS). After matching, 193 patient pairs were included. Tumors ≤ 2 cm were associated with significantly shorter operative and console times, lower warm ischemia, reduced EBL, fewer major complications, and higher trifecta achievement, compared with tumors > 2-4 cm. Renal function preservation was comparable between groups. Oncological outcomes were excellent in both cohorts, with 5-year RFS of 98.2% and 98.0% for tumors ≤ 2 cm and > 2-4 cm, respectively. RAPN for tumors ≤ 2 cm offers superior perioperative outcomes without compromising oncological control, compared with that for tumors > 2-4 cm. These findings support RAPN as a safe and effective nephron-sparing approach for managing incidentally detected sub-2 cm renal tumors.