Journal of Robotic Surgery最新文献

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.

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.