Journal of Robotic Surgery最新文献

Minimally invasive ileal pouch-anal anastomosis (IPAA) is the standard restorative procedure for ulcerative colitis (UC) requiring surgery. The clinical impact of the robotic approach remains uncertain. This study aimed to compare perioperative and long-term functional outcomes following robotic versus laparoscopic IPAA in two high-volume tertiary centers. This bicenter retrospective study included consecutive patients who underwent restorative proctocolectomy (RPC-IPAA) or restorative proctectomy (RP-IPAA) with IPAA for UC between 2012 and 2024. Patients were classified into robotic or laparoscopic groups. Perioperative outcomes included operative time, intraoperative complications, conversion to open, postoperative morbidity, and length of hospital stay. Functional results using the IPSS-20 score were evaluated at one year. One hundred and one patients were included, 58 (57.4%) in the laparoscopic group and 43 (42.6%) in the robotic group. Preoperative characteristics were comparable. Operative time was longer in robotic RP-IPAA (342 ± 70 vs. 300 ± 97 min, p = 0.013). Intraoperative complication (5%) and conversion (10.9%) rates did not differ between groups. Overall postoperative morbidity was 45.5%, with 13.9% severe complications, and similar between approaches. Absence of diverting ileostomy was the only factor associated with postoperative morbidity (p = 0.025). Length of hospital stay was shorter after robotic surgery (9.6 ± 4.0 vs. 12.8 ± 6.8 days, p = 0.005). At 1 year, pouchitis and cuffitis occurred in 23.2% and 4.7%, respectively, with comparable incidence between groups. IPSS-20 functional scores did not differ. Robotic IPAA is safe and feasible, providing perioperative and functional outcomes equivalent to laparoscopy while significantly reducing hospital stay. These findings support its use in expert centers.

Prostate cancer (PCa) is a major health concern in ageing populations. While guidelines often preclude older men from robotic-assisted radical prostatectomy (RARP), outcomes are not well defined. We evaluated functional and oncological outcomes of RARP in patients ≥ 80 years. A multi-centre review of prospectively maintained surgical databases from three high-volume robotic surgeons was performed. Men ≥ 80 years old who underwent RARP between 2016 and 2024 were included. Demographic, surgical, functional, and oncological outcomes were analysed. Thirty men (mean age 82.6 years) were included. Fifteen, five and ten patients had ISUP Grade Group 2-3, 4 and 5 diseases, respectively. Twenty (20/30, 67%) patients had high-risk disease, with 16 clinical stage ≥ T2c. Mean operative time was 132 min and mean estimated blood loss was 187 mLs. Two complications occurred, one Clavien-Dindo grade II and one grade III. Median follow-up was 30.5 months (IQR 11.5-45.3). At 12 months, 16 out of 23 patients (70%) were pad-free or using one safety pad, and 4 (4/23, 17%) required one pad/day. Pathology revealed locally advanced disease in 22 (22/30, 73%) patients (≥ T3), and 6 (6/22, 20%) patients with a positive surgical margin. Biochemical recurrence is defined as PSA ≥ 0.2 ng/ml (Bellera et al. Ann Oncol 23(8):2166-2172, 2012) and it was observed in 11 patients (11/30, 37%), with 7 patients receiving further treatment. Small cohort size and retrospective analysis limit generalisability. RARP is safe and feasible in carefully selected octogenarians, showing acceptable functional and oncological outcomes. Older men should not be precluded from surgery based on age alone. This study supports offering RARP to these men after counselling on peri-operative risks and alternatives.

The objective of this study is to comprehensively describe the use of robotic surgery for the excision of thyroglossal duct cysts (TGDCs) in the literature. PubMed, Scopus, Cochrane Library, and EMBASE databases were searched. Screening, selection, data extraction, and quality analysis were performed by two independent authors using pre-defined criteria. Conflicts were resolved by independent senior authors. Descriptive statistics were used to summarize the data. From 25 unique articles, 14 articles were selected, describing 26 distinct patients with lingual (n = 16), suprahyoid (n = 1), or infrahyoid (n = 9) TGDCs treated with robotic surgery. The median age was 11 years (IQR = 17). A simple transoral approach was performed for all lingual TGDCs (n = 16). Suprahyoid and infrahyoid TGDCs were treated using transvestibular sublingual (n = 1), postauricular (n = 8), and bilateral axillary-breast (n = 1) approaches. No intraoperative complications were reported. Post-operative complications included minor bleeding (n = 1), oral-cutaneous fistula (n = 1), nerve weakness (n = 1), and seroma (n = 1). No recurrences were reported across a median follow-up of 16 months (IQR = 7.5). The current available evidence is limited to small case series and reports. This study demonstrates low complication rates, no reported recurrences, and favorable recovery in patients undergoing TGDC excision, supporting the role of robotic surgery as a safe and effective option in select cases.

Artificial intelligence (AI) has become a transformative technology in surgical practice, revolutionizing modern healthcare and offering advancements in precision, efficiency, and patient outcomes. Despite its potential, the integration of AI technologies into surgical practice raises important professional and organizational barriers, as well as ethical concerns that must be addressed to ensure successful and morally sound integration. This research employs mixed-methods of 19 qualitative in-depth interviews with surgeons and hospital administrators, and a quantitative survey of 224 healthcare professionals across surgical specialties to investigate the acceptance of AI-enhanced surgical systems (AISS). The insights from study 1 informed the subsequent quantitative investigation in study 2, which adopts a dual-lens framework integrating the unified theory of acceptance and use of technology (UTAUT) and the technology-organization-environment (TOE). This novel approach enables examination of acceptance factors across individual and organizational levels. The findings from study 1 revealed three key themes shaping AISS acceptance, including performance, organizational, and environmental factors. Study 2 confirmed positive associations between attitude toward AISS and eight factors: performance expectancy, effort expectancy, relative advantage, compatibility, facilitating conditions, management support, social influence, and competitive pressure. Relative advantage emerged as the strongest predictor. Conversely, firm size and government pressure had significant negative effects. This research emphasizes the interdependence of individual and organizational factors influencing acceptance of AI in healthcare. It offers a roadmap for stakeholders to navigate technological integration, aligning with the objectives of the Healthy China 2030 initiative and Sustainable Development Goal 3 (SDG3): good health and well-being.