Journal of Robotic Surgery最新文献

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.

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.