Journal of Robotic Surgery最新文献

Objective: To compare 30-day postoperative complications after Roux-en-Y gastric bypass performed using a robot-assisted approach (RRYGB) versus a laparoscopic approach (LRYGB).

Methods: We conducted a retrospective single-center study including adult patients undergoing primary RYGB between February 2021 and November 2024. Early postoperative complications (≤ 30 days) were analyzed in the entire cohort and compared between surgical approaches, with propensity-score matching performed to reduce confounding. Complications occurring beyond 30 days were analyzed descriptively up to 1 year postoperatively, without matching, due to heterogeneous follow-up.

Results: Among the 406 patients included (27.1% LRYGB, 72.9% RRYGB), 15.3% experienced at least one 30-day postoperative complication, with no significant difference between groups (LRYGB: 20.1% vs. RRYGB: 13.2%, p = 0.09). After matching, this difference remained non-significant (20.2% vs. 13.8%, p = 0.279). The severity of complications according to the Clavien-Dindo classification was comparable between groups. However, the reoperation rate was significantly higher in the LRYGB group (8.2% vs. 1.7%, p = 0.004). Operative time was shorter for laparoscopy (74.2 min vs. 83.5 min, p < 0.001). No significant difference was observed regarding complications beyond 30 days.

Conclusion: In this high-volume bariatric center, robotic and laparoscopic RYGB demonstrated comparable short- and mid-term safety profiles. The robotic approach was not associated with increased early or late morbidity and was associated with a lower rate of early surgical reinterventions. These findings support robotic RYGB as a safe and reliable alternative to laparoscopy in experienced centers. Further studies with standardized long-term follow-up are needed to better define potential long-term benefits of robotic assistance.

Transoral robotic surgery (TORS) for laryngeal cancer was first described in 2007. Since then, relatively small case series have supported the safety and feasibility in humans. We aimed to examine 90-day functional outcomes and complication rates after TORS for laryngeal cancer using a publicly available national database. The TriNetX database was queried for all laryngeal cancer patients ages 18-90 undergoing robotic surgery. Primary outcomes were five-year overall survival and 90-day rates of planned tracheostomy, postoperative gastrostomy, and overall complications. One-to-one propensity score matching was used to examine of the effect of tracheostomy and concurrent neck dissection on primary outcomes. 413 patients from 41 healthcare organizations were identified: 126 (30.6%) patients underwent neck dissection, 39 (9.4%) underwent tracheostomy, 94 (23.6%) required gastrostomy, and 43 (11.47%) incurred postoperative complications. Five-year overall survival for laryngeal cancer TORS patients was 72.41%. Before matching, neck dissection was associated with greater odds of overall complications (OR = 2.10, 95%CI = 1.08-4.07, p < 0.027) and gastrostomy (OR = 1.66, 95%CI = 1.06-2.59, p = 0.027). Tracheostomy was associated with greater odds of gastrostomy (OR = 6.80, 95%CI = 3.35-13.81, p < 0.001). Matching identified 115 with and without neck dissection and 34 patients with and without tracheostomy. After matching, neck dissection was no longer significantly associated with higher overall complication and gastrostomy rates. Post-matching effects of tracheostomy on outcomes could not be studied due to reduced overall numbers. TORS for laryngeal cancer has acceptable complication rates. Neck dissection was not associated with greater odds of complications or gastrostomy. Larger studies are needed to determine the effect of tracheostomy on complication and gastrostomy rates.

 Robotic assisted surgery (RAS) is being increasingly used for minimal access surgery. There has been a growing interest in developing curricula for RAS training. We performed a systematic review of comprehensive RAS curricula. Methods: A systematic review of RAS curricula evidence and teaching was conducted on the platforms Medline, PubMed, Embase, CINAHL and PsycINFO combining robotic surgery with surgical training in February 2024 and updated in June 2025. After removal of duplicates 10,002 references were returned. Screening using the PICO framework for eligibility identified 175 relevant studies, out of which 39 studies reported on 29 comprehensive RAS curricula. Data were extracted and analysed using a predeveloped extraction tool. Analysis focused on common curricular elements and supporting evidence for curricula success according to Kirkpatrick's levels of evidence. Study quality was assessed using the MMERSQI (Modified Medical Education Research Study Quality Instrument) criteria. PROSPERO CRD42024566778. All 29 curricula included simulation training. The nature and volume of simulation training and mentorship varied widely across curricula. Objective assessment and non-technical skills training (NTS) were not uniformly included. Surgical societies outlined curricula with proficiency-based progression, modular intraoperative training and objective assessment. All studies found a benefit from curriculum implementation, but the methodological quality of evidence was low. Conclusion: A standardised RAS curriculum is feasible and beneficial and surgical societies have outlined RAS curricula which could be implemented locally. However, not all current comprehensive RAS curricular are grounded in the relevant educational frameworks. Further research supporting the implementation and evolution of RAS curricula is necessary.

Background: Preoperative prediction of surgical difficulty in robotic-assisted total mesorectal excision for rectal cancer remains challenging. While pelvic anatomical parameters measured by MRI have been associated with surgical complexity in laparoscopy, their role in robotic surgery is not well-established. This study aimed to develop and validate a predictive model for adverse surgical outcomes by integrating machine learning and logistic regression with comprehensive preoperative MRI pelvimetry and clinical data.

Methods: A retrospective multi-center study was conducted involving 1,367 patients who underwent robotic or laparoscopic radical resection for mid-to-low rectal cancer. Patients were divided into Cohort 1 (training/internal validation, n = 997) and Cohort 2 (external validation, n = 370). Eleven MRI-based pelvic parameters and baseline characteristics were analyzed. Three machine learning algorithms-Random Forest, XGBoost, and LightGBM-alongside traditional logistic regression were used for model development.

Results: Although LightGBM demonstrated the best performance among machine learning models (AUC: 0.770), logistic regression outperformed all machine learning approaches and was selected as the final model. Multivariable analysis identified six independent predictors: BMI > 25 kg/m², neoadjuvant chemoradiotherapy, tumor distance from anal verge < 5 cm, laparoscopic (vs. robotic) approach, interspinous distance < 9.94 cm, and intertuberous diameter < 11.98 cm. The logistic regression-based nomogram showed excellent discrimination, with AUCs of 0.857 (training), 0.820 (internal validation), and 0.810 (external validation). Decision curve and calibration analyses confirmed clinical utility and prediction accuracy.

Conclusions: This study successfully developed and validated a robust prediction model integrating MRI-based pelvimetry and clinical factors to identify patients at high risk of adverse outcomes following rectal cancer surgery. The model supports the use of robotic surgery to mitigate risks in anatomically challenging cases. Prospective multicenter studies are warranted to further validate its clinical applicability.

The purpose of this study was to evaluate the safety and efficacy of perioperative outcomes of the KangDuo Surgical Robot System versus the Da Vinci System in robot-assisted renal surgery. We conducted a comprehensive systematic search in key databases including PubMed, the Cochrane Library, Embase, and Web of Science, encompassing studies in all languages, with the final search date being October 2025. We also excluded articles comprising reviews, letters, and single-arm studies. Variables were assessed using metrics of Weighted Mean Difference (WMD), Standardized Mean Difference (SMD), and Odds Ratio (OR). The statistical synthesis of the data, encompassing diverse outcome measures, was conducted utilizing the Review Manager software. Moreover, the protocol for this systematic review and meta-analysis is publicly available on PROSPERO (Registration number: CRD420251181530). In a pooled analysis of 370 participants from five trials, the KangDuo Surgical Robot System demonstrated a significantly extended docking time relative to the Da Vinci System (SMD = 1.55, 95% CI: 1.21-1.90; p < 0.00001). Conversely, comparisons of operative time, estimated blood loss, incidence of minor complications, ischemia time, and postoperative renal function (assessed by 4-week serum creatinine and eGFR) yielded comparable results, with no statistically significant differences. In this meta-analysis with limited sample size, geographic focus on Chinese centers, and short-term follow-up, the pooled data indicate that the KangDuo (KD) Surgical Robot System achieved non-inferiority to the Da Vinci System on several key perioperative metrics in robot-assisted renal surgery, although with a longer docking time. These findings support the KD system as a promising alternative in comparable settings, yet they should be interpreted within the constraints of the available evidence. Future research, particularly large-scale, multicenter randomized trials with long-term monitoring of survival and renal function, is necessary to confirm its efficacy and safety profile for widespread clinical adoption.